Monday, February 23, 2015

Medicaid Poll: Very Complex

While pols have been quick to make Medicaid expansion and Obamacare a black and white issue (Dems: Expand! GOP: Repeal!), there does appear to be the making of a third path.  Making the rounds late last week was a memo by lobbyist Andy Blunt, analyzing a poll by the Winston Group which looked at “Missouri voters on their attitudes on health care and Medicaid reform for the Missouri Hospital Association.”

Excerpts from the memo…

The poll was in the field Jan. 3-5, with a sample size of 1,000 registered voters. I’ve never personally worked with The Winston Group, but they appear to be a known GOP consulting/polling firm… Based upon my review of the poll, the issue of Medicaid Reform is complex with issues that Missouri Republicans need to both watch and understand… Most striking to me was the overwhelming support, even among skeptical Republicans and conservatives, for a plan that reforms the Medicaid program in a way that works for the future of the state and expands access to ensure hospitals can continue to provide quality care (80% overall), instead of simply rejecting Medicaid expansion and an increased government role (15% overall)…

The contrast is presented as a solution versus a lack of a solution, and while there are clearly disagreements over expansion elsewhere in the survey, the solution-driven statement wins by very strong margins even among groups that oppose expansion.  Of particular note is the very strong support among GOP Women (83-10), which is a theme we see consistently in the rest of the poll where GOP Women are much more engaged on the issue of health care in general. 

The challenge comes when they introduced a state specific solution within the context of Obamacare.  A question posed with the state solution that introduces a fix to Obamacare versus rejecting it lost a fair amount of its potency among voters overall (62-31) with the margins even closer among Republican and conservative groups…

Clearly, there are opportunities and robust support for Medicaid Reform that includes expansion, but the introduction of Obamacare into the narrative takes it down from 80% support into the 60% support range.  This is no doubt why conservative Republican Governors like John Kasich (Ohio) and Mike Pence (Indiana) have worked so hard to detach their plans from Obamacare and are trying to focus on the policy objective itself. More detail found within the poll results reveals the following.

1. Voters across the state – both Republicans and conservatives – recognize the problem with uncompensated care costs and the closing of rural hospitals.  It’s not an issue of whether or not there is a problem, rather how to solve the problem. 2. The General Assembly’s decision to reject federal Medicaid funding does not have consensus support in the state.  More voters oppose the decision than support.   Republicans and conservatives support the decision to reject federal funds, but not by overwhelming margins.  However, voter views over the general question of accepting federal funding were negative. 3. The general concept of Medicaid reform, without any definition of the plan, is supported across parties.  However, for Republicans, expansion is not necessarily a part of their definition of reform... 

Other important issues that resonated strongly included:

1. Access to women’s health services.  2. The need to provide for a strong rural health care system, in particular, the closing of two rural hospitals in Missouri last year drew important and strong scores.  3. The issue that neighboring states that expanded were able to capture and return tax dollars to the state was popular statewide, but lost some luster among Republicans, but it was strong with Republican women. Perhaps they associate this issue with funding to support women’s health care services. 4. Health care coverage for veterans and their families...

This is a very complex issue.  Voters of all ideological and party affiliation were very supportive of a solution that works best for the state.  That was a unifying theme across all groups.  They preferred that statement to one that simply rejected expansion and increased government role.   However, challenges exist in terms of whether this move would increase the size of government and how the program would be managed…



In the Tesla-MADA back and forth, anti-Tesla folks are using the company’s 10Q filing to argue that exempting them from the Missouri franchise law would make consumers vulnerable.  That’s because traditional auto dealers are available to service the cars they sell if anything should go wrong.  But in Tesla’s filings (see it here) they write (page 57): Servicing electric vehicles is different than servicing vehicles with internal combustion engines and requires specialized skills, including high voltage training and servicing techniques… We service our performance electric vehicles through our company-owned Tesla service centers, certain of our stores, and through our mobile service technicians known as the Tesla Rangers… We only implemented our Tesla Rangers program in October 2009 and have limited experience in deploying them to service our customers’ vehicles. There can be no assurance that these service arrangements or our limited experience servicing our vehicles will adequately address the service requirements of our customers to their satisfaction, or that we will have sufficient resources to meet these service requirements in a timely manner as the volume of vehicles we are able to deliver annually increases.  We do not expect to be able to open Tesla service centers in all the geographic areas in which our existing and potential customers may reside… Traditional automobile manufacturers in the United States do not provide maintenance and repair services directly. Consumers must rather service their vehicles through franchised dealerships or through third party maintenance service providers. We do not have any such arrangements with third party service providers and it is unclear when or even whether such third party service providers will be able to acquire the expertise to service our vehicles… As our vehicles are placed in more locations, we may encounter negative reactions from our consumers who are frustrated that they cannot use local service stations to the same extent as they have with their conventional automobiles and this frustration may result in negative publicity and reduced sales, thereby harming our business and prospects.


Office of Engagement Tussle

The House Budget Committee is threatening to pull the plug on the newly created Office of Public Engagement.  See the Post-Dispatch article here.

Pull Quote: House Budget Committee chairman Tom Flanigan, R-Carthage, says he doesn't plan to add funding for the office to the budget currently awaiting consideration by his panel. Other state offices do similar things, he said, and since there was no statute that created the office, he doesn't know how he would appropriate funding for it…. Nixon has requested that the budget for the office, headed by former St. Louis Democratic Sen. Maida Coleman, double in the coming fiscal year to about $657,000 as part of the Office of Administration's budget, state budget director Linda Luebbering said. But Republicans have criticized Nixon for pulling $350,000 from various departments to fund the office at its inception. Budget Committee Vice Chairman Rep. Scott Fitzpatrick, R-Shell Knob, said that if the departments had money available to fund the engagement office, then they were either not being honest about department needs or the redirected money resulted in cuts to services. He also called the office more of a "political point" than a policy solution.


Lincoln Days Bits

CDT’s Rudi Keller has a nice recap of the Republican weekend.  See it here.  Including this tidbit: A straw poll was planned to show the preferences of the hundreds of GOP activists at Reagan Lincoln Days. The ballot box went missing Friday night, however, and when it was found Saturday morning it was stuffed with ballots, party Executive Director Matt Wills said.

John Hancock won the Party Chair election.  Reports had him installing former Senate 24 candidate Jack Spooner as the new finance chair, and Jon Prouty as the next executive director.

Sen. Will Kraus was emphatic that he’s not going anywhere.  I had suggested on Friday that with the entrance of Jay Ashcroft, it was time for Kraus to “wave the white flag.”  Not gonna happen.  As one supporter writes, “Will is an old friend. Kraus is a viable candidate in my opinion, but more importantly I've known him for ten years and I've never seen him more committed to something. He's in and not going anywhere. Anyone expecting to see a white flag from Will Kraus doesn't know this combat veteran.”

Eric Greitens looks like he’s going to be joining Tom Schweich, Catherine Hanaway and Randy Asbury in the Republican gubernatorial primary.  He was working the rooms like a man on the move…

With Secretary of State Jason Kander officially in for US Senate, does the race start to grab his current cash on-hand?  It can’t be used for his 2016 campaign, and today in the $5K+ Contributions (see below) Rep. Stephen Webber gets $30K for his Senate 19 race.

I can’t wait until the April reports to see who paid more for their hospitality suite entertainment… Hanaway’s lonesome cowboy, or Schmitt’s plump accordion player…


Hearing of Interest this Week


House Emerging Issues Committee – Upon Adjournment, House Hearing Room 5 – will hear Rep. Dave Hinson’s HB 800 – “Establishes the Missouri Compassionate Care Act which provides for the licensure of medical cannabis centers and cultivation and production facilities to provide medical cannabis to qualifying patient.”

House Government Oversight and Accountability Committee – Noon, House Hearing Room 7 – will vote on Sen. Ron Richard’s SB 11 – the Senate’s ethics bill.

House Workforce Standards and Development Committee – Noon, House Hearing Room 5 – will hear bills weakening the prevailing wage law.


House Local Government – Noon, House Hearing Room 5 – will hear bills related to St. Louis County’s sales tax pooling system.

Senate Judiciary and Civil and Criminal Jurisprudence – 1PM, Senate Lounge – will hear Sen. Jamilah Nasheed’s SB 42 – “Modifies the provision allowing law enforcement officers to use deadly force in certain circumstances.”

Senate Small Business, Insurance and Industry – 1PM, SCR1 – will hear Sen. Ron Richard’s SJR 7 – “Establishes a constitutional limit on punitive damages.”

Senate Education Committee – 3PM, Senate Lounge – will hear Sen. David Pearce’s SB 299 – “Modifies the eligibility requirements for the Bright Flight Scholarship Program and adds a forgivable loan component.”



Among the White House Internship Program participants for the Spring 2015 session, there was only one with Missouri ties… Charles Harned… Hometown: St. Louis, MO; College: Knox College, IL.

Ameren apparently sent an errant email describing their PSC negotiations.  Read the Post-Dispatch article here.  Pull Quote: The St. Louis-based utility told its investors Friday that on Feb. 10, it had “inadvertently” sent a proposed settlement in the case to all the parties involved, not just the PSC staff. It released those messages, some of which were sent by PSC staff to all the parties, too. The back and forth between Ameren and the PSC during the last two weeks shows the utility was willing to lower its rate request more than $100 million below its original proposal.

As we head into the final week of the month of February the state revenue numbers look solid even if the topline looks ugly.   For the month so far, sales tax revenue is up about 8% and individual income tax receipts are up about 6%.  However a surge in refunds have the overall numbers down about 4%.  We’ll see if these numbers turn around before the end of the month.


Help Wanted

Missouri Chamber of Commerce seeks Director of Conference Development.

“Performs any combination of the following duties: Plans, organizes, and executes conferences, seminars and webinars; Stays informed of current legislative issues, business law and event planning trends; Negotiates and approves contracts with hotels and other providers; Determines registration fees and calculates costs…; Performs public relations and publicity functions for Seminar Department; Designs, writes, and supervises production of brochures and other publicity pieces for Seminar Department; Mails brochures and other materials for Seminar Department; Writes letters to solicit speakers, exhibitors, and sponsors, and follows up; Contacts potential speakers and negotiates fees..; Processes registrations and invoices for Seminar Department; Determines annual budget for Seminar Department...”


“The Appellate Judicial Commission announced that it is accepting applications for judge of the Missouri Court of Appeals, Eastern District, to fill the vacancy created by the February 1, 2015, retirement of Judge Glenn A. Norton… Citizens are encouraged to nominate well-qualified candidates for the commission’s consideration…”


$5K+ Contributions

Missourians for Koster - $12,500 from Eastern Missouri Laborers’ Educational and Benevolent Fund.

Property Casualty Insurers Association of America Political Account - $16,362 from Property Casualty Insurers Association of America.

Citizens for Stephen Webber - $30,000 from Kander for Missouri.


Lobbyist Registrations

Brian Bernskoetter and Randy Scherr added City of Clarkson Valley, City of Vinita Park, City of Dellwood, City of Beverly Hills, City of Cool Valley, City of Glendale, and City of Moline Acres.

Richard Martin deleted Accenture LLP.


Notes on Registration

Scherr and Bernskoetter adding some St. Louis County municipalities is part of the on-going proposals to change the county’s pooling sales tax system.



Happy birthdays to former Rep. Rick Stream (66).