Tuesday, February 26, 2013

Medicaid Morning…


The Barnes’ Bill

Rep. Jay Barnes will unveil his Medicaid transformation bill this morning.  In the overview information distributed beforehand, Barnes dubs the bill Market-Based Medicaid, and goes to great lengths to distance his proposal from anything associated with “Obamacare.”


In fact he insists that “under this proposal, the number of Missourians eligible for Medicaid will decrease.”


The basic contour to his plan has two key parts.  First, he blankets eligibility at 100% of the federal poverty level (more on this below).  That brings in a lot of people who now wouldn’t qualify, but also leaves out some people who are in categories where they’re covered at higher levels.


Second, he injects the “market-based” reforms.  In addition to asking co-pays to “incentivize” patients, the plan aims to direct people into managed care.  In this way, his plan would both increase healthcare coverage for more Missourians, while also reducing the rolls of Medicaid.


To pull this off, Missouri would need waivers from the federal government, as this is not what federal lawmakers envisioned when they passed the Affordable Care Act.



Eligibility Question

Medicaid wonks poo-poo the eligibility standard at only 100% the poverty rate, saying that the feds have already declared this a non-negotiable breach of the ACA.



*Date*: December 10, 2012

*Subject*: Frequently Asked Questions on Exchanges, Market Reforms, and Medicaid


*Can a state expand to less than 133% of FPL and still receive 100% federal matching funds?


*A. No. Congress directed that the enhanced matching rate be used to expand coverage to 133% of FPL. The law does not provide for a phased-in or partial expansion. As such, we will not consider partial expansions for populations eligible for the 100 percent matching rate in 2014 through 2016. If a state that declines to expand coverage to 133% of FPL would like to propose a demonstration that includes a partial expansion, we would consider such a proposal to the extent that it furthers the purposes of the program, subject to the regular federal matching rate.



Polling on Medicaid

On the heels of the Barnes bill’s debut, there’s likely to be some talk about a recent poll on the subject of Medicaid expansion.  The poll – conducted by the Republican polling firm American Viewpoint – surveyed 1,000 registered voters in Missourian.  And although I don’t have the numbers, it appears that the purpose behind the poll was to test the issue for Republicans who may be skittish about touching the issue.


Here are the talking points from the memo, making the political case for Republicans to get behind some kind of Medicaid expansion/transformation.


“As seen across the country, Republicans suffer from a gender gap, although it is somewhat smaller in Missouri.  However, when it comes to healthcare services (such as labor and delivery services and care for breast and cervical cancer), the poll shows a considerable gender gap.  Republicans will need to tread very carefully on this issue as they consider Medicaid reform since certain women’s health care services could be some of the first to be negatively impacted without reform.


“Job creation and economic growth, by a large margin, continue to be the most important issue for the Governor and state legislature to address.  Voters who list economic issues as their top priority tend to support Medicaid reform since it is such a strong pocketbook issue.


“Obamacare continues to be very unpopular with Missourians, but a plurality of voters in Missouri believe that more Missourians should be covered by Medicaid.  And when those voters have more information about Medicaid reform, the support grows.”




82 GOP Votes Needed

Apparently Barnes’ presentation to his Republican caucus went well, and he’s worked hard to cover his bases with legislators.  Still with head count yet it’s impossible to gauge where things stand.


The House Republican caucus is said to be wary of “becoming Kansas” where the Republican majority often splits.  There Kansas Republican moderates will align with the Kansas Democratic minority on some issues to pass or block bills despite the core Republican right wing.


Therefore, House Republicans are mindful to keep their caucus unified.  The standard operating procedure is that they will not take any bill to the floor for a vote unless 82 Republicans assent to it.  They’d prefer to have all the necessary votes for passage in hand and not rely on any Democratic support.


It is a strategy to freeze Democratic out of any relevance.  But it also provides a higher test for legislation like Barnes’ bill.



Paycheck Protection

The Senate took up Sen. Dan Brown’s “paycheck protection” bill last night around 8pm.  Democrats were braced for a midnight filibuster, but the bill was laid over after a few hours and the body adjourned around 10:30pm.


We’ll see if they revisit it today.




Word is that Eli Yokley, of PoliticMO fame, will be joining Rod Jetton’s Missouri Times – as managing editor.



Jason Smith announced yesterday that he won the Farm Bureau endorsement in CD-8.  But the most interesting part of the press release was the contact name at the top of the page: Josh Haynes.  Haynes was Jo Ann Emerson’s right hand man.  He played the Republican nomination scrum fairly and evenly, and apparently has retained his position as a result.  No further word yet on other staffing bits though it’s said that resumes have been zipping around.



The House Republican Campaign Committee is already tossing coal into the tender – raising money.  Their budget for the next cycle is tentatively $4 big ones… that’s $4 million.  About a $1 million of that will come from lobbyists, $2 million will be from contributions from caucus members, with the final million expected to come from “major donors.”



KC Star report Jason Hancock explains the Senate Ways and Means Committee passing a billion-dollar tax cut yesterday.  Read it here.   One assumes that if Sen. Will Kraus was serious about the income tax cut portion, he wouldn’t let Sen. Paul LeVota love it to death like this.



Lobbyist Registrations

From the Pelopidas website:


Rodney Boyd, Brian Grace and Kelvin Simmons added Kansas City Zoo.

Tim Green added Burton-Liese Government Relations.

Jewell D. H. Patek added Laclede Gas; and deleted Rocky Mountain Dental Association.

Brian Schmidt added Collaborative For a Low Cost Digital Future.



$5K+ Contributions

MO Republican Party - $14,861 from August Busch III.

Citizens for Good Government - $50,500 from Professional Firefighters of Tri-County PAC.




Happy birthday to Brad Green (25).