Thursday, November 29, 2012


Nixon and Medicaid Expansion

As rumored yesterday, Governor Jay Nixon will support Medicaid expansion today.


It marks a big move for the conservative Democratic governor who spent his first term avoiding divisive issues, and spent his campaign begging off questions about this topic.


To make his case, Nixon will be armed with a fresh study from the University of Missouri (commissioned by the Missouri Hospital Association and the Missouri Foundation for Health).


Among its findings: expansion of Medicaid would generate “an additional 24,008 jobs in Missouri in 2014… (which equals) 12.8% of the total unemployment number in Missouri in 2011; it has the potential of adding another $9.6 billion in value-added output to the economy from 2014-2020; The Medicaid expansion will generate $856 million in additional state and local taxes from 2014 to 2020.”


In addition to this new study, supporters of the expansion are also banking on political pressure from rural hospitals to their legislators.


Hospitals will see their DSH (Disproportionate Share Hospital) payments phased out under the Affordable Care Act.  The thinking was that the Medicaid expansion would provide hospitals with a replacement revenue stream.  Now with Missouri’s participation in doubt, hospitals could face a crunch.  Several observers yesterday said that rural hospitals are particularly vulnerable.


Could they lean on Republican rural legislators to support the Medicaid expansion?  We’ll see.



Shading the Kaiser Report

I cited a Kaiser Foundation report yesterday which said the expansion would cost Missouri billions.  But one supporter of the expansion points me to page 14 (see the paragraph below) of the Kaiser Report where they offer the qualifications that their estimates of costs are high.  Several of the scenarios noted appear to be in play in Missouri.


“These estimates should be considered an overestimate of costs or an underestimate of savings if states were to implement the Medicaid expansion. Data did not permit us to develop state-specific estimates of several items. First, states could reduce their Medicaid spending on several beneficiary groups, who would instead be covered as newly eligible adults. For example, medically needy adults with incomes at or below 138 percent of the FPL who, without the expansion, would spend down to qualify for Medicaid could instead be covered as newly eligible adults who receive full Medicaid benefits at the higher federal matching rate.8 Second, states could cut non-Medicaid spending on health care services provided to formerly uninsured poor and near-poor adults whom the Medicaid expansion would cover with largely federal dollars. Examples include mental health and substance abuse programs and certain public health and social services. Third, the expansion could raise state revenue, including increased general revenue from heightened economic activity.”



A Third Way?

Many conservative Republicans are deeply dug in against everything about ObamaCare.  Therefore Nixon’s prospects of twisting enough arms and minds to win his way seem uphill.


Against that backdrop, one wonders if there is the will – and political imagination – to look for a third way which would expand Medicaid coverage in a way in which Republicans find palatable.


I don’t know what that destination looks like, but the direction is for Missouri to apply for a waiver from the federal government, and propose its own version of Medicaid expansion based on the Republican touchstones of market forces, and rational incentives that encourage personal responsibility yada, yada, yada…



Two Day Media

Whether by design or leaky luck, I don’t know, but it looks like Nixon gets a two-day splash from this decision.


Today the headlines have “may” in them.  So assuming he gets follow-up articles tomorrow, it’s a nice doubling of roll-out coverage.



Schmitt Unveils Tax Cut Plan

Yesterday Sen. Eric Schmitt announced he will prefile “The Broad-Based Tax Relief Act of 2013” next week.


“The bill would create a tax deduction for business income, beginning at 10 percent in 2013. The tax relief measure would be fully phased in at 50 percent by 2017. The deduction would apply to all businesses—no matter their size—reporting income on individual returns, such as sole proprietorships, S corporations, limited liability corporations (LLCs), and limited liability partnerships (LLPs). During the same five year period, the corporate income tax burden would also be reduced by 50 percent.”


This appears different from the “Kansas tax cut” in that it covers all businesses equally, while Kansas is zero-ing out some business taxes and leaving others untouched.




Spotted on a flight to Washington DC… Robin Carnahan “still trying to get a job in the Obama Administration…”



And attorney General Chris Koster has already started working on 2016 this week by making a round of courtesy calls to elected Dems…



eMailbag: Rep. Kelly on the Nixon Ashcroft Comparison

“I think (the comparison) is much more accurate with Ashcroft’s first term.  I was on Budget during his entire tenure and Chair during his last two years and found him to be actively engaged. I can cite at least two examples of significant legislation I handled where he personally played an active part; the Durable Power of Attorney for Health Care and the Federal Reimbursement Allowance.  In both of these Missouri was a national leader and Gov. Ashcroft was knowledgeable and quite pointed as to the structure of what ended up as very good laws. The comparison is inaccurate as to his second term.”  Rep. Chris Kelly



Lobbyist Registrations

From the Pelopidas website:


Jewell D. H. Patek added Liberty Mutual Insurance.

Jeff W Glenn deleted SEMO Asphalt Shingle Recycling LLC.




Happy birthdays to Rep. Mike Bernskoetter (53), Peggy Nalls, and Rep.-elect JD McGaugh.


Friday: Jobs with Justice’s Lara Granich  and Planned Parenthood’s Alison Gee.


Saturday: St. Louis County Executive Charlie Dooley, Frank Plescia (56) and Joe Knodell (67).