As has been widely publicized, the governor has spent the months since his re-election travelling the state to drum up support for expanding Missouri’s Medicaid program. At this point, there are probably few citizens who haven’t been lectured on the so-called benefits of the Medicaid expansion. The General Assembly, however, has mostly been excluded from this conversation.
On Tuesday, the governor finally reached out and met with members of the majority caucus to discuss the expansion. I appreciated the effort, although I wish he would have met with us sooner. We had a very thoughtful discussion and he was incredibly forthright and open about where he stands on this issue.
The problem, though, is the answers were more of the same talking points that have been repeated ad naseum over the last four months. There are still numerous questions we need answered before we even consider an expansion of this scope. There’s also the issue with our current Medicaid program, which has struggled to provide healthcare to citizens at a reasonable price to taxpayers for years. Growing it does nothing to address those fundamental problems.
Despite this, the governor has placed considerable pressure on the Legislature to act. Under the proposal, the federal government would pay 100 percent of the costs associated with the expansion for the first three years. We’ve been told if we don’t do something, Missouri will miss out on a year of “free” federal funding.
People don’t seem to realize, though, that those dollars are theirs. Regardless of whether your tax dollars are sent to Washington or Jefferson City, it’s still your money. It doesn’t matter how much the state will pay or what percentage the federal government will pick up, because, ultimately, it’s the taxpayers who will pay for this expansion. There is no “free.”
There’s also this misconception that if we don’t accept those federal dollars, they’ll instead go to other states. This is not true. There is no general fund for Medicaid expansion distribution. If Missouri doesn’t accept the expansion, it doesn’t go to Illinois or Kansas or some other state. Not accepting the Medicaid expansion simply means we’re refusing to increase the national deficit by billions and billions of dollars. Those funds just won’t get spent, which means our federal government won’t have to borrow more money from China to support yet another seriously flawed program. The total current U.S. deficit now stands at more than $16 trillion, a number so high, it nearly seems abstract. Washington has ceased operating within the bounds of any kind of fiscal sense.
Missouri must continue to forge its own path. Our reliance on federal dollars is already hurting us. Earlier this year, Moody’s cited our state’s dependence on federal funding is affecting our credit rating outlook. A drop in our credit rating would be disastrous. To come through one of the worst economic crises in half a century with our credit rating intact, only to see it crumble because of our need for Washington’s dollars, would be tragic.
After three years, Missouri would begin paying a percentage of the costs for the expansion. Estimates put this cost at around $100 million a year. But that’s just it, these are only estimates. We have no idea what this expansion will cost, but it’s a safe bet to assume it will cost much more than expected. It’s rare, if not unheard of, for a government program to come in underbudget. The entitlement state continues to grow, and its costs are always more than the government estimates.
Part A of Medicaid was launched in 1965. It was projected to cost $9 billion by 1990. It ended up costing $67 billion. Medicaid’s hospital subsidy was added in 1987. It was estimated to cost taxpayers $100 million a year. By 1993, it was costing us $11 billion a year. These figures are not at all uncommon. We’re spending more and more on these programs, which is strangling our ability to invest in measures that would create real prosperity for all American citizens. Between 2020 and 2030, the amount of spending on entitlements and interest will exceed all federal revenue, yet we’re supposed to believe this time will be different.
Before we even consider expanding Medicaid, we need to implement common-sense reforms into the program. Until then, Washington is just selling us a broken product. I can’t change what happens at the federal level, but I can protect the interests of Missourians, and part of my job is keeping the state solvent. Expanding Medicaid without first addressing the program’s underlying problems would put our fiscal future in serious doubt.
Contact Me
I always appreciate hearing your comments, opinions, and concerns. Please feel free to contact me in Jefferson City at (573) 751-2459. You may write me at Wayne Wallingford, Missouri Senate, State Capitol, Jefferson City, MO 65101, or email at wayne.wallingford@senate.mo.gov or www.senate.mo.gov/wallingford.
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