Legislative Column for Feb. 21, 2019
There’s a famous quote that’s often attributed to Everett Dirksen, a U.S. Senator from Illinois: “A billion here, a billion there, and pretty soon you’re talking about real money.” Dirksen denied ever actually saying that, but the sentiment sure rings true to me as I consider the state budget as a member of the Missouri Senate Appropriations Committee.
Recently, the committee heard the appropriations requests for Mo HealthNet, the umbrella term for Medicaid programs in Missouri. These programs are administered by various state agencies, including the departments of Social Services, Health and Senior Services and Mental Health. The total cost of Medicare spending in Missouri is expected to top $11 billion in 2020, with about 75 percent going to the Department of Social Services.
All told, these programs represent more than a third of Missouri’s $29 billion operating budget for the upcoming fiscal year. Social services spending is the single largest category in the governor’s proposed budget. Education is second, but lags the total spent on Medicaid programs by quite a bit. The things we think of as essential services – roads, public safety and keeping dangerous criminals behind bars – all pale in comparison.
More than half the money for Mo HealthNet comes from the federal government. Another 25 percent comes from fees paid by hospitals, nursing homes, pharmacies and other service providers. The rest comes directly from general revenues. If Missouri had to pay the entire cost of Mo HealthNet from its own pocketbook, the program would consume every dime collected from the state’s taxpayers.
Clearly, caring for the sick, aged and disabled is becoming the No. 1 job of Missouri government.
Nearly 1 million Missourians receive help from Mo HealthNet. That’s one out of every six people in the state. About 60 percent of recipients are children in low-income families. Parents of low-income children, pregnant women, the blind, disabled people and elderly Missourians also benefit.
Nearly two-thirds of Missourians receiving Medicaid benefits are enrolled in SCHIP, the State Children’s Health Insurance Program, which is administered by Mo HealthNet for Kids. This coverage is available to uninsured children of low-income families who do not otherwise have access to health insurance. Eligibility for this program varies with family size but, for example, a mother with two children and a household income below $60,000 a year would qualify.
We often hear calls for us to do more, but there is only so much money in Missouri’s budget. Do we take money out of schools to pay for Medicaid? If not, what would you cut? Some say we should raise taxes, but every additional dollar we ask Missouri taxpayers to send to Jefferson City is one less dollar our citizens have to spend on their own families. I don’t want to do that.
Rather than find fault that Missouri does not do more, I prefer to appreciate all that we do. Missourians, like all Americans, are generous people. We support people in need around the world, and here at home. The Mo HealthNet program, even in its current form, is an example of that.
Missouri spends one out of every three dollars in its budget caring for people in need. That’s a lot. No matter who said it, a billion here and a billion there is real money.
As always, I appreciate it when groups from around Missouri and from our community back home come to visit me at the Capitol. If you would like to arrange a time to come and visit me in Jefferson City, or if you ever have any questions, please don’t hesitate to contact my Capitol office at (573) 751-1882.