What are the truths and what are the rumors behind the idea of expanding Medicaid in Missouri? I do not believe anyone is 100 percent sure what will happen if we do not expand health care or what our actual cost will be if we do.

What I do know is that in the years I have served in the Missouri Legislature, every year we have tried to rein in spending and fraud, it gets harder. Once citizens become used to receiving a benefit of any kind — for example, a tax credit, supplemental funding for a program or cash assistance — they are extremely resistant to any change that might threaten that benefit. Citizens who feel they have been wronged can become vicious, not physically, but verbally and in written form — especially the organizations that want to "champion" whichever group whose benefits are in danger of decreasing. Most years the change really is not even a decrease; rather, smaller increases than they want. Given the history of many of our social programs, I do not know how anyone can think we will expand Medicaid to adults and those adults will not continue to expect assistance after the full funding for the three-year federal program has ended. After that time period, Missouri would have to take up at least some of the responsibility for that program’s funding.

I have received many calls on both sides of the question of Medicaid expansion. Why would we expand an already broken program? We do know that the system is currently inefficient and that expanding benefits to additional people could exponentially increase the inefficiencies. There are some businesses that say the expansion will provide them additional customers (for guaranteed payment from the government). I wonder if they remember who is really paying the bill: each and every one of you. Your taxes will increase, either at the federal or state level, if not both. We are already hearing that those who have private health insurance can expect their premiums to double as a result of the Affordable Care Act.

According to the Kaiser Family Foundation, in Fiscal Year 2010, Missouri spent $2.1 billion on Medicaid, which was approximately 10 percent of the total budget. The plan is to change the current cut-off rate from 19 percent to 133 percent of the federal poverty level, which would add approximately 300,000 Missourians to Medicaid. However, the governor claims our state would save $46 million in 2014 and as much as $140 million in 2016. There are also claims that this move would add 24,000 health care jobs in Missouri.

With only two weeks remaining in the 2013 legislative session, I do not believe Medicaid expansion will be taken up by the Missouri General Assembly. There is the potential an interim committee could be named to study this issue further yet this year, but that remains to be seen.

As always, if you have any questions or comments, please do not hesitate to contact my office. Thank you.