A Moment with Mike -- Dealing with Obamacare

With the 97^th General Assembly ready to convene in just a little over a month, the topics and issues that will be at the forefront are starting to emerge.   The new Speaker of the House, Tim Jones has indicated that his priorities are economic and job development, energy policy and education reform.  These are topics that are consistently debated and will continue to be relevant.  However, other important issues that could seriously affect our precarious budget situation and the future of our state may rise to the top.

      The Affordable Care Act which we all refer to as Obamacare was upheld by the Supreme Court of our land.  This act will have extreme consequences on some individuals, businesses and, of course, state and federal budgets.  We have already discussed the implications of creating a Health Care Exchange which will soon be required of all states.  Our Governor has already indicated that the state would not create an exchange and the people recently voted to only create one with the approval of the legislature or the people.  This means that the federal government will probably be creating some type of exchange in Missouri and the cost which will come from our taxes is only a guess at this time.

      The Supreme Court ruling did give each state the option to accept federal funds to expand Medicaid to those that earn up to 138 percent of the federal poverty level.  The Governor has come out in favor of this expansion and hospitals and primary care associations are leading the charge for this expansion.  Advocates say that this will not only provide health care for an estimated 300,000 people, but it will create jobs and increase the state and local tax revenues to help cover the costs.  The federal government will cover the costs for the first three years and then the state will gradually start paying a small percent and work its way up to ten percent after eight years.   Health care providers have already seen reduced payment for Medicaid patients and are looking to this expansion to help make up these losses when expansion would kick in.  They say that if the state does not enact this expansion that there will be providers that will no longer see Medicaid patients or possibly go out of business.

      There is another side of this, however, that we must consider before jumping into another federal government backed  assistance program, many of which are major contributors to an insurmountable national debt and have encumbered state budgets for years.   Health and welfare programs are already the biggest budget items for the state and far outpace the spending that we provide to educate our kids.  The huge amount of federal money, of course, is paid by your taxes and the amount that the state will eventually pick up is estimated to be well over $300 million, an amount that will expand every year.  This past budget year, with no change in eligibility, Medicaid costs went up $189 million.  How we come up with this kind of money when our state workers are the lowest paid in the nation, our education funding is hundreds of millions of dollars behind, the department of transportation is desperate for funds and we are very slowly crawling out of a recession raises a big question. 

      At this point our new Senate President Pro Tem and our Speaker of the House indicate that they will not support this expansion but will continue to look at the options that we have to deal with the numerous requirements and expenses of the Health Care Act.  We must act to do what is best for the people of our state but we must also live within our means, a concept that our federal government has not considered.

          If you have questions, you may reach me at my Capitol number 573-751-9465, at the local district number, 660-582-4014, by email at mike.thomson@house.mo.gov or by mail at Room 401B State Capitol Building, Jefferson City, MO 65101.