By Andy Ostmeyer

aostmeyer@joplinglobe.com

As the U.S. House prepares for a historic vote this weekend on health care, Missouri’s political leaders are wrestling with a health care crisis of their own.

The state is broke, but at the same time tens of thousands of residents have fallen into the ranks of the uninsured and are relying on the state’s program. Legislators said they are not sure what direction to take the program as they await federal decisions.

“It is hard to know where to go,” said Rep. Ron Richard, R-Joplin, speaker of the Missouri House.

Budget bust

Last fiscal year, the state budget had “negative growth” of 7 percent, said Mike Schwartz, budget and policy analyst for Rep. Allen Icet, R-Wildwood, the House Budget Committee chairman. To date for this year, the state is 10 percent in the red, which means the Missouri budget will be off by hundreds of millions of dollars. No one is sure exactly what to expect.

Last week, Gov. Jay Nixon cut $204 million in state spending, which wiped out 700 full-time and part-time jobs. That’s on top of $430 million he cut this summer.

Asked if that was going to be enough to balance the budget, Jack Cardetti, spokesman for Nixon, said: “As of right now, that’s the number we feel comfortable with.”

Whether that’s enough will be determined by future income and sales tax revenue, but Richard said that if more cuts are needed, Medicaid is one of the few places with a budget big enough to make a dent.

“If you’re going to decide to cut something, you got to go to prisons, Medicaid or education,” he said.

Nixon’s latest $204 million cut included $32 million in Medicaid cuts. Linda Luebbering, the state’s budget director, said it is too soon to know specifics, but the possibilities include reducing payments to providers and putting more emphasis on generic drugs.

Missouri’s Medicaid budget is around $6 billion annually, using fiscal 2009 totals. The state pumped in more than $1 billion last year; the federal government provided nearly $3 billion; and the rest came from other sources, including taxes on certain providers such as hospitals and pharmacies, and from tobacco money.

Schwartz said education has such a strong constituency that cutting there is tough. Besides, there are state constitutional mandates on education funding.

Likewise, there are limits on what the state can cut with regard to Medicaid, as well as political considerations. Part of the fine print that came with all that federal stimulus money was a promise that the states would not tighten eligibility guidelines for Medicaid recipients, Schwartz said.