The Joplin Globe, Joplin, MO

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March 23, 2014

Missouri Legislature at midpoint; Medicaid expansion tops docket

JEFFERSON CITY, Mo. — Missouri lawmakers spent the past week on a legislative spring break. Some went on vacation, others worked back home in their districts, and all of them prepared to return to the Capitol for the final half of this year’s legislative session.

The body passed six bills in the first half, one of which caps the out-of-pocket costs for oral chemotherapy. Another allows service members and disabled Missourians to send designees to the Missouri secretary of state’s office during candidate filing. The other four aim to ease the regulatory environment and weaken the control of municipalities on the telecommunications industry.

Gov. Jay Nixon, a Democrat, signed the candidate filing bill late last month, and he signed the other bills last week. The telecommunications package — which addresses management of rights of way and utility pole access, hastens the local regulatory procedure and offers the industry some local immunities in emergencies — was similar to legislation that was struck down last year by Cole County Circuit Court because of a technicality.

Lawmakers return to Jefferson City today, and the House of Representatives is expected to begin work on its version of the fiscal 2015 budget.

Health care

For Missouri and Joplin health care providers, one of the largest issues on the docket this year is Medicaid expansion. Nixon has made the issue his chief priority, and unlike last year, he has found a Republican dance partner. Rep. Noel Torpey, R-Independence, has filed House Bill 1901 and has joined Nixon at public meetings pushing the proposal.

The two are backing a plan to expand the state-administered health insurance program for the poor using federal funds made available through the 2010 health care law. Torpey’s bill would expand Medicaid to working adults whose income falls below the federal poverty level. The bill would require people who repeatedly use the emergency room to pay 1 percent of their income in premiums; would require hospitals to increase information on the price of services; and aims to help those making between the poverty level and 138 percent of the poverty level (the federal government’s expansion threshold to receive funding) buy a private plan in the federal health care exchange.

Paula Baker, president and CEO of Freeman Health System in Joplin, said expansion and reform (described by supporters as Medicaid “transformation”) is both a health issue and a business issue. On the health side, Baker said, Missouri has ranked No. 42 on a national scale in terms of health status.

“That’s not a reflection on the outcomes of hospitals, that’s just the status of the health of Missourians,” she said. “We believe that if every individual has access to health insurance, they’re going to get treatment more readily, preventive screenings, vaccinations, things that help keep people healthy.”

On the business side, Baker said, hospitals stand to lose as much as $1 billion annually because of the loss of what are called disproportionate share hospital, or DSH, payments. DSH payments, which the federal government gives to hospitals to help cover costs for individuals who cannot pay, were seriously reduced in the federal health care law, in part because of the assumption that states would expand Medicaid. But when Medicaid expansion was ruled optional by the U.S. Supreme Court in the decision that upheld the key components of the health care law, that trade-off became optional for states.

“Nobody expected one would happen without the other,” Baker said. “We experience those reductions, but we don’t have the money to augment that loss.”

Republicans, including those who make up the Joplin area’s delegation, argue that the state’s budget could take a hit when the federal payment is rolled back to only 90 percent over three years starting in 2017, putting the state on the hook for hundreds of millions more in Medicaid spending on top of the growth the program is already experiencing.

Baker said she has had positive conversations with area lawmakers, who “understand the pressure on their hospitals,” adding, “What is really in jeopardy is the smaller, rural hospitals operating on a very thin margin.”

While the chances for Medicaid expansion this session are unclear, another priority of Missouri hospitals and doctors — re-enactment of caps on noneconomic damages in medical malpractice claims — is making its way through the Legislature. Local lawmakers joined a majority in the House earlier this month to approve legislation that would reinstate the $350,000 cap on noneconomic damages that was struck down by a 4-3 decision of the Missouri Supreme Court in 2012.

Baker said a lack of caps on damages forces doctors to practice “defensive medicine,” which can add extra costs, and makes for a challenge in hiring physicians, especially when neighboring states like Kansas have caps.

“It dramatically affects our ability to recruit physicians,” she said. “It also makes physicians very cautious when they’re considering whether to take a very high-risk case. That has to be a consideration.”

A handful of Republicans — many from places like suburban Kansas City — voted against the bill, meaning the Legislature may not have the votes to override what would be a likely gubernatorial veto if the bill is passed out of the Senate. Rep. Sheila Solon, R-Blue Springs, said caps on damages attempt to “place a price tag” on a human life. “If we put back caps in place, we’re saying that a life is not worth more than $350,000 or $500,000 or whatever we decide,” she said.

Baker said “nobody is denying” a patient who may have been harmed a “right to judgment.”

“Hospitals are not opposed to it because we want to, in any way, have people who have had a bad outcome penalized,” she said. “It is really to provide that structure for it to be done in a reasonable way.”

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