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Republicans resist level of Medicaid expansion

JEFFERSON CITY - House Republicans indicated Wednesday that a family's level of income will be the focus of debate on a bill that would expand Medicaid coverage to uninsured children whose parents operate on a budget up to 300 percent of the federal poverty level.

Passage of the bill is a top priority for Gov. Mel Carnahan. He announced Tuesday that the Clinton Administration had approved the state's plan to apply the federal funds to Medicaid expansion.

As the House began debate, Republicans insisted that an amendment that categorizes income levels to determine amounts of required copayments and premiums keeps legislators from determining maximum qualifying levels this session.

"If you're going to make a decision to cap, you ought to make it now," said Charlie Shields, R-St. Joseph. Democrats said those decisions would be left to the yearly appropriations process.

The legislation intends to provide medical coverage for the estimated 175,000 uninsured children in Missouri whose parents do not qualify for Medicaid, do not receive coverage through their employers, and do not have enough to pay for private insurance. To do so, it would use the $51.6 million Congress made available in the Children's Health Initiative Program that passed last year.

Rep. Scott Lakin, D-Kansas City, who sponsored the bill in the House, called it a moral and economic issue. "The question is access to primary, preventive care," Lakin said. Claiming that the state will end up paying one way or another, he said "We can pay pennies for preventive care, not thousands for emergency care."

Republicans said expanding coverage to 300 percent of the poverty level would unnecessarily extend an entitlement program and prompt families to drop their private insurance for public assistance.

"This is a policy decision to expand a welfare program into the middle class," said Rep. Luann Ridgeway, R-Smithville. A family of four at 300 percent of the poverty level operates on a budget of $49,350.

Democrats said not expanding coverage to 300 percent shifts federal funds available for Missouri to another state and fails to reach the number of children it could.

"What Medicaid is all about is drawing down federal funds. We are leaving money on the table if we don't go up to 300 percent," Lakin said.