JEFFERSON CITY • Sen. Ryan Silvey, R-Kansas City, said Wednesday that it’s time for the Missouri Legislature to work to solve problems created by the federal Affordable Care Act instead of just hoping Congress will repeal it.
Silvey contends he has a way to solve one of those problems — the coverage gap that thousands of the state’s poorest adults fall into — without costing state taxpayers any additional money.
But at least so far, his plan isn’t even on the table. And critics of the health care law, led by Sen. John Lamping, R-Ladue, hope to keep it that way.
Silvey can’t introduce his plan as a bill because the deadline is past for filing legislation. He would have to substitute it for another Medicaid-related bill.
But when a wide-ranging Medicaid overhaul proposal came up on the Senate floor on Tuesday night, Lamping stalled it out of concern that it could grow into Medicaid expansion. After a brief debate Wednesday, the bill was shelved again.
Silvey said he was frustrated.
“I’m growing weary of the small group of senators who just refuse to acknowledge that there are problems that need to be fixed and want to bury their head and say, ‘Anything associated with Obamacare, we just can’t touch it,’” he said in an interview.
A summary of Silvey’s plan was circulated by Christopher “Kit” Bond. The prominent Republican former senator and former governor was hired to lobby for Medicaid expansion by the Missouri Chamber of Commerce and Industry. Silvey said he wrote the plan but the chamber and Bond support it.
The proposal would stockpile savings that the state expects to gain by shifting some people who are now on state-funded health care or traditional Medicaid into the expanded Medicaid coverage group. The expansion group includes working-age adults earning up to 138 percent of the federal poverty level, or roughly $32,500 for a family of four.
While Missouri receives about 60 percent funding from the federal government for traditional Medicaid patients, those covered under the expansion would be paid 100 percent by the government initially, dropping to a 90 percent federal share by 2020.
Silvey estimates the state’s savings could add up to $600 million by 2019. He said the state’s tab for the newly eligible recipients could be roughly $200 million a year when it hits the 10 percent level.
If there wasn’t enough money in the “lockbox” account to pay the bills for the new Medicaid participants, Silvey’s plan would cover the balance by reducing the rates paid to medical providers, such as hospitals. He includes a five-year sunset clause, which means coverage would lapse for the 300,000 newly covered adults unless the Legislature chose to renew it.
Though few details were available, Silvey’s proposal also promises to address other Republican priorities, such as encouraging recipients to work, requiring them to pay the maximum allowed in premiums and co-payments, and funneling some patients into private insurance plans.
On Wednesday, Silvey and Lamping questioned each other’s ideology and stance on Medicaid expansion until bill sponsor Sen. Gary Romine, R-Farmington, halted discussion of the bill.
Lamping said Missourians opposed the health care law, as evidenced by three decisions at the polls: opposing the mandate to purchase insurance, in 2010; preventing the governor from setting up a state-based insurance exchange, in 2012; and favoring Mitt Romney when he ran against President Barack Obama, in 2012.
“True reform” would be a block grant from the federal government that would allow the state to design its own health insurance system for the poor, Lamping said.
Romine’s Medicaid bill is SB739.