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Draft Report: Missourians Favor Medicaid Expansion

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JEFFERSON CITY, MO.  —  They traveled to six, far-flung Missouri cities. They held marathon public hearings. They got detailed state briefings.

So what did the 52-member House Citizens and Legislators Working Group on Medicaid Eligibility and Reform conclude?

That people want both Medicaid expansion and reform.

A seven-page draft report circulated by state Rep. Noel Torpey, R-Independence, the group’s chairman, ends with that statement. There is no elaboration. The rest of the report generally highlights testimony received, without naming witnesses.

For example: “Witnesses discussed the need for greater care coordination for Medicaid recipients and the benefits of giving recipients a stake in their health care.”

Though the report is light on details, Torpey said the undertaking could have a big impact on the Legislature’s Medicaid deliberations next year.

“I can look someone in the eye and say, ‘Representative, this is what we heard time and time again, and we need to keep an open mind’ ” about expansion, he said.

“I think if we do the right kinds of reform, there’s a chance of getting expansion done,” he said.

Last spring, the Republican-controlled Legislature rejected expanding Medicaid as envisioned by the Affordable Care Act. The federal government would have paid the full cost for new participants the first three years, with the state picking up a share after that.

Critics said that the safety net program for the poor was flawed and adding people to the rolls was financially unsustainable.

The topic is likely to be on the Legislature’s agenda again in January. The key question is, what reforms will legislators seek?

Asked for an example of a needed change, Torpey said Medicaid currently paid for knee replacements but not the follow-up rehab therapy. “That’s just crazy,” he said.

He also called for more transparency in hospital billing practices.

Some of the House working group members were disappointed that the group wasn’t given a chance to hash out specific recommendations. The panel included 14 legislators and 38 non-legislators, many of them with expertise in various health care sectors.

“You had this high-powered group of people that spent 90 hours of their own time and money, and (the chairman) never had them engage in a dialogue among themselves,” said Dr. Ed Weisbart, a member from Olivette.

He said some might have declined the appointment if they had known they were “just being a transcriptionist.”

Torpey said House Speaker Tim Jones, who appointed the committee, had been clear from the start that the group’s goal was simply to receive public testimony.

He said working group members could submit written comments, which will be appended to the report.

Then, the document will be handed off to another House committee, which will meet Wednesday morning to decide how to develop legislation.

A Senate committee studying Medicaid reforms also will meet Wednesday morning. Experts from the Center for Health Law Studies at St. Louis University’s School of Law are expected to testify, among others.

The meetings will precede the Legislature’s annual veto session, which kicks off at noon.