SUPREME COURT BACKS HEALTH CARE MANDATE : States Have Decisions to Make; with Ruling, Government Can't Force Expansion of Medicaid Eligibility; SUPREME COURT HEALTH CARE RULING [Corrected 07/16/12]

Article excerpt

JEFFERSON CITY - Despite Thursday's Supreme Court ruling, Missouri's lawmakers appear unlikely to take steps to participate in the Affordable Care Act any time soon. Illinois leaders, by contrast, are accelerating their plans.

In one part of Thursday's health care ruling, the U.S. Supreme Court said the federal government cannot force states to expand income eligibility for Medicaid, a health care plan for the poor, which had been required by the act. The ruling means state leaders will have to decide whether the program should be expanded to cover an estimated 308,000 more Missourians and at least 630,000 more Illinoisans.

"States will now have to make a series of decisions moving forward. Those include the political, fiscal and policy calculations of whether or not this particular expansion makes sense," said Matt Salo, executive director of the National Association of Medicaid Directors.

Missouri House Minority Leader Tim Jones, R-Eureka, who is in line to become House speaker next year, said he thinks the Legislature is unlikely to expand the Medicaid program. A staunch opponent of the federal health care law, Jones called the elimination of the mandatory expansion "the one bright spot" in the court's ruling.

"We need to get a handle on entitlements in this country," he said. "Everyone agrees that reform is needed, so I don't think that anyone will be interested in expanding entitlements."

In Illinois, Gov. Pat Quinn said at a news conference in Chicago that he wants to press ahead with the state's plans to expand Medicaid. He called it a "great, great day" for Illinois.

"The Affordable Care Act is the law of the land, and we in Illinois plan to carry it out," he said. He noted that an estimated 1.5 million Illinoisans are currently uninsured.

In a sharp contrast, Missouri Gov. Jay Nixon, who is running for re-election, remained relatively quiet on the issue. He issued only a brief statement and would not answer questions.

"We're just now beginning to review this ruling so that we can understand exactly what it means for Missouri," his statement reads. "This ruling has significant complexities and implications for families, health care providers and insurers in our state. Here in Missouri, I'm committed to working collaboratively with citizens, businesses, medical providers and the Legislature to move forward in a way that works best for families in our state."

Nixon, a Democrat who advocated Medicaid expansion during his campaign four years ago, spoke out against the health care law's individual mandate earlier this week. He has declined to address repeated questions from the Post-Dispatch about whether he supports the Medicaid expansion or a provision that directs states to set up health exchanges in which people can purchase subsidized insurance.

'Very high share'

Under the now-optional Medicaid program, the government would cover anyone under age 65 who makes less than 133 percent of the federal poverty level, which is less than $25,389 for a family of three.

A report from the nonpartisan, nonprofit Kaiser Commission on Medicaid and the Uninsured estimates that Missouri would have to spend $431 million from 2014 to 2019 on the expansion, while Illinois would pick up a $1.2 billion tab. However, the federal government would chip in nearly $8.4 billion for Missouri and $19.2 billion in Illinois.

"The federal government will pay a very high share of new Medicaid costs in all states," the report concludes.

Timothy McBride, a health economist and associate dean for public health at Washington University, said that influx of money could become a powerful bargaining chip.

If a state declines to participate, he said, "You're walking away from a lot of money."

McBride expects lawmakers will feel pressure from consumer advocates and the health care industry. …


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