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
"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
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
"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
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. …