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Before Christmas, Matt Blunt was busily trying to get past his Ebenezer Scrooge image by announcing three different forms of state government largess that he is proposing.

The first is a $121 million dollar increase in state aid to education–four percent more than the state is spending now. Blunt neglected to mention, though, that the added funds are hardly prompted by the Mother Teresa portion of his soul. Rather, it is a raise mandated by the new school foundation formula.

The other two examples of his munificence and his concern for the poor have to do with his two replacement programs for Medicaid. MO HealthNet is Medicaid under a jazzy new name–and covering fewer people than the old program did. Insure Missouri is for the working poor.

Blunt is recommending that doctors treating patients under MO HealthNet receive more appropriate compensation. In 2006, they got only 45 percent of what doctors were paid for treating Medicare patients. The 2007 budget bumped the payout up by $66 million, so that doctors received 55 percent of the Medicare reimbursement rate. Blunt is proposing to add another $52.8 million a year starting July 1, so that doctors treating Medicaid patients would receive at least 65 percent of the Medicare payment rate.

Blunt’s recommendation to raise MO HealthNet compensation is, like his proposal to raise education spending, disingenuous, since the bill that created MO HealthNet dictated that the minimum rates would rise. It’s not like the governor woke up one morning and decided to raise those rates so that more of the poor could find doctors who would treat them. The bill already spelled that out.

Still, despite the guv trying to take credit where it isn’t due, it would be heartening to see a more reasonable rate of compensation, because many doctors have begun refusing to treat Medicaid patients. Don’t hold your breath, though. The increase in payment rates to doctors isn’t likely to happen anyway because the money for it probably won’t be there. And Blunt knows that.

No matter what a given bill says the state must spend on something, states aren’t like the federal government: they may NOT engage in deficit spending. First and foremost, they must balance their budgets. And Missouri is on a list of thirteen states that are projected to have a budget shortfall in fiscal 2009, which begins this July.

And no matter what the MO HealthNet bill may have mandated, the money for paying more to doctors of Medicaid patients hasn’t been included in the budget. If we have a budget shortfall–as the downturn in the economy and the housing market makes more than likely–some programs will have to be cut (or taxes raised–as if). And the programs that are at least in the budget to start with–like the increased money for education–are more likely to get the funding. Raises for doctors of Medicaid patients will be left out in the cold like orphans.

Finally, on the list of Blunt’s recent bounty, we come to Insure Missouri, the health insurance program for the working poor.  The first of its three phases, for working people who live below the poverty line, is budgeted and due to start this February. But the other two phases still have to get through the legislature. Lotsa luck.

Fiscally conservative Republicans liked the way those Medicaid cuts two years ago helped the budgeting process, and they’re not inclined to undo what they accomplished. They’ll oppose it. That might not be a problem if Dems would vote for it, but they’re not itching to give Blunt that kind of legislative victory in an election year, especially since they figure he’d fund it just long enough to get himself elected and then let it wither. That’s what he did in 2004 with Medicaid–promised during the campaign that he would continue to fund it and then axed it in 2005.

So don’t count on the next two phases of Insure Missouri to materialize. Blunt will make all the noise he can about his fiscal beneficence. But however much he crows, the noise may only serve to remind taxpayers what a stingy ass he was three years ago.

It’s a tough call for the governor: shut up about health care and pray for short voter memories or try to undo the lingering pr damage. Looks as if he’s opting to brag.

Crow, Chanticleer.  

Photo courtesy of Missourinet