I’ve hammered Budget Chairman Allen Icet and his cohort Rick Stream for wanting to turn down more than a hundred million abso-freakin’-lutely free dollars to put most of the people living at less than half the poverty level back on Medicaid. The proposal to accept the free funds did eventually get into HB 11, but so what?–because now the House has turned down the deal. What I said about the niggardliness of Republicans on the Budget Committee applies to Republicans in the House at large:

All those hundreds of millions of pennies would cost our cash strapped state not a single penny. For them to thumb their collective nose at such free funds is not penny wise and pound foolish but just plain foolish.

The Missouri Hospital Association is willing–nay, wanting–to give the state more than fourteen million dollars ($14,150,000 to be precise) to be used for health care for Missourians making less than half the poverty wage. That investment would bring in another $91.7 million in federal dollars–almost $104 million altogether. But the Republicans oppose giveaways to those church mice. The effrontery of anyone to remain in such penury! Why don’t they go out and earn a Ph.D. in chemistry and make a decent living working for Monsanto?

Of course, the Senate might talk House Republicans into accepting its proposal, whereby the churchmice could get back on Medicaid, but only if they can come up with a thousand smackeroos a year. Be real. These are people living on less than half of poverty level. They don’t have and can’t find a thousand bucks, so the Senate plan is about an eyelash better than just turning the funds down flat, as the representatives did.

These people are Scrooge reincarnated. We have Representative Ebenezer Icet. Representative Ebenezer Stream. Senator Ebenezer Schmitt. And a host of other Ebenezers.

Aw, Senator Schmitt, you didn’t give us the whole story. You spoke feelingly to the audience of AARP Dems about getting health care for those earning below fifty percent of the poverty level:

This is a real passion of mine longterm on health care reform because we cannot deny we have about 750,000 uninsured people in our state. And that is a real problem because their point of entry into the health care system is generally the emergency room, which is the most inefficient way to deliver health care. It costs about ten times as much as it does to go to a primary care hysician. So the focus of the bill was to say that we’re gonna use the dollars that the hospitals received for that unreimbursed care … from the federal government. So we’re using those dollars–and the hospitals are on board with doing this–to use those dollars to plug those folks into insurance so that we can start focusing on preventive treatment, wellness, those types of things for people who really need it. So I’m proud of that. And hopefully the House will …. [Applause]

But when you spoke of plugging those folks into insurance, what you neglected to add was “well, sort of.” People making less than fifty percent of the poverty level can get Medicaid IF they can scrounge up a thousand dollars a year for a “health savings account” and IF they meet a laundry list of eligibility requirements that will eliminate some of them and that will require a federal waiver for the program. Oh, and that’s IF in any given year, the legislature chooses to appropriate the funds.

And IF hell freezes over?

Tsk. I do jump towards being harsh, don’t I? Perhaps the bill you’re co-sponsoring makes sense to you, Senator, but consider, in contrast, Governor Nixon’s proposal. He is asking that people under fifty percent of the poverty level be included in Medicaid, using the additional funds from the Hospital Association and the federal funds that money would draw down. Simple.

The plan outlined in SB 306 is Rube Goldberg-ian.  

It sets up a new bureaucracy, which will increase costs. As a recent Post-Dispatch editorial points out:

A peer-reviewed study published last June in the journal Health Affairs concluded that switching Medicaid enrollees to private insurance would increase costs by 26 percent – an average of nearly $1,500 per person.

Oh wait, I have a brainstorm. Why not go with Medicaid, save the fifteen hundred per person and spare the churchmice from coming up with a thousand apiece? And I’m not even suggesting that you put that extra $500 into insuring a few more people.

Another problem with the Senate plan is that it requires recipients to use HMOs, despite the fact that many of them live in rural areas that are not served by HMOs (but would be served by Medicaid).

And none of this labyrinthine law is necessary.

My question is “Why?” If you really want to help poor people get health care, why set up unnecessary hurdles and why ask people who earn, well, almost enough money to feed themselves and rent a roof to find another thousand bucks somewhere?

I have to say that I’m in danger of becoming cynical about Republican motives when it comes to helping the poorest among us get health care.

Goldberg cartoon courtesy of Wikipedia