It begins with education.

Medicaid expansion has been facing stubborn opposition from the republican majority in the Missouri General Assembly. Yet, the Missouri Medicaid Coalition, an umbrella group, continues to organize in support of Medicaid expansion at the grassroots level across the state.

This evening in Warrensburg the Johnson County Democratic Club hosted Martha Stevens from the Missouri Rural Crisis Center for an informational presentation on Medicaid expansion and on behalf of organizing for its expansion.  

Martha Stevens of the Missouri Rural Crisis Center speaking on Medicaid expansion on behalf of the Missouri Medicaid Coalition.

According to the Missouri Rural Crisis Center, because Medicaid expansion in Missouri has been blocked in the General Assembly:

Two hospitals in Missouri have already closed, costing 1,800 rural employees their jobs, while other hospitals are being forced to cut back on services. [….]

Without Medicaid Expansion, Missouri hospitals would lose approximately $3.5 billion by the end of 2019.

68% of all rural physicians are older than age 50, and it’s harder to recruit physicians to rural areas because of the high risk of uncompensated care, due to a lack of Medicaid and insurance.

[….]

If Missouri hospitals continue to cut back or close, rural Missourians will be forced to travel larger and longer distances to have access to a hospital….

[….]

Again, who represents the rural areas of the state in the General Assembly? I thought so.

Previously:

HJR 40: let’s give voters an opportunity to put it in the Constitution (February 19, 2015)

Since the General Assembly won’t act on Medicaid expansion, right?

A joint resolution, introduced yesterday by Representative Jeremy Lafaver (D):

FIRST REGULAR SESSION

HOUSE JOINT RESOLUTION NO. 40 [pdf]

98TH GENERAL ASSEMBLY

INTRODUCED BY REPRESENTATIVE LAFAVER.

2224L.01I D. ADAM CRUMBLISS, Chief Clerk

JOINT RESOLUTION

Submitting to the qualified voters of Missouri an amendment repealing section 37 of article IV of the Constitution of Missouri, and adopting one new section in lieu thereof relating to the expansion of the MO HealthNet program.

Be it resolved by the House of Representatives, the Senate concurring therein:

That at the next general election to be held in the state of Missouri, on Tuesday next following the first Monday in November, 2016, or at a special election to be called by the governor for that purpose, there is hereby submitted to the qualified voters of this state, for adoption or rejection, the following amendment to article IV of the Constitution of the state of Missouri:

Section A. Section 37, article IV, Constitution of Missouri, is repealed and one new section adopted in lieu thereof, to be known as section 37, to read as follows:

Section 37. 1. The health and general welfare of the people are matters of primary public concern; and to secure them there shall be established a department of social services in charge of a director appointed by the governor, by and with the advice and consent of the senate, charged with promoting improved health and other social services to the citizens of the state as provided by law, and the general assembly may grant power with respect thereto to counties, cities or other political subdivisions of the state.

2. Effective January 1, 2017, individuals who meet the following qualifications shall be eligible for the alternative package of MO HealthNet benefits as set forth in subsection 3 of this section, subject to the other requirements of this section:

(1) Are age nineteen or older and under age sixty-five;

(2) Are not pregnant;

(3) Are not entitled to or enrolled for Medicare benefits under Part A or B of Title XVIII of the Social Security Act;

(4) Are not otherwise eligible for and enrolled for mandatory coverage under Missouri’s MO HealthNet program in accordance with 42 CFR Part 435, Subpart B; and

(5) Have household income that is at or below one hundred thirty-three percent of the federal poverty level for the applicable family size for the applicable year as converted to the MAGI equivalent net income standard, except the household income may be reduced by a dollar amount equivalent to five percent of the federal poverty level for the applicable family size as required under 42 U.S.C. Section 1396a(e)(14)(I)(i).

3. Except for those individuals who meet the definition of medically frail, the individuals eligible for MO HealthNet benefits in subsection 2 of this section shall only receive a package of alternative minimum benefits. The MO HealthNet division of the department of social services shall promulgate regulations to be effective January 1, 2017, that provide an alternative benefit package that complies with the requirements of federal law and subject to limitations as established in regulations of the MO HealthNet division.

4. Individuals eligible for coverage under subsection 2 of this section who meet the definition of medically frail shall receive all coverage they are eligible to receive under section 208.151, RSMo.

5. The MO HealthNet program shall not provide MO HealthNet coverage under subsections 3 and 4 of this section to a parent or other caretaker relative living with a dependent child unless the child is receiving benefits under the MO HealthNet program, the Children’s Health Insurance Program (CHIP) under 42 CFR Chapter IV, Subchapter D, or otherwise is enrolled in minimum essential coverage as defined in 42 CFR Section 435.4.

6. The department of social services shall establish a screening process in

conjunction with the department of mental health and department of health and senior  services for determining whether an individual is medically frail.

7. The department shall provide premium subsidy and other cost supports for individuals eligible for medical assistance under subsection 2 of this section to enroll in employer-provided health plans based on cost effective principles determined by the department.

8. As used in this section, the following terms shall mean:

(1) “Caretaker relative”, a relative of a dependent child by blood, adoption, or marriage with whom the child is living, who assumes primary responsibility for the child’s care, which may, but is not required to, be indicated by claiming the child as a tax dependent for federal income tax purposes, and who is one of the following:

(a) The child’s father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece;

(b) The spouse of such parent or relative, even after the marriage is terminated by death or divorce;

(2) “Child” or “children”, a person or persons who are under nineteen years of age;

(3) “Department”, the Missouri department of social services, or a division or unit within the department as designated by the department’s director;

(4) “MAGI”, the individual’s modified adjusted gross income as defined in Section 36B(d)(2) of the Internal Revenue Code of 1986, as amended, and:

(a) Any foreign earned income or housing costs;

(b) Tax-exempt interest received or accrued by the individual; and

(c) Tax-exempt Social Security income;

(5) “MAGI equivalent net income standard”, an income eligibility threshold based on modified adjusted gross income that is not less than the income eligibility levels that were in effect prior to the enactment of Public Law 111-148 and Public Law 111-152;

(6) “Medically frail”, individuals with:

(a) Serious emotional disturbances;

(b) Disabling mental disorders;

(c) Substance use disorders who are at high risk for significant medical and social costs;

(d) Serious and complex medical conditions; or

(e) Physical or mental disabilities that significantly impair their ability to perform one or more activities of daily living.

[emphasis in original]

The General Assembly still has to approve placing this on the ballot. Maybe it would have a chance if there was something in there about guns, a Canadian tar sand pipeline, or a bit of posturing on immigration.

Previously:

On improving practical utility (February 17, 2015)

HCR 17: What would Sarah Palin (r) think? (February 18, 2015)

On January 2nd Senator Ed Emery (r) made a request of constituents about their wish(es) for the new session of the General Assembly:

Ed Emery ‏@edemery

If you could choose one piece of legislation for the Missouri Legislature to pass this year, what would it be? Leave a comment below. 11:30 AM – 2 Jan 2015

Much social media hilarity ensued:

Jake McDaniel ‏@jacobmcdan

@edemery Medicaid expansion 11:55 AM – 2 Jan 2015

That’s never going to happen. Especially if Senator Emery (r) has a say.

Hal Higdon ‏@HalHigdon

@edemery Badly needed equity funding for community colleges. Thanks 12:50 PM – 2 Jan 2015

Probably not going to happen.

Andrew Shaughnessy ‏@andrewshag

@edemery Missouri Nondiscrimination Act (MONA) 12:50 PM – 2 Jan 2015

Probably not going to happen.

David Johns ‏@davidjohns11

Repeal of the death penalty. [….] 12:54 PM – 2 Jan 2015

Definitely not going to happen.

John Jackson ‏@JumpinJezebel

@edemery @eyokley Ethics, followed by a manditory redistricting committee for 2020 of neutral members with charges to encourage competition. 2:23 PM – 2 Jan 2015

Definitely not going to happen.

Darrell Boyer ‏@MrDBoyer

@edemery I would like to see only law makers that have taught to create legislation impacting education. 8:18 PM – 2 Jan 2015

That’s never going to happen.

rebecca l. gorley ‏@rebeccalgorley

@edemery Medicaid expansion for 300,000 Missourians! #MOMedicaid #moleg 9:38 AM – 5 Jan 2015

Brian K ‏@Briligerent

@edemery Missouri Medicaid Expansion. Thank you for asking.10:14 AM – 5 Jan 2015

Glic ‏@Glic

@edemery #MOmedicaid expansion 10:19 AM – 5 Jan 2015

Alison Dreith ‏@alidreith

Medicaid expansion! @edemery #moleg #MOMedicaid 10:21 AM – 5 Jan 2015

Seth Bundy ‏@SethBundyMO

@edemery – closing the coverage gap, strengthening rural hospitals & bringing our tax dollars home through #Medicaid expansion & reform 10:23 AM – 5 Jan 2015

Jillian Adams ‏@JillianRAdams

This Missourian wants #MOmedicaid expansion, @edemery. #moleg 10:55 AM – 5 Jan 2015

Jennifer Bernstein ‏@JenKBernstein

@edemery Please pass Medicaid Expansion this session. Lives are on the line. 11:09 AM – 5 Jan 2015

He did ask.

Sadly, Senator Emery (r) pre-filed the following bills before he asked that question of his constituents:

SB 27 – Emery – Modifies provisions relating to elementary and secondary education

SB 28 – Emery – Requires the State Board of Education to develop a simplified annual school report card for each school attendance center using a letter grade of A to F

SB 29 – Emery – Modifies provisions relating to the employment of teachers in school districts

SB 64 – Emery – Requires the State Board of Education to classify the school districts as either unaccredited, provisionally accredited, accredited, or accredited with distinction

SB 65 – Emery – Creates the Equal Opportunity Scholarship Program to grant scholarships to students from unaccredited school districts for certain educational costs

SB 66 – Emery – Requires the Senate to try all impeachments except for the impeachment of the Governor, which shall be tried by the Chief Justice of the Missouri Supreme Court

SB 85 – Emery – Authorizes certain social workers and licensed professional counselors to provide behavioral health services in the MO HealthNet program

SB 86 – Emery – Allows a court to place a person on electronic monitoring with victim notification if a person has been charged with, or found guilty of, violating an order of protection

SB 87 – Emery – Requires persons who submit petitions for political subdivision audits to reside or own property in the subdivision and allows for signatures to be rescinded

SB 92 – Emery – Modifies bond requirements for certain county offices

SB 93 – Emery – Creates the Campus Free Expression Act to protect free expression on the campuses of public institutions of higher education

SB 94 – Emery – Modifies retirement benefits for newly elected members of the General Assembly and statewide elected officials

SB 98 – Emery – Exempts capital gains on gold and silver from income tax and authorizes the storage of gold and silver in private repositories

SJR 4 – Emery – Requires the Senate, beginning January 1, 2017, to try all impeachments except for the impeachment of the Governor, which shall be tried by the Chief Justice of the Missouri Supreme Court

Nope, nothing about expanding Medicaid in there.

So there. A bill, prefiled yesterday for the 2015 session in the Senate by newly elected right wingnut Bob Onder (r):

SB 51 Relating to prohibiting governments from compelling individuals to purchase health insurance and participate in health care systems

Sponsor: Onder

LR Number: 0574S.01I Fiscal Note not available

Committee:

Last Action: 12/1/2014 – Prefiled

[….]

Current Bill Summary

SB 51 – This act modifies what is commonly known as the Health Care Freedom Act which was approved by the Missouri voters in 2010. The act restates Missouri’s public policy of allowing its citizens the freedom to choose or decline to choose any mode of securing health care services without facing a penalty and provides that it is against Missouri public policy to implement or operate a health insurance exchange in Missouri. The act also posits several findings of fact of how the Patient Protection and Affordable Care Act and implementing a state-based exchange would subject Missouri citizens and employers to penalties. The act further provides that if a health insurance issuer operating in Missouri accepts any remuneration that may result in the imposition of penalties contrary to Missouri’s public policy, then the Director of Insurance shall suspend the issuer’s license to transact business in Missouri. The suspension will stay in place until the issuer represents that it has returned the remuneration to its source and will decline any such future remuneration. The act further imposes a duty upon the Attorney General to seek injunctive relief and other appropriate remedies whenever the public policy set forth in the act is being violated.

This act is identical to SB 546 (2014) and SB 473 (2013).

[….]

You were expecting anything different?

Previously:

You were expecting anything different? (December 1, 2014)

It’ll be a cold day in the General Assembly… (December 1, 2014)

Now we’re just waiting on the Agenda 21, Sharia law and nullification bills (December 1, 2014)

Yard signs have been out in yards in west central Missouri:

“I Support Medicaid Expansion”

That would be almost everyone except for the right wingnut majority in the Missouri General Assembly.

Here’s why there’s no Medicaid expansion for Missouri

May 15

By BARBARA SHELLY

The Kansas City Star

Missouri had a path to Medicaid expansion this year

The governor and the state’s leading business groups wanted it. All of the legislature’s Democrats and a growing number of Republicans supported it. Retired U.S. Sen. Kit Bond, a Republican, lobbied tirelessly for it.

Barring an end-of-session miracle before 6 p.m. Friday, however, Missouri will not expand Medicaid eligibility this year. Nearly 300,000 working adults will spend another year locked out of access to affordable health care because their income level places them in a coverage gap.

Standing in the path of Medicaid expansion are a few self-righteous men in the Missouri Senate….

Letters to the Editor

May 07, 2014 12:00 am

Failing to expand Medicaid damages our public health systems

….When I arrived as the director of Health and Hospitals around 1990, not one nickel of our city dollars had ever been matched with federal Medicaid dollars. Over that 25-year period from 1965 to 1990, the state of Missouri left millions of dollars on the table because our local and state politicians either did not read or simply did not act on Medicaid law. The cash value of this inaction is calculable. However, more importantly, taking a pass on this opportunity has cost some of our fellow citizens their lives by damaging our community’s ability to develop more robust public health and health care systems that better meets the needs of our population.

Our state politicians are once again failing to act on national legislation (in this case the Affordable Care Act), which would bring federal Medicaid dollars to our state for both the urban and rural poor. This time around, no state match is needed for the first three years because the expansion of Medicaid to those at 138 percent of poverty level will simply bring our tax dollars back home to Missouri.

Failing to fully expand Medicaid will cause some hospitals and clinics to curtail services, and some will close. This time around the entire state will be affected. Some Missourians will lose their lives, and we will damage our public health and medical care systems.

Dr. William L. Kincaid  •  St. Louis

Former director of Health and Hospitals, city of St. Louis

“….Failing to fully expand Medicaid will cause some hospitals and clinics to curtail services, and some will close. This time around the entire state will be affected. Some Missourians will lose their lives, and we will damage our public health and medical care systems.”

A sign of our current time, for sure.

This morning, in Jefferson City, on the way from the state capitol building.

“I Support Medicaid Expansion”

Today TPM reports that former Florida govenor Charlie Crist, who is running against Medicare-fraud perpetrator Governor Rick Scott to regain the governorship of that state, spoke some home truths to MSNBC’s Chuck Todd about the consequences of failing to take advantage of Obamacare’s Medicaid expansion provisions:

About a million of my fellow Floridians are not getting health care today, and I am told by friends SEIU (sic), that means six people in Florida die every day as a result of that. Every day,” Crist said.

[…]

It’s not hard to figure that out. It’s common sense. Look at it. If people are sick, and they aren’t getting health care, what happens? They usually get sicker,” Crist said. “Or they die. I mean, those are just the facts, Chuck. That’s what happens. In addition to it, it’s economically stupid. As a result, we’re not getting $51 billion over the next 10 years for the health care institutions in Florida. So the people get better health care, so that kids don’t get sick, that we take care of people. That’s what public servants are supposed to do. That’s why I’m running against Rick Scott, because he’s not a good servant.”

The claim that six people will die daily if Medicaid is not expanded likely comes, as TPM noted, from a joint Harvard University and  City University of New York report published last month. You can quibble about the actual number – it’s an estimate after all – but the point is that people will die while ideologues posture and babble incoherently about “government dependency” and the “unsustainable costs” involved in directing federal tax dollars back to the home state.

What does this factoid mean for Missouri? Approximately 2190 yearly deaths that could have been prevented.

But we can take it farther. Most Republicans oppose expanding Medicaid and most Democrats support it. In the Missouri Senate, 24 members are Republicans; in the House, 106 representatives are Republicans, making a total of 130 Republicans running things in Jefferson City. We can do some rough math and conclude that if Medicaid is not expanded, each Republican in the legislature will be responsible for the death of 16.8 Missourians per year, give or take a few.

A crude, tongue-in-cheek exercise perhaps? But no matter, it’s a sure bet that there will be deaths as a result of the action – or rather inaction – of Missouri Republicans. And no matter how you count our dead fellow Missourians, they’ll amount to quite rack of trophies for each Missouri GOPer.

First sentence amended for clarity and a link was added.

Previously:

Opening of the 2014 legislative session – photos (January 8, 2014)

House Democratic Caucus press conference – Jefferson City – January 8, 2014 (January 8, 2014)

House Democratic Caucus press conference – Q and A – Jefferson City – January 8, 2014 (January 9, 2014)

House Republican Caucus press conference – Jefferson City – January 8, 2014 (January 10, 2014)

“…Putting a billion dollar band-aid on a broken system does not improve health care outcomes. And, in fact, uh, two major pieces of information came out this week  – the State of Delaware, uh, did a Medicaid expansion, completed Medicaid expansion last year. They were handed a bill this year, uh, at the very beginning of this year that said they had to come up with an initial twenty-five million dollars. Secondarily, there was a major study that came out of Oregon that said that Medicaid expansion does not pro vue, not improve access to health care or health care costs and actually visits to the E R have increased. So, before we just dump money into the same old, uh, broken system let’s look at reforming it and making it better so more Missourians could benefit…”

Here’s what the Oregon Medicaid study really said

By Ezra Klein

May 2, 2013 at 3:11 pm

….The initial batch of results was released in August 2012. The data covered the first year of the Medicaid expansion and found that the folks on Medicaid were getting more care, reporting better health (both physical and mental), and seeing fewer financial problems than the people who weren’t on Medicaid.

The second set of results was released Wednesday. The data now covers two years and, importantly, includes clinical measures of health rather than relying on the reports of the study participants. These results are more mixed, but also more telling.

Here’s what we can say with certainty: Medicaid works as health insurance….

[….]

….There’s voluminous evidence that managing diabetes and treating depression and being able to go to the doctor improves health. You have to be willing to throw quite a lot of existing theory and evidence out the window to believe that stuff won’t pay off down the road….

Medicaid calculation change could cost Delaware $25 million

Jan. 2, 2014

[….]

“….There’s nothing wrong with what the federal government did,” Landgraf said. “It’s just that it was terribly unfair that they gave us preliminary numbers that we’re basing our budgets on and all of a sudden there’s a dramatic shift in that number.”

Medicaid, which is jointly funded by the state and federal governments, provides health insurance for the poor and disabled. More than 215,000 are enrolled in Delaware, a number that’s growing due to a slow and imbalanced economic recovery….

….By 2020, the federal government will pay 90 percent of the health care costs for new beneficiaries and higher reimbursements for about 40,000 adults making up to 100 percent of the poverty level already receiving Medicaid. Stephen Groff, director of the state’s Medicaid program, said the calculations indicate that the expansion under Obamacare will still financially benefit the state in the long run….

[….]

On Wednesday afternoon the House Republican Caucus held a press conference in the House Lounge after the opening of the legislative session in Jefferson City. Speaker Timothy Jones (r) took questions from the media after his prepared remarks.

Speaker Timothy Jones (r) taking questions from the media at a press conference

in the House Lounge after the end of the first day of session on January 8, 2014.

This is the first half of the question and answer session.

The video:

The transcript:

Speaker Timothy Jones (r): I have many of my caucus members here who can get more specific on some of these issues if you’d like to speak to any of them or address your questions to them. Uh, in addition, uh, the issue that will, of course, be here at the beginning of session, all the way through and at the end, the budget, our House Budget chairman, Rick Stream, is here to answer those questions. So, happy to take any questions.

Question: Mister Speaker your, your, your comments on the speech on, on school choice, does that mean that [inaudible] here is essentially dead in the House?

Speaker Timothy Jones (r): Uh, I’m not sure, I’m not sure I understand the question, premise of the question.

Question: You’re, are you saying that, that you opposed to giving school districts in St. Louis County and Kansas City area the right to refuse kids transferred out of unaccredited schools [inaudible]?

Speaker Timothy Jones (r): As I’ve said, uh, I am hopeful that all students continue to have the option for a good education. You know, I think we need to remember where this law came from. Uh, this law was passed with great foresight by a Democratically controlled General Assembly many, many years ago, and I believe, signed into law by a Democratic governor. I applaud their foresight. They, they, this was, this was an option that, that folks hoped would never happen , but in the case, if we had failing schools with, with no, with no end in sight for the status quo that this law would take effect. And I would say that it is a large bipartisan coalition that is very excited that for the first time in nearly forty years kids have an opportunity to escape the failing districts that they have, that they have been consigned to because of their zip codes. So, I’m willing to consider, uh, any legislation that will allow school districts to operate in a better efficient manner and to help them, uh, deal with the new, with the new law that’s been affirmed by our Supreme Court. But I want to make sure we protect the students’ choice, the students’ opportunities to finally have the opportunity for good education.

Question: What, what do you say to those school districts in St. Louis County that have been arguing [inaudible] that they don’t have adequate resources, facilities, and enough teachers to handle the potential numbers that’d be coming in from Normandy School District?

Speaker Timothy Jones (r): You know, it’s interesting that you bring up that question. I actually was speaking with uh, former, uh, well, I, I actually don’t know his current status, but the superintendent of the Ferguson Florisant School District, Dr. Art McCoy. And I, I had a meeting about a month or two ago and he said we have the capacity, and any superintendent who wants to try and serve these children can absolutely do so. I know that shortly after Dr. McCoy accepting new students into his district he was, he was placed on some form of, uh, of, of leave. And I don’t know what his current status is. So, it seems that the education establishment continues to want t punish those who want to change the status quo and not work with us to change these districts that have been failing for so long. So, I, I would, I would take the words of Dr. McCoy to heart. I think if, eh, if, uh, if, if a school district wants to help the children in these failing districts they can do so. And I’ve spoken to many superintendents who have said, we just need some parameters, we need some tweaking, but, uh, I think to, to completely end the opportunity for choice is huge mistake for kids of our state.

Question: Is making some changes to the transfer law a priority for you this session?

Speaker Timothy Jones (r): You know, I will be happy to, to, uh, you know, education is a priority for me. Helping kids succeed is a priority for me and I think it’s a priority for our caucus. So I will be happy to consider, uh, any piece of legislation that will assist in that regard.

Question: Is it broadening choice? Is that still on your agenda? Because right now you talk about choice, but it’s only for students that are in the failing districts. Are you gonna push again for something, tax credits , vouchers, however you want to put it, to, to broaden out that choice?

Speaker Timothy Jones (r): You know, I, I won’t be filing any particular legislation in that regard but I’ll, I’ll wait to see what my caucus members file and what people want us to move forward on.

Question: Do you think the current law. If no changes are made, can work as it is now? Or do you see this as a law that needs some clarification to it?

Speaker Timothy Jones (r): Well, this law has been in effect for several months now and the world has not come to an end in the world of public education. As I said, I think if superintendents and, and local school leaders want to make this law work I think they can. If they feel they need some assistance from the legislature I invite them to come up with a proposal, uh, uh, to, to make it better.

Question: And are you concerned at all there’s those urban districts that are saying that they could go bankrupt if nothing’s done to fix this transfer situation?

Speaker Timothy Jones (r): They have gone bankrupt or they could go [crosstalk], they could go bankrupt?

Question: They could go bankrupt.

Speaker Timothy Jones (r): Well, I think we’ll have to wait and time, time, time will see exactly what changes we need to make. As I said, I’m more than happy to consider, uh, any proposals that are put before us to make sure that kids are the number one priority here.

Question: Income tax cuts, uh, how are they going to be different than last year?

Speaker Timothy Jones (r): Well, I know those bills, uh, have been drafted and will, and will soon be filed. I, I think there’s going to be, uh, probably some bills that are filed that may be very similar to the ones last year. I think you’re also gonna see some new proposals that focus on families, uh, middle, middle income families, uh, on small businesses. So I think you’re gonna, because, because we don’t know if the Governor is interested in providing tax relief for any Missourian I think you’re gonna see a number of options being put on the table. So the Governor can pick and choose, uh, as to whether he wants to provide tax relief for anyone.

Question: Have you talked with the Governor about this?

Speaker Timothy Jones (r): Uh, he, he, uh, he and I have not spoken on this subject.

Question: Do you plan to?

Speaker Timothy Jones (r): Uh, my door is open to the Governor, uh, any day, any time. I’m, I’m actually free this afternoon if he’d like to stop by and talk about tax relief.

Question: Subject of education funding, the Governor and the House Democrats have both called for more funding for the foundation formula. I believe you’ve used the term, appropriate funding for public education. What do you consider appropriate?

Speaker Timothy Jones (r): Well, you know, the House has always been committed to more funding for education. Every single year I’ve been here the Missouri House, uh, has, has appropriated more money for education, except during the, the incredibly difficult budget years where we had to cut nearly a billion dollars out of the budget. And then we held education harmless. So, that’s been a priority for us. The Governor has been the one that’s used the most severe budget axe on the education system. He has time and again cut millions of dollars out of higher education. He’s withheld transportation dollars from K through twelve. Uh, you know, the, the Governor has used our education dollars and our budget in general, uh, to, to whatever his whims may be. Uh, I, I, I know you’re gonna see some significant legislation this year to prevent the Governor from using the budget, uh, as his own personal slush fund, to follow the constitution and to follow the appropriations, uh, as he signs in the bills that the General Assembly passes. So, last year the Missouri House, I believe, appropriated more money in a single year than ever before to K through twelve education. We’ll continue to make that priority again.

Speaker Timothy Jones (r).

Question: Mister Speaker [crosstalk].

Question: Will you expect any leadership support for any type of, say, alternate Medicaid proposal that would include both reforms and somewhat of an, of an increase or expansion of the, basically, what Representative Barnes has been working on?

Speaker Timothy Jones (r): You know, the Missouri House had several bills last year that, that moved, uh, moved forward, um, and involved transforming Medicare, uh, Medicaid and reforming Medicaid. Uh, there’s also been some stand alone reform bills. Uh, as we saw last year the Missouri Senate, um, was simply not interested in the topic. And we need a partner in this if we’re gonna move forward, uh, in, in actually getting the issue across the finish line. In the mean time I’m, I will be more than happy to move legislation forward, uh, along the same lines that we did last year, transforming Medicaid, making it better. We have a broken system. Putting a billion dollar band-aid on a broken system does not improve health care outcomes. And, in fact, uh, two major pieces of information came out this week  – the State of Delaware, uh, did a Medicaid expansion, completed Medicaid expansion last year. They were handed a bill this year, uh, at the very beginning of this year that said they had to come up with an initial twenty-five million dollars. Secondarily, there was a major study that came out of Oregon that said that Medicaid expansion does not pro vue, not improve access to health care or health care costs and actually visits to the E R have increased. So, before we just dump money into the same old, uh, broken system let’s look at reforming it and making it better so more Missourians could benefit.