When it comes to Medicaid, Missouri’s GOP is animated by two forces: spite and the sort of rigid ideological simplicity that we commonly label stupidity. What this means for Missourians is that many are going to be royally shafted.

The spite has been evident for all to see for a long time, most notably when our GOP lawmakers refused the federal funds provided by Obamacare to extend Medicaid eligibility. Who denies his or her state its share of the federal pie, especially when that pie is going to help hundreds of thousands of poor Missourians obtain essential health care for the first time? Could it be bitter, hyper-partaisan losers who are determined to defy the will of the electorate and destroy the legacy of a president who actually had the temerity to keep his campaign promises and reform a badly broken health care delivery system?

But it could also be the kind of mean-minded ideologues who think that if you extend a helping hand to those who need it, you’re just enabling worthless social parasites – and God forbid that it should be government (by and for the people, incidentally) that extends that helping hand. Unfortunately, it’s GOPers of this persuasion who claim that they have to “reform” the system in Missouri before they can heed the pleas from all and sundry to just take the Obamacare Medicaid expansion funds.

The nature of the reforms envisioned by our Missouri Republicans aren’t, however, likely to meet the requirements for federal funds which stipulate that access be expanded – some past proposals have actually narrowed eligibility requirements. And it is at this juncture where “the stupid” enters the picture. Just how stupid? Take a look at Kansas where “reforms” of the Medicaid system mirror some of those hinted at by our Missouri Republicans.

As you might expect, given the conservative antipathy to letting government work for anyone other than the 1%, most of the reforms proposed by our state GOP pols involve privatizing Medicaid. Which is just what Kansas has done to a greater extent than any other state, having, as Steve Vockrodt of the Pitch News reports, “cannonballed into the deep end by shifting all of its Medicaid management to three private companies.” So what’s the goal?:

Gov. Sam Brownback has said the wholesale privatization of Medicaid under KanCare was meant to save $1 billion over five years. He also promised that the move wouldn’t sacrifice Kansans’ level of care, and the number of people on Medicaid’s waiting list would be reduced.

But the only way for the three managed-care organizations to realize cost savings on clients with permanent physical disabilities [ . . .] is by cutting Medicaid services. …

Sounds like the goal is savings and qualilty care be dammed. It’s early days yet for the Kansas experiment, but, it’s not looking too good – over 5,000 people on a developmental-disabilities waiting list and a logjam of cases contesting denial of services. Nor is it even clear that crippling state services in this way will result in any real savings.

Interestingly, other states have already backed away from privatized Medicaid. Vockrodt cites the case of Connecticut:

In 2012, Connecticut dumped the insurance companies that were managing its Medicaid program to the tune of more than $800 million a year. A USA Today report said those insurance companies were “erecting barriers to care” while plowing the state’s Medicaid money into administrative salaries and profits.

“Erecting barriers to care” sounds a lot like what Vockrodt describes in Kansas. It’s possible that some combination of managed care and traditional Medicaid could deliver savings without compromising quality of care, but I’m not sure I’m willing to trust folks who don’t think government has a role to play in shaping health care delivery – that is to say, our Missouri Republicans – to come up with the right mix.

When I think about how our state-level Republicans have tried to sabotage Obamacare, I get furious. When I hear them talk about Medicaid reform, however, I just get very frightened. A major precept of medicine is “first do no harm.” I’d suggest that it would be a good proviso for politicians also except that I’ve seen too many lately who are too blinded by either ideological rigidity or just general intellectual incapacity to be able to evaluate the real world in a way that would allow them to make the right choices. There’s a reason, after all, that red states aren’t doing so well right now.

Late in May I wrote about how Jan Brewer, the GOP Tea Party governor of Arizona, saw the light and went to bat for the Obamacare Medicaid expansion in her state, fighting tooth-and-nail against her once simpatico Tea Party legislature. Today I learned that she managed to prevail in her fight. Shows what all-out commitment will do – and maybe suggests just why our cautious, low-key Democratic governor isn’t able to achieve similar goals.

Of course, it looks like the GOP-dominated legislature may be having second thoughts about expanding access to Medicaid – or perhaps they’re just worried that blowback from such a wanton rejection of measures that would improve the quality of life for thousands of Missourians might hurt them in the long run, particularly when it becomes clear to Missourians just how costly the GOP’s mindless opposition to anything Obamacare will be for the state. It seems that both houses have now appointed panels that will prepare Medicaid “reform” legislation for the 2014 session.

Sadly, I fear that the reforms these ALEC-fearing jokers might have in mind might be almost as bad as going without. Last year, some GOP lawmakers supported changes that would have moved Medicaid into private, managed care systems – which have proven problematic in many states where they have been tried (see here, here and here) – and it’s likely that they will continue on down the path toward what State Rep. Jay Barnes (R-114) speculated could be “the most market-based system in the entire country.”

Of course, many healthcare economists are unequivocal that the biggest problem contributing to raising health care costs is simply our private delivery system with its perverse incentives and cumbersome administrative costs. Nor do we always get good value for the money spent. Oh well – if it gets more people into the system, I guess we can afford a little degradation in the service – it’s just the usual cost of doing business with ideologues and corporatists.