Missouri Governor loses Medicaid expansion fight, wins with First Steps funding

By Mike Sherry, HCF guest blogger and KHI News Service journalist

Shortly after winning a second term in November, Missouri Gov. Jay Nixon again hit the campaign trail.

As he crisscrossed the state this spring, it seemed as if he was imploring each and every one of his million-plus election supporters to join the crusade to expand Medicaid, as envisioned by the federal Affordable Care Act.

In the end, though, the only number that mattered was 134.

That’s the total number of Republicans serving in both chambers of the General Assembly. They outnumber Nixon and his fellow Democrats by a margin of more than 2-1.

Going over the heads of elected officials is a time-honored political tactic. The aim, of course, is to pressure lawmakers into switching positions by whipping up a groundswell among “the people.”

But Nixon seemed destined to play the Big Bad Wolf on the Medicaid issue. He could huff and puff, but the odds were long that he could blow down the brick house of opposition erected by the GOP majority in the General Assembly.

It’s hardly surprising that Nixon failed to generate a pro-expansion tsunami. Many Missourians, it seems, hate the health reform law.

Twice in the past three years, Republicans have placed anti-Obamacare measures on the statewide ballot in Missouri.

Voters overwhelming approved both propositions, including one in November that prohibits the governor or any state agency from implementing health insurance exchanges without legislative authorization or voter approval.

Nixon is a veteran politician who has, at times, drawn criticism from supporters for being too cautious. So, the governor surely had good policy and political reasons for undertaking such an uphill battle so forcefully.

Whatever the reasons, Nixon refuses to surrender.

Last week, he released a cheerleading letter he sent to members of the coalition that pushed the Medicaid expansion.

Nixon had signaled only a few weeks before that he was not going to retreat and lick his wounds from the Medicaid loss.

In the waning days of the session, Nixon took to the stump yet again.

This time he was urging constituents to tell Republicans in the General Assembly how wrong it was to threaten funding for First Steps, a program that serves children with intellectual and developmental disabilities.

One of his stops was in Kansas City, Mo., and I asked him why he thought his First Steps campaign would turn out any differently than the Medicaid fight.

He argued that First Steps had shown results and enjoyed strong bipartisan support throughout its 20-year history.

“We need to make sure it stays a high priority,” he said. “That’s not to say that Medicaid expansion shouldn’t have gotten done, but this discreet task to be done here, can get done, (and) should get done.”

In the end, lawmakers sent him a couple vehicles that preserved First Steps funding.

Don’t forget: The Big Bad Wolf blew down two houses before the third proved too strong.


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HCF's Local Health Buzz Blog aims to discuss health and health policy issues that impact the uninsured and underserved in our service area. To submit a blog, please contact HCF Communications Officers, Jennifer Sykes, at jsykes@hcfgkc.org.



About Bridget's Blog

Bridget McCandless

Bridget McCandless, MD, MBA, FACP, HCF President/CEO

Bridget McCandless is the President/CEO of the Health Care Foundation of Greater Kansas City and is a Board Certified Internal Medicine Specialist with an interest in chronic disease management and poverty medicine. She shares her thoughts and perspectives on health and policy issues that impact the health of the community as a whole.

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