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Mo. House Budget Plan Skips Medicaid Expansion

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JEFFERSON CITY, Mo. (AP) — Following through on Republican opposition, the top budget writer for the Missouri House outlined a spending plan Thursday that omits Gov. Jay Nixon’s proposed Medicaid expansion.

The plan by Budget Committee Chairman Rick Stream also provides a smaller increase for public colleges and universities, early childhood initiatives and various other programs that the Democratic governor had proposed for the 2014 fiscal year.

Although Nixon presented a budget last month, the governor cannot compel legislators to stick by his plan when they actually file legislation. The budget bills Stream introduced Thursday intentionally left out Nixon’s most prominent proposal to accept about $900 million from the federal government to expand Medicaid health care coverage to nearly 260,000 lower-income adults who earn too much to qualify under current guidelines.

“It basically goes against our philosophy to expand government, and none of us campaigned on that,” said Stream, R-Kirkwood. “We don’t think it’s the right thing to do — especially to put more money, $1 billion basically, into a system that we think is broken and needs to be fixed,”

Nixon has been traveling the state promoting the Medicaid expansion as “the smart thing” and “the right thing to do” — both for the health of Missouri’s residents and in order for the state to get its fair share of federal tax dollars.

President Barack Obama’s health care law provides full federal funding for the first three years of the Medicaid expansion, then requires states to gradually pick up a share of the cost until states are paying 10 percent in 2020. Although Republican governors in some states have embraced the Medicaid expansion, other Republican governors have rejected it. Missouri’s Republican-led Legislature has cited fears that the federal government may not make good on its funding promises in the future.

Nixon’s budget plan assumed that the additional federal Medicaid money flowing into doctor’s offices, hospitals and other medical providers would generate $15.5 million in new state taxes next year. It also assumed that the expanded Medicaid program would save $31 million in state expenditures that otherwise would have been made on health and mental health services. Nixon proposed to spend that $46 million in new and saved revenues in other areas of the budget.

Because Stream axed the Medicaid expansion from the budget, he also had to come up with $46 million in other cuts or savings.

Stream’s plan would pare back Nixon’s proposed $34 million funding increase for public colleges and universities to $20 million. Nixon had proposed to distribute all of that money based on whether higher education institutions had met particular performance criteria, such as student retention and graduation rates.

“There was some question as to whether they really needed it,” Stream said.

Among other things, Streams’ budget plan cuts $5 million that Nixon had proposed for the state’s information technology budget, eliminates $2.3 million for an export initiative and also reduces Nixon’s proposed funding increases for preschool grants and cultural programs.

Stream’s budget plan also relies on carrying over about $15 million more than Nixon had proposed from the current year into the 2014 fiscal year, which starts July 1.

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