Medicaid proposal sparks heated exchange in Senate

JEFFERSON CITY – Two Republicans dueled over Medicaid this morning, as the Senate's foremost opponent of expansion accused another senator of taking the "easy" route in rolling out a plan that would increase coverage.

Sen. Ryan Silvey, R-Kansas City, has a proposal that would provide insurance for adults earning up to 138 percent of the federal poverty line but would also make extensive changes to assistance programs for the poor. His proposal follows a News-Leader op-ed last week where he said Republicans must offer more than just a "no" vote on Medicaid expansion.

On the floor, Sen. John Lamping, R-St. Louis County, said Republican lines such as "pragmatism" and "problem-solving" operate as code words that allow conservatives to support policies that lead to more government and more debt.

"It's time to take the hard stand and say no. You're taking the pragmatic stand, the easy stand," Lamping said to Silvey.

Silvey fired back as senators sat in rapt attention, listening to the unusually testy exchange, which lasted about 20 minutes.

"It's easy? It's easy for me to stand up in the Republican party with people like yourself who would rather talk about sound bites and Obamacare than the actual problems Obamacare has created? It's easier for me to do that than it is to stand with you and never get into the issue?" Silvey said.

Lamping, who is not running for reelection, replied that maybe it is easier for Silvey because of his district. Silvey won his Senate seat in 2012 in a close race beating his Democratic opponent 52 percent to 48 percent.

At that point, Romine asked that the Senate move on from his bill, ending the exchange. Sen. Ron Richard, the majority floor leader, quickly moved to recess the Senate until later in the afternoon.

Silvey's proposal, which has not yet been introduced as legislation, would cover individuals up to 100 percent of the federal poverty level through a managed care plan. Individuals between 100 percent and 138 percent would be enrolled in a health care exchange plan — similar to what is found in a bill sponsored by Rep. Noel Torpey, R-Independence.

Silvey's plan is more expansive than Torpey's in changing the state's welfare programs. Under Silvey's plan, Electronic Benefit Transfer (food stamp) cards would have a photographic ID. Establishments would be required to match the photograph to the purchaser.

In addition, Silvey's plan imposes a work requirement on food stamp recipients. Individuals would have to offer proof of work status or show that they are seeking work or further education.

Food stamp recipients would be required to report any instances in which their monthly gross income exceed the maximum allowed for their household size and would have to undergo a recertification process each year.

This morning, Silvey, who started the exchange with Lamping, began by asking Lamping if they could at least agree that the Affordable Care Act has created problems that senators have a responsibility to solve, such as the coverage gap that exists for individuals. In Missouri, the gap exists for individuals between 19 percent (the state's current Medicaid eligibility threshold) and 138 percent of the federal poverty line.

Lamping said that before the Affordable Care Act there were no subsidies for anyone over 19 percent of the federal poverty level.

"I don't see a problem with there being a gap between (19 percent) and 138 percent," Lamping said.

Silvey continued by probing Lamping's opposition to Medicaid expansion. In addition to opposing expansion, Lamping said earlier he also opposes a Republican reform bill without expansion because the changes open the door to expansion. As the exchange continued, tension between the two senators mounted.

"Your faith in government is not my faith in government," Lamping told Silvey.

Silvey replied: "It's not my faith in government, it's my faith in this body to make the tough decisions, to solve problems that (the federal) government created."

Shana Marchio, spokeswoman for Kit Bond Strategies — former U.S. Sen. Kit Bond's consulting firm — provided reporters with an extensive outline of Silvey's plan. Bond, a Republican, has been hired by the Missouri Chamber of Commerce to advocate for Medicaid expansion.

"Senator Bond believes Senator Silvey's efforts will accomplish the entitlement reform conservatives in Jefferson City have long fought for and will continue to support his efforts," Marchio wrote in an email.

Last week in a News-Leader op-ed, Silvey said Republicans need to do more than just stand against Medicaid expansion.

"Too many times politicians take the easy way out by trying to govern by sound bite rather than invest in understanding the issues and communicating a way forward. After all, it's much easier to rally the masses with a bumper sticker than a policy paper," Silvey wrote.

Silvey wrote that cuts to rural hospitals might be avoided by reforming the current Medicaid system, using federal money to cover new people in creative ways that require participation from recipients and achieving financial savings through new mechanisms that would protect taxpayers.

Implicating Torpey's proposal, Silvey wrote that none of the current plans put forward achieved all those things.

Silvey has acknowledged there's only "a slim possibility" his proposal will pass this year and that the discussion may carry over into next year. But he nonetheless has been meeting with individual senators.

Although a House committee has been working on Torpey's bill, Silvey's plan is the first serious Republican effort at expansion in the Senate. A handful of Republican senators, most prominently Lamping, have vowed to block expansion.

The Associated Press contributed to this report.