Gov. Jay Nixon

Arguing that expanding Medicaid is “the right thing and the smart thing to do,” Gov. Jay Nixon made the case Monday for growing the federal program in Missouri.

Nixon addressed a group of about 60 people that included business leaders, members of law enforcement and health care professionals at Mercy Hospital Washington after helping dedicate a rail transfer facility earlier in the day at a Washington industrial park.

Nixon has been traveling throughout the state over the past few months lobbying for expansion of the program to 138 percent of the federal poverty level which would extend coverage to about another 300,000 Missourians who he described as “the working poor.”

“These are the folks who make $9, $10 or $11 an hour for companies who don’t provide insurance....these people work just as hard as anyone in this room. They work at entry level jobs, at places like daycare centers,” Nixon said.

The Democratic governor told the gathering that Washington was his 39th stop in his campaign to make Missourians aware of the economic benefits of his proposal which he said would generate 24,000 jobs according to a University of Missouri study.

He said that is one of the reasons why business groups across the state including over 60 individual Chambers of Commerce have endorsed the plan. That number includes the Washington Area Chamber of Commerce which endorsed expanding Medicaid in March.

Nixon was introduced by Tom Holtmeier, a member of the Washington Area Chamber of Commerce Board of Directors.

Medicaid is a joint federal and state program that currently provides health coverage to about 880,000 people in Missouri or about 1 of every 7 residents.

Under a provision in the Affordable Care Act, states that decide to elect to expand Medicaid coverage from 100 percent to 138 percent of the poverty level can receive 100 percent funding for the first three years. Nixon said that equated to $1.7 billion in additional federal dollars coming to the state in the first year alone and up to $5.7 billion over the three-year period when it is fully funded.

Beginning in 2014, the federal funding gradually decreases to 90 percent by 2020. Making up the difference in the subsequent years has prompted opposition both here and in other states.

Missouri’s Republican-led House has defeated several Democratic attempts to expand Medicaid but a GOP alternative did win initial committee approval last week.

Nixon said taking advantage of the 100 percent federal funding for the first three years represented an “unprecedented opportunity” and the time was right to take our existing Medicaid system and make it better.

“Other states are moving forward,” Nixon said. “It’s not a Democrat versus Republican thing .... it’s about making a choice with our tax dollars that we send to Washington. Do we want to use them here or let them go elsewhere?”

Nixon reeled off the names of Republican governors who have already pledged to expand Medicaid in their states including Chris Christie of New Jersey and Jan Brewer of Arizona.

Addressing members of the law enforcement community, Nixon said that expanding Medicaid would provide more dollars for mental health services. He pointed out that of the additional 300,000 people who would be covered, an estimated 50,000 have mental health issues. He said people with serious mental health issues often end up in jail and when they are released they are taken to hospital emergency rooms and often wind up back to jail.

“What they need is long-term psychiatric in-patient care,” Nixon said. “The city jail is not the place for mental health services. The county jail is not the place for mental health services. The ER is not the place for mental health services.”

Nixon said that there are ways to implement reforms in the state’s Medicaid system and said that the Republican bill introduced last week was the “right vehicle to get it done” even though he didn’t agree with everything in it.

He said he is making progress and acknowledged the role business groups have had in keeping the Medicaid issue alive in the Republican-controlled Legislature.

“It has had a real impact,” Nixon said of the business community’s support. “Look at where we were in November and December of last year. We’ve gone all this distance and I don’t think we would be here today without their help. I would call it a significant sea change.”

He said he met with House Republicans last week and had a “very thoughtful discussion” on the issue. He said the question he poised was do we keep the state’s Medicaid system as it is now or do we improve it.

Dave Hinson, R-St. Clair, described last week’s meeting as “very productive and very cordial.”

“There wasn’t any yelling or shouting,” Hinson said Tuesday from Jefferson City. “He made his points we pointed out our concerns which include what are the long-term costs going to be for the state and for taxpayers? No one knows what the federal government is going to do three years from now and we don’t want to put the state in a bind. We had a good discussion on some ideas for some reforms we would like to see happen.”

Hinson said he ran into Nixon at a gas station in New Haven Monday morning while the governor was on his way to Washington. He said after they exchanged pleasantries, the conversation turned to Medicaid. He said Nixon told him he was going to speak with Health and Human Services Secretary Kathleen Sebelius about some possible waivers for Missouri under the federal health care act.

“He is very engaged on this issue,” he said. “In the three years I’ve been in Jefferson City I’ve never seen him so energized. This is really a big issue for him. It was pretty brave of him meeting with us last week. It was like walking into the lion’s den. It was a productive meeting.”

On Tuesday, Nixon met with Republican senators on his plans for Medicaid expansion. He called it a “substantive, thoughtful discussion.”

Sen. Brian Nieves, R-Washington, said Nixon is intentionally misleading everyone he talks to about Medicaid.

“He tells people that Missouri tax dollars will be sent to other states if we don’t expand medicaid and that simply is not true,” Nieves said in an e-mail.

“The program is paid out to the states on a ‘per recipient’ basis and therefore states only get what that particular state qualifies for. In other words, if New Jersey expands Medicaid and Missouri does not, New Jersey simply gets its money based on how many recipients they have and will not receive a single penny more if Missouri does not expand. He (Nixon) also continues to say we can simply “back out” or sunset the expansion after three years if we don’t like the way it works out for us.”

Nieves, like Hinson, expressed concerns over the long-term costs of an expanded program.

“During our meeting this morning I asked the governor to answer this... When have we ever expanded an entitlement program with federal dollars and then, at a later date, after people are accustomed to receiving it, stop the program and take the entitlement away from those who have been receiving it.

“We all know that if Medicaid is expanded, it will be forever expanded and our state simply cannot afford that.”

Missourian staff writer Josh Mitchell and the Associated Press contributed to this story.