Missouri Debates Medicaid Expansion: The Elephant in the Living Room

Missouri has two legislative committees working on developing proposals for re-inventing Medicaid in the 2014 legislative session. The Senate committee has, apparently,  been discussing its draft in public. From what I can see in the press, there are lots of ideas about Medicaid Managed Care, Accountable Care Organizations/Patient Centered Medical Homes, and emergency department use by Medicaid beneficiaries. Nothing surprising here. These are important  and worthwhile topics for all Medicaid programs.

What is surprising is the reported failure of the draft to discuss Medicaid expansion.  That appears to be the elephant in the living room on  Missouri Medicaid reform. The Senate committee draft report, as I understand it, proposes to neither endorse nor reject Medicaid expansion (you may read the Kansas City Star's report on this here http://www.kansascity.com/2013/11/14/4620782/missouri-senate-panel-rejects.html) though silence, of course, is an implicit endorsement of the status quo. It also signals, however, a fearful ambivalence about a subject when it is too controversial to talk about. Pay no attention to that elephant in the living room.

In the meantime, some localaties are advancing the Medicaid expansion substantive debate themselves. You may read about the Mayor and City Council of Columbia, Missouri voting a non-binding resolution of Missouri Medicaid expansion on business and job expansion grounds here: http://www.bizjournals.com/stlouis/morning_call/2013/12/columbias-city-council-calls-for.html. Apparently, the Missouri Chamber of Commerce is talking up a storm as well. You may read their position statement here: http://www.mochamber.com/mx/hm.asp?id=healthcare.

Sometimes,  strategies to shunt debate to the side only serve to promote debate elsewhere.

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