McCaskill: Jeff City lawmakers "nuts" for health care vote

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By Tim Sampson

Missouri News Horizon
– Sen. Claire McCaskill has one word to sum up actions taken by the Missouri State Senate this week – “nuts!”

That’s how Missouri’s Democratic U.S. senator described state Senate Bill 464, which seeks to limit the Governor’s ability to implement a key portion of the federal health care reform law.

“The irony to me is, while these guys are pounding the podium saying, ‘get Washington out of our lives,’ they’re refusing to set up the very mechanism that get’s Washington out of their lives… it’s nuts!” McCaskill said during a media conference call earlier this week.

The GOP dominated Senate’s actions are in response to a provision in the health care law – derisively referred to by critics as “ObamaCare” – that requires all states to create government run health care exchanges by 2014. These exchanges are designed to be a virtual one-stop shop where consumers can compare and purchase health care plans from private insurance companies. Supporters of the exchanges say it will increase competition among health insurance companies and drive down the overall cost.

But many in the state legislature, who view the health care bill as an unnecessary and unconstitutional infringement by the federal government, oppose the idea. Republican lawmakers have dragged their feet on establishing the exchanges as they wait for legal challenges to work their way through the Supreme Court. Legislation to implement the exchanges died in the House of Representatives last year.

But Senators have a new fear, that Gov. Jay Nixon may attempt an end-run around the General Assembly by creating an insurance exchange through executive order.

That’s why Sen. Rob Schaaf, R-St. Joseph, introduced SB 464. His bill would prohibit the governor from establishing the exchange by executive order. Schaaf, a family physician by trade, said his bill does nothing to stand in the way of enacting the federal health care law. But he argued from the floor of the state Senate this week that the legislature’s right to appropriate funds – regardless of the fact that the money comes from the federal government – should be protected.

“This bill doesn’t stand in that way at all,” Schaaf said. “But do you think state money should be spent without being appropriated by the state?”

But Sen. Jolie Justus, D-Kansas City, who led vocal opposition to SB 464, argued that it would be permissible, provided that the money being spent came from the federal government and not state taxpayers – as is the case with the healthcare exchange funding.

Although Justus agrees the governor should not circumvent the legislature in creating the health care exchange, she accused Republican lawmakers of using SB 464 as just another means of delaying or avoiding implementation of the federal mandate altogether.

During floor debates, Justus introduced a failed amendment that would have at least allowed state agencies to discuss plans with the federal government for creating an exchange in the event that the General Assembly does not take action by 2014. If the legislature does not act by then, it is expected that the federal government will come in and impose an exchange. Justus said that by allowing agencies to at least talk with the federal government about the particulars of the program, Missouri could at least insure that the program is tailored to the needs of the state.

McCaskill and Justus both said that by choosing not to implement a plan of it’s own design, Republican lawmakers are ensuring their worst fears: a strict federally designed program being forced on the state without oversight from the General Assembly.

“I hope that we do get a state health care exchange bill passed,” Justus said. “But the reality is, I don’t think that’s going to happen based on what I saw last year and based on the continuing dysfunction I see here in the state capitol.”

Schaafs bill ultimately received first round approval in the Senate on Tuesday. It faces one more full vote in the chamber before heading the House of Representatives.