Will Missouri Republican Lawmakers Stand Against Voters And Implement Obamacare?

Going solely on the remarks of Missouri State Rep. Jay Barnes, that answer is yes.

Yesterday I promised to assist in the primarying of any Republican lawmaker who refused to stand with the people who have twice voted against Obamacare. I disagreed on Twitter with Rep. Barnes’s assessment of our options where it concerns state exchanges and asked him about his quote in the St. Louis’s daily. His reasoning is that it’s better for us to implement Obamacare exchanges at the state level because that way we retain some sort of control, a premise that I and a frillion other conservatives who have followed this topic closely strongly dispute — along with Governors Perry, Jindal, Walker, Kasich, Snyder, Scott, and others, plus voters in Alabama, Montana, Wyoming, my state of Missouri, Ohio, Arizona, and Oklahoma who have voted for or amended their state constitutions to exclude Obamacare, and the 27 states suing over Obamacare — Barnes’s assessment. But apparently, we’re all uninformed and it’s a good thing we have state lawmakers with imperialistic complexes to guide us through the difficulties of self government.

I figured that we would end up agreeing to disagree but what I did not expect was to be yelled at, grotesquely condescended to, and have my intelligence questioned on live air by a sitting state representative simply because I disagreed with his opinion. I was shocked, to say the least. I want better for my listeners than a conversation where one party constantly interrupts and talks over the other one as she tries to ask a question. I wished it had gone better.

One question I tried to ask, to which Rep. Barnes responded with straw man and immediately convoluted, concerned how the Supreme Court gave states an opt out where it concerns Medicaid. Specifically:

By upholding the mandate as a constitutional exercise of Congress’s taxing power in June, the U.S. Supreme Court maintained the provision that helped hold the law together. But if the mandate is the cement, the law’s expansion of Medicaid and establishment of subsidized health insurance exchanges is the house itself. It’s these two provisions that will be responsible for $1.7 trillion of spending over the next decade, according to the Congressional Budget Office.

 

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One of the silver linings of the Supreme Court decision is that it gave states the ability to opt out of the Medicaid expansion. Medicaid is one of the programs that is crushing state budgets and if implemented as intended, Obamacare will add 18 million beneficiaries to the program’s rolls. Though the federal government lures states with a honey pot in the short term – covering all of the expansion through 2016, by 2020 the states will be asked to kick in 10 percent of the cost, amounting to billions of dollars of spending imposed on states nationwide each year. It would be to the long-term benefit of governors to opt of the expansion.

How are states going to cope with this added cost?

My colleague Jagadeesh Gokhale estimates that expanding Medicaid will cost individual states up to $53 billion over the first ten years. That’s before an emboldened President Obama follows through on his threats to shift more Medicaid costs to states.

Unfortunately, I wasn’t able to fully ask this question at it relates to Missouri as Barnes interrupted and stated that Obamacare has nothing to do with this. Obamacare has nothing to do with increasing Medicaid costs for the states?

The law requires states to offer Medicaid to everyone making less than 138 percent of the poverty line — just over $30,000 for a family of four. In exchange, the federal government covers the cost of the expansion for the first three years — and 90 percent thereafter.

 

Sounds like a great deal for the states. But the administrative expenses involved in expanding the program will increase Medicaid costs for most states — even during the period when the government foots the bill, according to a new survey conducted by the Government Accountability Office.

Oooook. I’m not sure if Rep. Barnes understood what I was trying to ask or if he was excited and heard something else. I’m inclined to give him the benefit of the doubt even if his manners today have shown he doesn’t deserve such a courtesy; there’s simply no way possible that one can separate Obamacare from the increased costs states are going to assume with Medicaid in addition to the costs associated with operating the health exchanges estimated to be anywhere from $10 million to $100 million per year.

Furthermore, there is only the appearance of state control. As Phillip Klein notes:

Though the law creates the veneer of providing states with flexibility on the exchanges, the reality is that all of the major decisions – from the broad structure of the exchanges to the details of what kind of health care plans will be offered in the exchanges and how they will be marketed – will be made from Washington. A careful reading of the law finds that all of the sections about state “flexibility” are filled with caveats that render them useless in practice, because Secretary of Health and Human Services Kathleen Sebelius will be running the show. For instance, Obamacare specifies that, “The Secretary shall, by regulation, establish criteria for the certification of health plans as qualified health plans.” And later orders that “An Exchange may not make available any health plan that is not a qualified health plan.” In other words, Sebelius will get to decide what type of health care plans can be offered on these state exchanges.

 

The law dictates that states must “assign a rating to each qualified health plan offered through such Exchange in accordance with the criteria developed by the Secretary” and “utilize a standardized format for presenting health benefits plan options in the Exchange.” The law also specifies that health plans must disclose certain information in plain language. Who determines what constitutes plain language? Well: “The Secretary and the Secretary of Labor shall jointly develop and issue guidance on best practices of plain language writing.” Then, there’s this dandy: “An Exchange may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary under this subtitle.”

 

Given that governors will have no real control over the exchanges anyway, they may as well let Obama administration officials sleep in the bed they made for themselves.

Rep. Barnes’s claims, and the claims of any Missouri Republican who say that these exchanges will be free of HHS oversight, simply don’t make sense, especially as the law itself dictates otherwise.

Barnes’s argument is that because Prop E says “legislature,” the will of the voters can be overlooked, emphasis mine:

Shall Missouri Law be amended to prohibit the Governor or any state agency, from establishing or operating state-based health insurance exchanges unless authorized by a vote of the people or by the legislature?

 

No direct costs or savings for state and local governmental entities are expected from this proposal. Indirect costs or savings related to enforcement actions, missed federal funding, avoided implementation costs, and other issues are unknown.

Reminder: the people of Missouri have twice rejected the supremely unpopular law. Being elected to office isn’t a free pass to supplant voters’ will with that of your own.

I want to help the Republican party become more constitutionally-focused and see them win more elections. It’s really difficult to do that when voters feel undermined after twice making their wishes known to lawmakers only to find them falling upon deaf ears.

Help me help you. 

Please keep the pressure on.

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