Iowa’s Medicaid waiver should push Missouri Republicans to act:

Another of Missouri’s border states, with a Republican governor no less, is a step closer to expanding Medicaid and reaping the economic benefit of billions of dollars flowing into its state.

For those pushing to bring more health care to the working poor of the Show-Me State, and the massive economic benefits an infusion of $8 billion in federal spending would bring, this is a very important development.

This month, the Washington Post reports, the federal Department of Health and Human Services told Iowa that it was prepared to approve its request for a waiver that would allow it to expand Medicaid in a way different than what is called for in the Affordable Care Act.

Instead of merely adding people making less than 138 percent of the federal poverty level to the state’s Medicaid rolls — the simplest and least expensive solution — Iowa wants to do what other Republican-led states have proposed. It wants to expand Medicaid to people making 100 percent or less of the federal poverty rate, and then offer subsidies for those between 100 percent and 138 percent of poverty to purchase private health insurance through the state insurance exchange.

Why does this matter in Missouri?

It’s very similar to the Medicaid expansion proposal developed by state Rep. Jay Barnes, R-Jefferson City. Mr. Barnes understands what Gov. Jay Nixon, a Democrat, understands, what the Missouri Chamber of Commerce understands, what researchers at the University of Missouri understand: Bringing $8 billion in federal investment to one of Missouri’s most important business sectors isn’t just the right thing to do morally, it creates jobs.

As long as the Missouri Legislature flounders and fails to adjust the state’s health care system to the new federal reality, our tax dollars will go elsewhere, to border states like Iowa, Arkansas, Illinois, Kentucky and Tennessee, or the 21 other states smart enough to expand Medicaid with the federal government paying the freight.

It boggles the mind that Mr. Nixon and the Legislature would commit the state to giving up about $2.4 billion in taxpayer dollars to lure up to 8,000 jobs from Boeing, when by just saying yes to the infusion of $8 billion in federal dollars over just three years almost three times as many jobs will be created if you apply the same economic multipliers.

In one case, Missouri taxpayers are literally paying a company for the right to locate their jobs here, thus limiting the economic impact those eventual jobs will have.

In another case, the federal government is willing to pay Missouri to give more poor people access to quality health care services, and thus create jobs in an industry that generates about $19 billion in economic activity per year in the state.

Mr. Barnes’ recent analysis of his proposal shows that, if implemented, the Medicaid expansion could save money in the state’s general revenue budget for the next eight years. That’s five years into the time period in which the state takes over some of the cost of expansion.

Create jobs. Save the state budget. Provide health care for those who need it.

What is the Missouri Legislature waiting for?

If this was called Boeingcare instead of Obamacare, the Legislature would have acted long ago.

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The Kansas City Star, Dec. 21

Finally, progress is made in costly border war:

Missouri Sen. Ryan Silvey has offered a straightforward plan that could be a strong start toward reducing the costly economic development border war between Kansas and Missouri.

Silvey’s bill would prevent Missouri from giving public subsidies to companies for any existing jobs they would poach from the Kansas-side counties of Johnson, Wyandotte, Miami and Douglas.

The bill would be contingent on Kansas not using its incentives to lure companies and their current jobs from Jackson, Clay, Cass and Platte counties in Missouri.

The laws now in effect are pure folly.

In recent years several large businesses have left Kansas City, Mo., for Johnson County, Kan. — and vice versa — and lowered their tax responsibilities in doing so, while simply bringing existing jobs across the state line. As a result, these companies aren’t paying their fair share of taxes. That puts pressure on others that don’t get the tax breaks to come up with enough money to continue providing essential public services.

The bottom line: The incentives have diverted hundreds of millions of public dollars to private companies for few net new jobs in the region.

In an interview Friday, Silvey made it clear that companies creating new jobs when they move from one state to the other could still be eligible for state incentives under his bill. The key should be to consider rewarding new economic activity with taxpayer subsidies, although both states also could be a lot stricter on even those giveaways in the future.

Silvey’s bill should be a high priority for the Missouri General Assembly to act on when it begins meeting in January. It also should get the support of Gov. Jay Nixon.

Locally, the measure has been embraced by leaders of the Greater Kansas City Chamber of Commerce, who properly have criticized the current situation because it favors the chosen few companies that scoot across the state line.

Bill Hall, president of the Hall Family Foundation, an influential proponent of ending the border war because of the financial havoc it causes, called Silvey’s bill a “tremendous step forward.”

In Kansas, Gov. Sam Brownback appears ready to provide much-needed leadership in working toward meeting the reasonable restrictions laid out in Silvey’s bill.

That’s a positive change from a few years when Brownback and others — including the mayors of some large Johnson County cities — downplayed the concerns about “competition” between the states, ignoring the fiscal damages both were suffering.

Today, because of excessive tax cuts in Kansas, the state needs all the revenue it can get to provide basic services. Kansas especially shouldn’t be giving away precious tax dollars through overly aggressive incentive programs.

Brownback is in a perfect position to tell the mayors and others that Kansas can, indeed, compete with Missouri and other states when it comes to luring jobs.

But keeping the status quo is unacceptable because it ratchets up corporate welfare in both states.

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Springfield News-Leader, Dec. 18

Good government is open:

One of the most important elements of successful government is transparency.

If the voters understand what is happening and how it happens, they can make informed choices. They can let their elected representatives know how they feel about a proposed bill, and they can cast their votes dependent upon how those representatives perform.

So, when Springfield Rep. Charlie Norr co-sponsored a bill that would require lawmakers to disclose the source of the language in a bill, we approved.

We want to know where our lawmakers are getting their legislative ideas, but that doesn’t mean we disapprove of getting good ideas wherever they can.

Norr, a Democrat in a heavily Republican Missouri House of Representatives, was taking aim at organizations that provide model legislation to friendly lawmakers. He is especially aiming at the conservative American Legislative Exchange Council — ALEC, which is known to distribute draft legislation on conservative issues such as so-called “right to work.”

The problem, as Norr sees it, is that ALEC, organized as a 501(c)(3) charitable organization, doesn’t have to register as a lobbying group, although it acts like one. His bill would require that.

We disagree. Including the source of the language is enough.

Rep. Eric Burlison, a Republican from Springfield, has introduced ALEC-inspired bills, especially regarding right to work, an issue Burlison is passionate about passing. He points out that ALEC has helped legislators learn about bills that were successful in other states, allowing them to develop best practices.

We are still evaluating the right-to-work issue in the Missouri General Assembly, but we like the idea that legislators learn from other states and from organizations, including lobbying groups, that have a vested interest in an issue. It makes good sense to find out what works and then try to make that work for Missouri.

Burlison insists ALEC is not a lobbying group and that no one from ALEC has ever lobbied him on a bill. But ALEC has provided Burlison with the language for a bill.

Providing that information in the bill should not offend Burlison or ALEC, or any other conservative or liberal group. If a voter supports or opposes a bill based on where the language came from, that is a legitimate issue for the voter.

Being completely transparent about the source of the bill’s language is not making ALEC a “straw man,” as Burlison complains.

It is good government.

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Jefferson City News Tribune, Dec. 20

Ease ‘critical shortage’ of mental health professionals:

We encourage lawmakers to narrow a dangerous gap in the availability of mental health professionals to serve Missourians.

Gov. Jay Nixon announced Dec. 18 he will propose budgeting $20 million in grants for Missouri colleges and universities to train more students to work in mental health fields.

He will ask the legislators to approve his “Caring for Missourians: Mental Health” initiative when they convene in January for their regular session.

A chasm separates supply and demand on mental health issues.

The supply has been characterized by Nixon as “a critical shortage.” Specifically, the governor said Wednesday, 104 of Missouri’s 114 counties and the city of St. Louis have been designated by the federal government as mental health shortage areas. No licensed psychiatrist is available in 72 Missouri counties and no licensed behavioral analyst resides in 90 counties. The analysts treat autism spectrum disorders.

In addition, regardless of your opinion on the Affordable Care Act, the federal law is in effect and is likely to increase demand for mental health services. Among its 10 essential health benefits is treatment for mental health disorders, behavioral health and substance abuse.

Substance abuse, homelessness and incarceration are not uncommon among people who suffer mental disabilities.

The tax dollars spent to identify, intercept and treat mental health issues represents a fraction of what is spent to deal with the human and societal consequences of mental illness.

People who never have suffered from anxiety, addiction or depression may have difficulty understanding how debilitating and paralyzing those ailments can be.

We agree … that the stigma associated with mental illness must be eliminated through awareness and education. And we concur with the governor that more professionals must be trained to address mental disabilities in Missouri.