JEFFERSON CITY, Mo. – After a contentious debate over statewide managed care, the Missouri Senate on Wednesday approved the state’s $26 billion annual operating budget for Fiscal Year 2016.
For several hours Tuesday night into Wednesday morning, Sen. Rob Schaaf of St. Joseph waged his war on the Centene Corporation and other managed care companies hoping for passage of a Senate plan to expand the program statewide.
Joined by Sen. Bob Onder, another Republican doctor from St. Louis, Schaaf led a filibuster against the policy championed by Senate Appropriations Committee Chairman Kurt Schaefer.
“Who wants this? The managed care companies!,” Schaaf said. “This is the wrong thing to do. It is bad policy.”
Under Schaefer’s budget proposal, passed last week by the Senate Appropriations Committee, nearly 200,000 Missourians currently accessing health care based on a fee-for-service model would be shifted to a managed care program that would allow private companies to manage their health care services, spreading the program currently limited to the Interstate 70 corridor statewide.
After hours of debate, a frustrated Schaaf sat down, agreeing to a mild compromise with Schaefer that he said would protect doctors from Schaaf’s concerns that they might go underpaid or cut out entirely from managed care services.
“The concern is providers will not be eligible to be a part of managed care. This cures that problem,” Schaefer said. “As far as a reduction in fees… this will guarantee that fees will not be less than 100 percent of is fee per service.”
Schaaf, speaking early Wednesday morning, said he disagreed.
“It won’t save money, but it will make Centene a lot of money,” he said.
After an initial flub, the bill funding the Department of Social Services passed anyway by a vote of 18-15.
In the rest of the budget, the Legislature increased funding for K-12 education, but stalled over provisions that Schaefer said aimed to slash projected growth in the state’s spending on social programs like foster care, seniors and those with mental illnesses.
Schaefer, the Republican of Columbia, said his controversial plan to provide lump-sums of money to the Departments of Health and Senior Services, Mental Health, and Social Services rather than explicit line-item appropriations allows the Legislature to quell the rising costs of welfare programs. Schaefer said his plan would save the state money by giving the state agencies large chunks of money to leverage for managed health care coverage.
“Every year they eat up every bit of increase we have in economic growth,” he told lawmaker Tuesday evening. “That money has to come from somewhere.”
The proposal, which will face another vote before being taken up by a conference committee, faced fierce opposition by other Republican lawmakers. Sen. Mike Parson, of Bolivar, said he disagreed with Schaefer that it would either save money or properly appropriate it.
“I don’t think this is the right thing to do, turning the budget process over to the agencies,” he said.
Aside from the changes to social services spending, the measure includes an $84 million increase to the state’s foundation formula for K-12 education. Sen. Jill Schupp. a Democrat of Ladue, said the increase was not enough to fully fund the formula.
“We did fund it more than the governor did, if that makes you feel any better,” said Schaefer, to which she replied, “It doesn’t.”
The measure includes a provision that would make college more expensive for undocumented students who might be in the country illegally.
“I think the purpose is to deny people whose families came here as undocumented immigrants, to deny them the opportunities we give our very own children,” Schupp said.