In 2010, Congress passed the Patient Protection and Affordable Care Act (PPACA), a massive health care overhaul that asserted fresh federal control over nearly one-fifth of the U.S. economy. As written, the PPACA would have, among other things, forced states to expand their Medicaid programs or risk losing all of their existing Medicaid funding. Ultimately, the U.S. Supreme Court struck down the law’s mandatory Medicaid expansion provision, finding that it was impermissible under Congress’s spending power. As a result, states do not have to choose between expanding their Medicaid eligibility or losing federal funding for their entire Medicaid programs. Indeed, many states have already rejected the expansion.

Missouri policymakers have a decision to make, but if they are going to seriously consider expanding the state’s Medicaid program, two fundamental — and so far, largely neglected — questions must be answered: How much would the expansion cost Missouri taxpayers, and how would the state pay for it?

Among the elements of the new health care reform law that was passed by Congress is a requirement that almost every adult would either have to purchase a health insurance policy or face punitive fines to be collected by the Internal Revenue Service. There has been widespread debate in legal circles about whether the courts would uphold such a requirement, but lawmakers in at least 40 states are trying to do what they can to insulate their citizens from such a requirement. In Alaska, members of this legislature are considering HJR 35, which very closely resembles the legislation known in other states as Health Care Freedom amendments.

Dave Roland, a policy analyst with the Show-Me Institute, testifies before the Senate Governmental Accountability and Fiscal Oversight Committee and the House Special Standing Committee on General Laws about SJR 25 and HJR 57, also known as the Health Care Freedom Act, which would offer citizens the opportunity to modify the Missouri Bill of Rights to formally recognize their right to decide for themselves whether they will participate in any private health care system. Under this amendment, the government would not be permitted to prevent citizens from offering or accepting direct payment for health care services, and neither could it substantially limit the purchase or sale of health insurance in private health care systems.