Tracking allegiances in the Missouri legislature at times requires a scorecard.

Take the proposed expansion of Medicaid (Democrats and hospitals largely favor this) and limiting medical malpractice damage awards for pain and suffering (Republicans and hospitals largely favor this).

Our regional communities — St. Joseph, yes, but also Maryville, Cameron, Chillicothe, Albany, Bethany and others — benefit greatly from the presence of their hospitals and qualified health care providers. Boosters of these communities know to listen when these institutions and doctors have concerns.

This is how the Medicaid debate has turned in some locales, with hospitals explaining they will lose from hundreds of thousands to millions of dollars in Medicare reimbursements under the federal health care law.

To balance these cuts, they want the Medicaid rolls expanded so they can get the government to pick up more of the costs of caring for their poorer patients and so these patients will have access to preventative care and become less costly to serve.

This also is how the medical malpractice debate has turned. The doctors and hospitals point to the state’s cap on noneconomic damages adopted in 2005. Until the cap was overturned last year, lawsuits against physicians dropped almost 58 percent, the state added nearly 1,000 doctors and liability insurance premiums fell $27 million, the Missouri State Medical Association says.

In short, the law and its reasonable $350,000 cap on losses from pain and suffering worked to reduce the cost of medicine and encouraged doctors to practice in the state. At the same time, measurable damages — including medical expenses, lost salary and future earnings — were excluded from the cap.

The GOP-controlled legislature continues to wrestle with Medicaid, and this has the medical community seriously concerned. These same lawmakers, meanwhile, appear ready to reinstate caps on malpractice awards and seek voter approval of a constitutional amendment making this possible. Legislation already has cleared the House and is awaiting action in the Senate.

Citizens across Northwest Missouri must stay tuned in to these debates, scorecards in hand, weighing the pros and cons for their health care providers and for taxpayers who ultimately pick up the bill.

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