Budget debate becomes issue of definition

JEFFERSON CITY, Mo. -- Gathered in a hypothetical room are about a dozen people. Among them are a pregnant teenager, a single mother of two, a family with several adopted children, a widowed great-grandmother and a paralyzed man who needs help getting from bed to his part-time job.

Who is "the most vulnerable?"

That is the real-life quiz playing out at Missouri's Capitol as lawmakers wrestle with how to balance a $19.1 billion budget by cutting the state's social services. Some of the people in the hypothetical room will be told to leave; others will get to stay in the state's care.

The goal is to "protect the most vulnerable" -- Republicans and Democrats agree on that.

But the challenge is determining who is most vulnerable.

The budget passed last Thursday by the House eliminates some people from the Medicaid health-care program, reduces the health benefits of others and cuts subsidies to some parents who adopt foster children -- all to protect government services for the most vulnerable, according to Republicans.

But Democrats contend the budget cuts actually affect the most vulnerable.

In the past two weeks, as the House debated various Medicaid and budget bills, legislators referred to the "vulnerable" about 20 times -- the references coming almost equally from Democrats and Republicans.

At times, the vulnerability debate turned into a rhetorical volley.

For example, Republican House Budget chairman Brad Lager, of Maryville, concluded his description about the budget bill for the Department of Mental Health by assuring: "Those in our state with the greatest vulnerabilities are protected."

To which Democratic Rep. Margaret Donnelly, of St. Louis, immediately rebutted that the bill "leaves our safety net for some of our most vulnerable citizens hanging by a thread."

So who is right?

House Speaker Rod Jetton, of Marble Hill, would side with Lager's interpretation. But he acknowledged there is no clear-cut answer to that question.

"The hardest thing is we have to decide who is the most needy," Jetton said, "and that's where you have to make the tough choices."

Applying the scenario of the hypothetical group gathered in a room, the House budget has essentially concluded that the children of the single parent rate are among the "most vulnerable."

The budget increases spending for schools and shields children from cuts to the Medicaid health plan for the poor, although the children's parent could have to pay more money out of pocket if her income was high enough.

The parent, meanwhile, would be considered among the least vulnerable. To qualify for Medicaid coverage, the mother could earn no more than $292 a month. That equates to about $67 a week, or about 13 hours of work weekly at the $5.15 minimum wage.

The budget is projected to eliminate coverage for about 68,000 of the 175,000 parents now on Medicaid. Those who remain would have to make co-payments of between 50 cents and $3 for each doctor's visit. And Medicaid no longer would pay for their dental work and eyeglasses.

Were that mother to get pregnant again -- like the teenager in the hypothetical room -- she again would qualify for full Medicaid benefits and could earn up to $2,481 a month, the equivalent of a $14-an-hour, 40-hour-a-week job. That's because the House budget shields pregnant women from all the Medicaid cuts.

The paralyzed man, great-grandmother and adoptive family would fall somewhere in between on the vulnerability scale.