Yesterday, the (take a breath) Missouri Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform (exhale) met in Independence to discuss the state of Medicaid and what should be done to fix it. The time set aside for the hearing was similarly long — nine hours — but the meeting ended up concluding after only three hours of testimony. I have expressed my strong reservations about expanding Medicaid under the Affordable Care Act (ACA) in the past, and as you might expect, nothing that I heard at today's hearing has changed that perspective.

It was remarkable, however, to hear the "hospitals' case" for Medicaid expansion repeated before this state-level committee, which includes their own budget concerns related to cuts made by the Affordable Care Act. Why is this so remarkable? Because the hospitals supported the ACA, which would have substantively forced states to expand Medicaid rather than opt-into it, until the Supreme Court nixed that provision last year. In the version of the law that hospitals supported, Missouri's government would have been an afterthought because the hospitals' deal for the state's tax dollars was substantively made with the federal government, not the Show-Me State. Now, hospitals are appealing to Missouri to give them the state tax dollars that . . . the federal government promised them.

There are lots of great people in the health care industry, but when hospitals, as institutions, put themselves out as public servants disconnected from the politics of their predicament, it's important to remind folks that's simply not the case.