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This is MORNING EDITION from NPR News. I'm Steve Inskeep.

As we've reported on this program, Medicaid has become the single biggest budget item for most states. Nearly all of them are trying to limit the growth of the health program for the poor and no state has gone after Medicaid more aggressively than Missouri. Politicians there have cut 90,000 people from the program and have laid plans to end it entirely. The cuts have opened a moral divide with some preachers expressing outrage. The governor, a devout Christian, defends the cuts as morally correct. Frank Morris of member station KCUR in Kansas City reports.

FRANK MORRIS reporting:

As Missouri's governor, Matt Blunt, and the Republican legislative leadership found out this year, slashing Medicaid can provoke a noisy fight.

Unidentified Man #1: Governor Blunt, this is pure unadulterated sin.

Unidentified Man #2: Yeah.

Unidentified Woman: Yeah.

(Soundbite of cheering)

Unidentified Man #1: Sin. It's just sin.

Unidentified Man #2: Yeah.

Unidentified Woman: Yeah.

Unidentified Man #1: Sin...

Unidentified Man #2: Yeah.

Unidentified Man #1: ...that's what it is.

Unidentified Man #2: It's sin.

Unidentified Man #1: Let's call sin what sin is.

Unidentified Man #2: Sin.

Unidentified Man #1: Wrong sin.

MORRIS: Sixty or so activists held a prayer vigil outside Truman Medical Center, one of Kansas City's big indigent-care hospitals. Earlier, protesters chained their wheelchairs to a door at the Statehouse, but Governor Blunt hasn't wavered from his position, that failing to cut Medicaid would force him to raise taxes and that raising taxes is wrong.

Governor MATT BLUNT (Missouri): I don't know what's moral about the tax increase on hard-working Missouri families, and if you're opposed to reducing spending in state government, that's the only option.

MORRIS: Missouri's Medicaid program has more than doubled in size in the past decade, expanding to cover almost one in five citizens. Governor Blunt says continually raising taxes to cover the mushrooming costs of insuring all those people would poison the state's economy. He says he's made hard choices to tame the program and the governor believes that under some circumstances, cutting some people off Medicaid will actually do them good. Jessica Robinson is the governor's press secretary.

Ms. JESSICA ROBINSON (Governor's Press Secretary): Concern or fear over losing health coverage could become motivation enough to learn a new trade or to seek out a position that will otherwise provide that coverage.

Ms. ANGEL BRIDGEWATER: OK. And what is that?

Unidentified Child: A man.

Ms. BRIDGEWATER: All right.

MORRIS: Angel Bridgewater is helping her seven-year-old niece with homework on her front porch in a tough inner-city neighborhood as a police helicopter hovers nearby. As of this year, Bridgewater's $6.70-a-hour part-time job at McDonald's leaves her much too rich to qualify for state medical assistance. Though she supports three kids, she'll now have to make less than $86 a week to qualify for Medicaid. Before the cuts, she qualified while earning about $300 a week. The new eligibility standard is the lowest allowed by federal law and reflects priorities Bridgewater calls sickening.

Ms. BRIDGEWATER: We're human beings and we need help when we need help, and that should be the last thing they should try to cut.

MORRIS: If Bridgewater got a better job and made more money, she could lose her rent and child-care subsidies and perhaps have to pay for her children's state health insurance. As it is, she says a serious illness or injury could land her and her kids on the street. Medical bills would be the least of her worries.

Ms. BRIDGEWATER: If I get really sick where I have to really go to the emergency room, I'll go to Truman Medical Center and just let them bill me and just let them bill me.

MORRIS: Hospitals won't be the only financial losers. Federal grants cover most of the cost of Medicaid. The $630 million cut here means an almost $380 million annual loss to the state economy. A strong federal match has been an incentive against cutting Medicaid, though Tennessee passed a plan this year to take some 300,000 people off the rolls. Amy Blouin, with the Missouri Budget Project, says Tennessee started with a much larger, more generous program. She says Missouri is pushing into new territory.

Ms. AMY BLOUIN (Missouri Budget Project): You have to question if we're really kind of like the crash-test dummy for the nation. Are we going to be standing out as the Show Me State for other states, we're showing them not what to do?

MORRIS: Blouin predicts the cuts will cost Missouri thousands of jobs, possibly among them the home health aids that sustain 44-year-old Irene Shivers.

(Soundbite of dog barking)

Ms. IRENE SHIVERS: They want us to die. We are a burden on the society. So they don't care.

MORRIS: Shivers spends all day in an ancient mobile home she shares with two dogs, a yellowed computer and a collection of dolls. Cerebral palsy has destroyed her coordination and slurred her speech. Under the new guidelines, she'll have to spend her income down to less than $500 before Medicaid kicks in and then she'll have to pay more for doctor visits and drugs. She says she'll have to ration food and get rid of the dogs, even the one trained to alert her before she had a seizure.

Ms. SHIVERS: Some days I get so depressed I'm ready to go. I'm just ready to go.

MORRIS: As both sides seek the moral high ground in this debate, some leaders are formulating plans to make further cuts. A commission will soon be formed with a mandate to dismantle Medicaid here by June 30th, 2008. For NPR News, I'm Frank Morris in Kansas City.

INSKEEP: Details about Missouri's Medicaid problems are at npr.org.

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