As he keeps his options open, Missouri Gov. Jay Nixon said Wednesday that he expects it will be next winter – after the general election ends and the next legislative session begins – before the General Assembly is ready to address two key health-care issues: whether to expand the state’s Medicaid rolls or set up an exchange for the uninsured to buy insurance.

Both actions are part of the federal Affordable Care Act, generally upheld last month by the U.S. Supreme Court.

“Anything we do in this area will require work with the legislature,’’ Nixon said in an interview, apparently seeking to tamp down any talk – particularly from Republicans – that he might try to take action unilaterally.

But Nixon, a Democrat, did point out a political reality about the federal Affordable Care Act: “Congress passed the bill. The Supreme Court upheld the bill.”

Now, he continued, the quest for all public officials should be to “find out what the best fit for Missouri is.”

Nixon’s remarks came during a brief session with reporters following Wednesday's lunchtime address to the Regional Chamber and Growth Association.

In his in-depth speech, which focused on economic issues, the governor made only a passing reference to the looming health-care debate in Jefferson City. He said he hoped for a “calm and rational discussion’’ of the state’s options.

The governor later indicated to reporters that he was not ready to take a stand on expanding Medicaid rolls, as sought by the Affordable Care Act. Under the act, the federal government would cover all the additional costs for the first three years, then Missouri would gradually take over a small percentage of the costs. By 2022, the state’s share would be 10 percent.

Missouri’s Republican legislative leaders have indicated they will oppose any such expansion on philosophical as well as financial grounds. But they also have opposed a call by some – led by state Sen. Brad Lager, R-Savannah and a candidate for lieutenant governor – for a special session this fall devoted to laying out how Missouri could oppose implementing any of the federal requirements in the Affordable Care Act.

Nixon, who is running for re-election, didn’t mention the special-session dispute – a hint that he wasn’t going to be a player in that decision. (A special session can be called by the governor or by legislative leaders if they get a three-fourths vote of their members.)

The governor said that at some point, likely after the November election, his administration will “reach out to work with folks as we get back into town’’ for the January start of the regular legislative session.

Nixon discusses insurance exchange options

Nixon noted that the Supreme Court decision did allow states more flexibility in deciding whether to comply with the act’s provisions of Medicaid expansion. The court struck down the Affordable Care Act’s harsher penalties against states who decline to comply.

Nixon observed that some states already are discussing various options. “I do think that the flexibility given to the states on the Medicaid side…will prove to be an important pivot for folks in their long-term analysis,’’ the governor said.

He did imply that he expected the General Assembly eventually to become more receptive to the act’s requirement that states offer an insurance exchange,  where people without coverage can shop for policies from various insurers. If a state declines to set up an exchange, with the help of federal money, the federal government will set up the exchange.

The issue, said Nixon, will boil down to whether Missouri wants to control what’s offered through its exchange or “cede that control to the federal system.”

The governor indicated that he expected legislators to decide eventually that they would prefer to wield such power – and set up a state exchange.

Kinder vows to block exchange

But Wednesday night, Lt. Gov. Peter Kinder – a Republican locked in a nasty primary with Lager -- told a Republican group in Crestwood  that he would balk at any effort to set up an exchange in Missouri.

Kinder, who presides over the state Senate, accused Nixon of attempting to begin the process to set up an exchange in late 2011, until Republican legislators crashed a meeting of the Missouri Health Insurance Pool.

(Republicans at the time accused the volunteer board of improperly preparing to accept $21 million in federal money for initial activities in preparation for a state exchange. Nixon has denied their assertions. The federal money has not been accepted.)

“We should not set up an exchange. We should be in the ‘Just Say No’ column,’’ Kinder said at Wednesday’s gathering of the Gravois Township Republican Club. His comments touched off applause.

Kinder contended that he’s been advised by national opponents of the Affordable Care Act that “if you refuse to implement the exchange, you will largely disable the health-care law in your state.”

Kinder continues to be in a legal fight with Secretary of State Robin Carnahan, a Democrat, over her office’s ballot summary for a proposal slated for the November ballot to bar the state from setting up an exchange without approval of the General Assembly or a statewide vote.

Kinder maintains that Carnahan’s summary is tainted and aimed at persuading voters to reject the proposal; Carnahan’s staff disagrees.

Kinder told Wednesday night's audience, "I have just begun to fight on Obamacare, and I hope you're there with me."

Nixon didn’t get into that dispute or other details of the continuing Missouri battle over health care during his appearance before the RCGA.  During the question-answer session, none of the audience asked about health care either.