Scenes from the health-care struggle in Jefferson City

The walls of the Capitol in Jefferson City are etched with lofty phrases about liberty and justice. But the quotes from long-buried visionaries aren't what make Adrain Graham think about Independence Day. Her reason for confronting Missouri's House of Representatives is etched in the scars trailing down the left side of her body.

Last year, Graham was celebrating the Fourth of July outside her tidy home on Kansas City's East Side. She lit a firecracker and placed it in a metal tube that was meant to fire it safely away, like a canon. She waited but heard no sound, no fizzle as the fuse burned down. She leaned forward to check.

At that moment, the firework exploded.

She emerged from a coma five days later at the University of Kansas Medical Center, third-degree burns slicking her left arm, one shoulder and half her chest. She had to wear "a Darth Vader suit," she says, so the skin on her arm wouldn't adhere to her torso. Doctors skimmed flesh from her left leg and grafted it to her shoulder.

After a month in the hospital, her bill totaled more than $30,000.

Graham works full time at Care Staff, a local nursing agency. She earns about $1,000 a month, barely enough to cover living expenses and the needs of two teenage kids. It's not enough to pay for health insurance.

She used to be covered through the state's Medicaid system. But that changed in 2005, when then-Gov. Matt Blunt and the Missouri Legislature tightened eligibility requirements. Instead of allowing a family of three living on nearly $12,000 a year into the system, the state cut eligibility to the minimum required by federal law. Now, a single parent with two kids can earn no more than $3,500 a year to get Medicaid coverage.

Graham was one of thousands kicked off the rolls. Faced with a five-figure bill she couldn't pay after the accident, she applied for emergency Medicaid coverage. She was denied. "They said I made too much money," she says with a still-disbelieving smile.

Like a car-crash victim or a lifelong smoker diagnosed with cancer, Graham has found herself propelled into a costly health-care system she now can't escape. She still regrets that fleeting moment of thoughtlessness. She thinks about it every time she hears a loud bang in her neighborhood.

On a mid-April morning nine months later, she's among a small army of Kansas City residents in Jefferson City urging legislators to expand health-care coverage. Missouri now ranks in the nation's bottom five states when it comes to parent eligibility for Medicaid, and lawmakers, they argue, should do more to help the state's most vulnerable citizens, especially during a period of high unemployment. Shifting uninsured residents to programs such as Medicaid makes sense, they say, because otherwise those citizens wait until a crisis forces them to seek medical attention — often leaving hospitals and taxpayers stuck with the costs.

They scatter in groups of three and four, crowding the hallways outside the House chamber as they share their stories with policymakers. It's easy to sort the Democrats from the Republicans. Democrats tell the visitors that they're still fighting to expand health-care eligibility. Republicans give stiff apologies, saying the state can't afford to add even one more person to state-subsidized health care.

After a midday rally in the rotunda, the group parades through the hallways to the office of Gov. Jay Nixon. As they walk, they so forcefully bellow the gospel song "This Little Light of Mine" that perplexed workers peer out of their offices to witness the commotion. By the time they reach Nixon's office, building security is there to warn against their noisy conduct.

That impromptu raising of voices isn't nearly as loud, though, as the bitter fight on the floor of the Missouri House of Representatives.

There is a triangle of power in Jefferson City that decides who gets a slice of the state's $23 billion budget. At one of those points sits Allen Icet.

A Republican from Wildwood, the dark-haired engineer behaves with Victorian decorum. His back seems always straight. His elocution is precise. He takes a dim view of handouts.

Icet is the House Budget Committee chairman, giving him a grasp of the state's purse strings rivaled only by Nixon and Senate Appropriations Chairman Gary Nodler. Icet constantly raises the specters of New York and California — states, he warns, that have spent themselves into oblivion. Missouri's financial situation is far less dire. Still, when the governor releases his proposed budget on January 27, 2009, Icet is poised to challenge any spending increases.

Two of Nixon's health initiatives stick in Icet's throat. The governor wants to tweak the State Children’s Health Insurance Program (SCHIP). In 2005, Blunt increased the number of families that have to pay a monthly premium to get coverage and he also upped that premium for others. Thousands of kids fell out of the program. Nixon wants to get 27,000 of those children back by eliminating or lowering fees. To do that, he adds an extra $13 million to the program — an offering that will bring a $42 million federal influx.

Icet thinks those parents should be responsible for their own children. His revision: zero additional assistance for SCHIP.