Ambition, Personal Politics Block Medicaid Expansion

Ask anyone who needs ongoing health care for a chronic condition and they’ll tell you that it’s a crying shame that the Missouri legislature failed to expand Medicaid again.

Approximately 300,000 individuals will not qualify for Medicaid or the health insurance marketplace because they are cramped in the coverage gap at up to 138 percent of the federal poverty level. To put it in real-world terms, a family of three who makes less than $27,000 has nowhere to turn for affordable health insurance.

Medicaid expansion would have allowed this family, and many others, a safety net for ongoing health care coverage—a move that could have diverted thousands from leveraging the emergency room for preventative ailments.

Missouri lost out on $1.13 billion dollars in federal funding to expand the program this year. Between 2014 and 2020, $8.2 billion in federal funds are available for Missouri Medicaid expansion. And yes, Missouri would have to pay $332 million over that same period to expand the program, a contention Republican opponents claim as their primary reason not to expand.

Robert Schaaf, a Republican senator and family physician from St. Joseph opposed to expansion, believes that helping low-income individuals afford health care is “economic slavery.”

Sen. Kurt Schaefer, a Republican from Columbia, Mo., has his sights on the 2016 attorney general’s race. After winning re-election as a moderate two years ago, his politics have swung decisively to the right, as he vies for GOP primary voters. Supporting Medicaid expansion would be counterintuitive.

“Unfortunately, because of the federal cuts to Medicare, hospitals continue to pay for Medicaid coverage that they are not receiving,” said Herb Kuhn, president and CEO of the Missouri Hospital Association. “Missouri can’t afford to leave federal funds on the table – it will cost everyone with insurance more for care and harm the state’s health care system.”

Hospitals are receiving less federal funding to care for those who are unable to pay. This funding, called disproportionate share hospital (DSH) funding, is re-directed to pay for Medicaid expansion in other states. So basically, Missourians’ tax dollars are paying for Medicaid expansion, anyway, while rural hospitals get hit hard.

On the flip side, several Republicans have embraced expansion because they see the greater good. The governor and the state’s leading business groups are for it. Retired U.S. Sen. Kit Bond, a Republican, actively lobbied for it. And certain Republicans, like former Rep. Chris Molendorp from Belton, were tireless champions of expansion.

“If we don’t do this, we will be facing two realities: a large, growing group of underserved, sick and unwell Missourians,” Molendorp said. “This group will continue to flood Missouri’s ERs, but access to the emergency room will be threatened. With DSH payments going away and reduction in Medicare reimbursements staring our hospitals in the eye, it becomes the perfect storm of increased need with shrinking provider resources.”

Molendorp said the challenge of passing Medicaid lies within the Republican Party. “This is a squabble amongst Republicans. It’s a family fight. GOP voters who agree need to let GOP legislators know how important this is to our state.”

Advocacy groups have vowed to re-energize for 2015. “We are disappointed in our legislators, but our resolve has not weakened and we are not going away,” said Jacqueline Lukitsch, National Alliance on Mental Illness director of advocacy is St. Louis. “Missourians across the state will continue to speak out in support of Medicaid expansion until it is passed. When the people you advocate for are dying, you don’t have the luxury of taking a break.”

Safety Net

Health Forward Foundation
2300 Main Street, Suite 304
Kansas City, MO 64108
(816) 241-7006