Missouri Medicaid Expansion: A Matter Of Life And Death

Missouri Governor Jay Nixon was here in Joplin on Wednesday.

Susan Redden of the Joplin Globe reported that Nixon was in town “to assert that Medicaid expansion would be a good business decision for the state.” From the story:

With officials of area hospitals and health care providers standing behind him, Nixon told a Joplin crowd that rejecting the Medicaid expansion available under the Affordable Care Act would send tax dollars collected in Missouri to other states where the coverage has been expanded.

“The question is narrow: Will we bring back those federal tax dollars to help the state or not?” the governor said in a presentation at the Robert W. Plaster School of Business at Missouri Southern State University. “If we don’t, other states will get the help, and we’ll pay the bill.”

The article notes that some 300,000 Missourians will benefit from the expansion of Medicaid, and in the words of Governor Nixon,

the people it will help are working folks who otherwise are going to end up in the emergency room.

Naturally, since the expansion will help “working folks,” many Republicans are against it, including leadership in our right-wing-dominated legislature. But the Missouri Chamber of Commerce and some local chambers, but not yet including Joplin, are on board because they recognize the foolishness of rejecting the expansion, just to spit in the eye of Barack Obama.

Expanding Medicaid happens to be good for business and employment:

Nixon cited a study by the University of Missouri suggesting that the additional funding for health care would create 24,000 new jobs in Missouri the first full year of the expansion. And, he said, states that don’t expand coverage could be put at a competitive disadvantage when small businesses are looking to add jobs, which often start on the lower end of the wage scale.

“If businesses are paying the same wage, and workers are getting health coverage in one state and not another, it could make a difference,” he said.

Medicaid expansion is projected to bring back to the state $1.8 billion in the first full year of coverage, and $5.7 billion over three years, Nixon said. “If we take a pass, Missouri residents pay that money in taxes, but it goes to other states,” he said.

As most of us know, the Supreme Court, in upholding the constitutionality of the Affordable Care Act, ruled that the provisions in the law that required states to expand Medicaid coverage to folks earning below 138 percent of the federal poverty level went too far. The Court’s decision allowed states to opt out of the expansion, even while staying in the Medicaid program.

Some Republicans claim our state can’t afford to expand Medicaid. But the entire cost of the expansion is covered by the federal government from 2014 through 2016. Then, until 2020 the states have to cover 5% of the annual cost, and after 2020, the states have to cover 10%. And that’s it.  Providing health insurance to 300,000 working folks in Missouri is a damn good deal.

And it’s a good deal for hospitals and other health care providers, who clearly recognize the foolishness of keeping poor people from getting health insurance. Those poor folks often seek care—expensive care—at emergency rooms, and much of that care—mandated by EMTALA—is uncompensated.

The federal government, through Disproportionate Share Hospital allotments, provides support to hospitals (“safety-net hospitals“) that treat the uninsured who can’t pay. In 2011, that support amounted to $11.3 billion, a little more than one-fourth of the estimated cost ($41.1 billion) to hospitals for providing care to those who can’t afford it.

The Affordable Care Act, because its purpose was to insure people and reduce uncompensated care, lowers federal payments to hospitals that treat those who can’t pay. But because the Supreme Court made the expansion voluntary and because many Republican governors and legislatures hate Obama and ObamaCare, the states who opt out are burdening the hospitals in their states with extra costs.

That’s why here in Joplin Governor Nixon met with local hospital leaders, who have given him their blessing. One of those leaders, Paula Baker, president of Freeman Health System, said,

He didn’t need to sell us on it.

But beyond the finances of the Medicaid expansion, there is the human element. Consider this from The Incidental Economist, a blog dedicated to studying America’s health care system:

First of all, Medicaid is good for health. Let’s start with a simple truth: having health insurance is better than not having health insurance. Not only is health insurance good for health, but it actually saves lives. Medicaid is, of course, health insurance. Therefore, it comes as no surprise that studies show Medicaid improves health. Now some people have garnered a lot of attention by claiming that Medicaid actually hurts people. They’re citing studies that show correlation, not causation. Medicaid doesn’t cause bad health; people who qualify for Medicaid are more likely to have bad health for other reasons. There’s a huge randomized controlled trial of Medicaid going on in Oregon right now, and that’s the kind of study you’d do to prove causation. It’s showing that Medicaid is good for health.

Expanding Medicaid is not only a good thing to do in terms of finances, it is “good for health.” It is good public policy. It is the right thing to do. And it does save lives, as was suggested in the Globe article. A woman named Patricia Bailey was visiting a local Joplin clinic that serves a significant number of folks on Medicaid:

Bailey, 61, of Joplin, said she has been on Medicaid for the past four years. Without it, she said, she wouldn’t have sought treatment that included three hospitalizations.

“I couldn’t have afforded it. I think I’d probably be dead,” she said.

More than the money, more than anything else, as Missourians, as Americans, we should expand Medicaid coverage because for some folks, it is a matter of life and death.

Posted by R. Duane Graham on February 14, 2013

https://duanegraham.wordpress.com/2013/02/14/missouri-medicaid-expansion-a-matter-of-life-and-death/