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.

Previous Post


  1. ansonburlingame

     /  February 15, 2013


    One point, an important one. Medicaid IS insurance, according to one of your quotes above. I agree, just as Medicare is insurance for older Americans. Such an observation was disputed by Jim W. about a year ago for reasons that I now cannot recall.

    The key element in any insurance program is that premiums paid by many cover the costs of the smaller number that receive insurance payments. That of course is a falacy in government provided medical INSURANCE. No way do premiums cover all the costs.

    Fix that little problem with HC insurance and you might have a good humanitarian argument to support government HC payments. Fail to fix it and you get back to the robbing Peter to pay Paul dilemma.

    I also suspect you are wise enough to be familiar with “bait and switch” tactics. The federal government pays all for three years, the bait, and then States must pick up some of the burden, the switch. Given such, now leap forward 4 years and estimate the cost of Medicaid to MO, and then tell us all what part of the budget will pickup those additional costs.

    My guess is you will call for higher taxes to do so. Fine, say so and then get it passed, raising MO taxes for Medicaid, or anything else, politically in three or so years. If not increased taxes however, such increase future costs must come out of current budget lines. Which ones in my question to you and your commentors.



  2. Jane Reaction

     /  February 15, 2013

    The solution is pretty damned easy. Reduce the military budget. Doing so would be the best legacy we can leave.


  3. The battle continues. Are we one tribe, or are we a nation of special interests ruled largely by the hereditarily-privileged? I know how Billy Long would vote, and it’s different from how I would.


  4. ansonburlingame

     /  February 16, 2013


    At least Jim backs up his concerns with making his own substantive points, here and in his own blog.

    You on the other hand with your inane and pithy comments do little but show how shallow you really are, poltically. “Just reduce the military budget”. My if it was all that simple. How much, which budget lines, which programs, and what to defend against are all valid questions in that debate.

    You sound exactly like the opposite of Tea Partiers, “just make government smaller” with little to back it up other than polemics and disdain.

    Now go take another whack at my own military retirement pay and show your ignorance, again!!! Or better yet, make the effort to write your own damn blog, I will attend with bells ringing!!



    • Anson,
      Inane and pithy are not synonymous. Example: The cut of Bullwinkle’s jib was a dry oasis of tepid heat, tenderly bashed about with forceful inertia.


  5. ansonburlingame

     /  February 16, 2013

    Now Jim,

    I like your term “hereditarily-privileged”. Except I consider it in a different perspective than you intend it to be understood, the “white men of America”, I suspect.

    I see and read people claiming exceptional priviledge today based on the heredity of slavery. What else is Affimative Action, for example? I see the immigration arguments from Hispanics to be based on “heredity”, Hispanic origins and concerns. Those are special interests based primarily on race, greed and former culture, are they not and you support them, by and large.

    To me this blog, one entailing “life and death” or so it says, boils down again to an argument between have’s and have not’s. And many of the have nots have a different heretiage than that of “white men”.

    In the debate to help the have not’s, class should have nothing to do with it. Yes the have’s should help have not’s. Go read today’s Globe headline article related to Water Gardens. Have you ever met or read James Whitford views on such efforts. His Globe columns would be thrased all over the place in this blog. He is a strong advocate of tough love, efforts to help the homeless and downtrodden help themselves, not just take handouts.

    As well I would guess that the religious affiliation of his efforts will draw disdain herein as well, at least shallow disdain with his calls for Christ-like responses to the homeless.

    Now where did I meet James? Yep, it was in the monthly gathering of libertarians and conservatives, sponsored for the last 15 years by a wealthy woman that contributes to many “conservative” causes. She and her son have been raked over the coals herein for several years as well, yet SHE introduced me to James and his efforts, worthy and thoughtful efforts to help people help themselves in a manner usually disdained herein.



    • Anonymous

       /  February 16, 2013

      @ Anson,

      By “hereditarily-privileged” I did not mean “white men of America”. What I had in mind was the advantages obtained for their descendants by the rich among us because of their wealth. The Bush political dynasty, H.W, W., Jeb et. al. come to mind. The Ivy League crowd and the Rockefellers too.

      You apparently don’t remember but we discussed this a year or two ago on a blog post, but anyway, the point is that the effects of poverty, like those of wealth are multigenerational and despite exceptions, and there are those, they are not readily overcome. Children of rich people enjoy a vocabulary-rich and attention-rich environment from the get-go. Better pre-natal care, better nutrition, better healthcare. Kids raised by a single working mother, in comparison and on average, are shorted in those things, and perhaps even more importantly, they are shorted in having social confidence and basic safety – crime and poverty beget more of the same.

      The advantages enjoyed by the wealthy continue of course right on up the ladder – better schools, travel, employment assistance, family support – I know you get the idea. Each generation benefits and promotes the next – that’s how dynasties are formed.

      Affirmative Action doesn’t have to be unfair or unreasonable, although I don’t doubt that such a large-scale program has been so at times. If it’s done right, and I know it can be, the values of hard work and ambition do not have to be abandoned. I do know that the Clinton years saw considerable progress with “welfare reform”, getting the underprivileged back to work. That was the right thing to do.

      Why should we have Affirmative Action programs and the like? I say it depends on what kind of society you think is worth investing in. At one extreme is a plutocracy, a pyramid with poverty and crime at the bottom, and the other, a vibrant society in which all people can equally aspire to maximize their personal potentials.

      Affirmative Action will always be controversial because it appears to unfairly advantage people because of their race, but their race is part and parcel with the root causes of poverty. So when you blithely accuse me of snubbing “white men” as a category you seem to be intentionally demeaning my intelligence and ignoring what I know we previously discussed. However, I will give you the benefit of the doubt and will assume you failed to absorb that information because you rejected it out of hand.

      This is not of course a simple subject. I recall that you generally disdain “links”, preferring your own experience, but since you choose to pursue the subject here I hope you will check out a couple of references, one of which, the one on Wiki, shows that the effort has been embraced internationally, not just here.




  6. ansonburlingame

     /  February 16, 2013

    Well Juan,

    You have made my point, as well. Your own comment was inane AND pithy. Of course the two are not the same. But a comment can combine both atributes!! You frequently achieve that lofty goal, as well!! But now I am just getting tedious, I suppose.



    • Anson,
      I completely agree that you are tedious. However, I would question placing an adverb before the adjective, as “just” implies that you have only recently become “boring, monotonous and repetitive.”


  7. ansonburlingame

     /  February 17, 2013


    One quick point. You say poverty is multi-generational. Maybe it is but it does not HAVE TO BE SO. There I believe is where we depart. If I went to Watered Gardens and gave a homeless man $10,000 how long do you think it would be before he was back in the bread line? Not long in my experience working with similar people, people that don’t have the “values” to rise above their conditions in life.

    Poverty is by and large and in my view a “values” issue if we really want to “fix” poverty. We have yet to figure out how to achieve such improvements, particularly in the “lowest of the low” the homeless population. But I deal almost on a daily basis with many people that are about one foot away from such poverty. The solution for those folks is NOT money, it is a rigourous program to improve their personal values and I have seen it work over many years of observing. Of course it is also NOT a government program, either, yet funded as needed by dollar bills right out of the pockets of “poor people” by and large.

    I would also add that some of the people with whom I associate, almost daily, have previously been homeless but no longer bear that burden. Yes they had help, lots of help, but it did not come from government, either and they did the heavy lifiting, lifiting of the “soul” if you will, themselves. No one “gave” it to them.



%d bloggers like this: