By Doug Brooks
Special to The Globe
JOPLIN, Mo. —
With full implementation of the Affordable Care Act less than a year away, our conservative Missouri Legislature faces a critical choice: Accept or reject Medicaid expansion.
The ACA is complicated, but the issue before our lawmakers is not. If Missouri expands Medicaid coverage in 2014 to approximately 218,000 low-income adults, the federal government will fully fund the first three years of the costs, with Missouri gradually sharing no more than 10 percent of the cost by 2020.
Besides providing health care for low-income working adults ages 19 to 64, the expansion will boost state and local economies. That's why our local hospitals are strongly in support of it.
In a recent Joplin Globe article, Paula Baker, president of Freeman Health System, said: “We support it because it increases access to health care for patients who really need it because they cannot afford health insurance. Because they do not receive the care they need, they have to prioritize. Their care takes a back seat to food, mortgages and rent.”
Gary Pulsipher, president of Mercy Hospital Joplin, said: “For every one of our Missouri tax dollars spent on the expansion, the federal government has promised a return of at least $10, if not more. If those dollars do not come to Missouri, they will be sent elsewhere.”
The Missouri Hospital Association, the Missouri Chamber of Commerce and Industry and the Missouri Primary Care Association also support expansion.
So, for every $1 spent, the state gets $10 back, and if we don’t take the deal, the money will go toward other states’ health-care costs — who could be against this type of deal? Well, it turns out most of our Missouri Republican legislators are against Medicaid expansion.
Lt. Gov. Peter Kinder called it “ruinous”; House Speaker Tim Jones said “… the state can’t afford it”; and Senate President Pro Tem Tom Dempsey said Medicaid expansion is highly unlikely.
Why don’t they get it? The math and the logic are simple. A study by the University of Missouri School of Medicine projects that in 2014 alone, expansion will create over 24,000 jobs, then from 2014-2020 it will generate state and local tax revenues over $855 million.
Missouri HealthNet (Missouri’s Medicaid program) now provides health care for poor children and pregnant women, some disabled persons and some impoverished adults. There is no help for other adults who make just enough to survive and can’t afford insurance.
Without Medicaid expansion, they will continue to lack primary care and will depend on high-cost emergency rooms. Unpaid bills are shifted to patients who can pay through escalating insurance premiums and to government subsidies to hospitals (i.e., your taxes). As the ACA is implemented, those subsidies will be reduced, depriving hospitals of support. Some hospitals could close, especially in rural Missouri.
The real reason behind the objection to Medicaid expansion is that conservative lawmakers fear attacks from the right wing of their party if they cooperate in any way with Obamacare.
Republican lawmakers are in a squeeze from big constituents who support expansion — the business and medical communities. Is it too much to ask that they also consider the health needs of low-income Missourians?
Missourians help each other and work together every day to make our state a better place to live. We deserve leaders who will do the same. Ask your senator and representatives to do the right, smart thing for Missouri through Medicaid expansion. It will help us all.
Doug Brooks, of Joplin, is chairman of the Southwest Missouri Democrats and a member of the Democratic National Committee.