The Joplin Globe, Joplin, MO


March 4, 2014

Doug Brooks, guest columnist: Human toll should have prompted Senate to act

JOPLIN, Mo. — Again this year, Republicans in the Missouri Senate voted not to allow Medicaid expansion in Missouri. This is a big deal.

Conservative Republicans in the state Legislature have to be aware of the many economic reasons why the expansion would be positive for the residents of Missouri.

Credible studies have identified these benefits, such as the creation of jobs and the tax benefit of Medicaid revenues. A 2013 study by the University of Missouri School of Medicine projects that in 2014 alone, the expansion would have created over 24,000 jobs; from 2014 to 2020 it would generate over $855 million in state and local tax revenues. If this study is anywhere close to being accurate, Medicaid expansion will pay for itself many times over.

Increased productivity is another benefit. According to the National Academy of Sciences’ Institute of Medicine, a large uninsured population is associated with an astonishing loss of economic productivity because of missed work. Uninsured employees are significantly less productive than insured workers because they cannot afford care that would prevent them from getting ill or help them recover from an illness or injury more quickly. Under the Medicaid expansion, 300,000 working uninsured Missouri taxpayers would be eligible for those services.

For states that accepted the expansion, the benefits began Jan. 1, 2014, with 100 percent of the cost paid by the federal government for the first three years.

Republicans appear to have three arguments against the Medicaid expansion. The first is their suspicion that after 2016, when the state gradually becomes responsible for up to 10 percent of the cost, the federal government will drastically increase the states’ portion of the cost. If this were to happen, however, Missouri can simply withdraw from the agreement at any time.

The second argument is that Missouri cannot afford the taxpayers’ 10 percent cost of the expansion after the federal government’s contribution is reduced to 90 percent. That 10 percent is estimated to be $100 million.  

The Republicans neglect to mention there is a hidden tax for not implementing Medicaid expansion. Under the Affordable Care Act, Missouri will begin to lose almost $400 million a year in what are known as DSH (disproportionate share hospital) payments — federal funds that help hospitals and clinics cover the costs of caring for the uninsured. This is money that people with insurance — that is, taxpayers — will have to pay because those federal funds are being withdrawn and because someone has to pay for the uninsured.

A tax by any other name is still a tax. Medicaid expansion provides many more people with insurance, thus replacing the money to be withdrawn from hospitals. The replacement of the DSH revenue loss, the increased productivity predicted by the Institute of Medicine and with the increased revenue predicted by the University of Missouri study dwarf the 10 percent Missouri taxpayers will be responsible for after 2016. Maybe Republican senators would prefer to do what some other states are doing — directly subsidizing hospitals for their DSH losses, at costs far higher than their 10 percent Medicaid cost share and as a more visible tax.

The third argument is that the ACA, including Medicaid expansion, is bad legislation for the country. This is a political argument the Republicans have already lost. The real question is, are Missouri taxpayers going to get back the tax money they have already sent to the federal government to fund Medicaid expansion?

If the economic arguments are not persuasive to our Missouri Republicans, perhaps the human toll can give them a reason to act. Recent studies, such as the Oregon Health Insurance Experiment and studies reported in the New England Journal of Medicine and the American Journal of Public Health, indicate that low-income women will forgo recommended lifesaving breast and cervical cancer screening; diabetics will forgo medications, and all low-income adults will face a greater likelihood of depression, catastrophic medical expenses and death.  

Researchers at Harvard Medical School used these and other studies to conclude that having Medicaid expansion in Missouri in 2014 would result in an estimated 7,770 fewer people suffering catastrophic medical expenditures, 21,816 more people being screened positive for depression, 12,947 more diabetics receiving medication for their illness, 4,086 more mammograms among women ages 50-64 and 14,434 more pap smears among women ages 21-64.

Tragically, the lack of health care services that would have been provided under Medicaid expansion will result in an estimated 459 deaths in our state in 2014.

How much more does it take to make this a big deal for conservative Republicans?

Doug Brooks, of Joplin, is a member of the executive committee of the Democratic National Committee.

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