The Joplin Globe, Joplin, MO

May 20, 2013

Herb B. Kuhn, guest columnist: Delaying Medicaid reform could hurt rural Missouri

By Herb B. Kuhn
Special to The Globe

JEFFERSON CITY, Mo. — The Missouri Legislature missed a rare opportunity in the just-ended session to transform Medicaid and make a real difference in the lives and health of hundreds of thousands of our neighbors. Rural Missouri has the most to lose from the legislature’s failure to act.

Health care choices are more limited in rural areas, which means there is tremendous dependence on the facilities and dedicated professionals providing care. The local hospital is not only essential for medical services, it is often the largest employer in a rural community. National studies show that on average, 14 percent of total employment in rural communities is in the health sector. Quality rural health services are critical to attracting and retaining businesses, industries and new residents, as well as retirees.

Rural Missouri will be subject to disproportional distress from Medicaid inaction because so many people rely on relatively few facilities and providers. In recent years, Missouri’s rural hospitals handled one-third of all emergency room visits, nearly 40 percent of the state’s inpatient admissions, a quarter of all childbirths and 28 percent of all heart attack victims. Studies show rural Missourians have more chronic diseases than their urban counterparts, and decreased availability of care can be life-threatening. The legislature’s failure to act means there will be real pain for both the uninsured and for those relying on medical services that are now subject to severe cuts or elimination.

Already, Missouri health care providers are assessing areas in which to reduce or eliminate services because of federal funding shortfalls caused by this year’s inaction in Jefferson City. It will be an anxious summer that has implications for a grim fall and winter.

For example, Heartland Health in St. Joseph has alerted local officials that without additional enrollment of individuals through Medicaid reform, it can no longer subsidize $1.7 million a year in ambulance losses and will discontinue its ambulance services.

Hospitals’ uncompensated care costs will continue to grow unsustainably. In 2011, Missouri hospitals provided $1.1 billion in uncompensated care. These costs are projected to rise to more than $3.5 billion per year by the end of the decade without Medicaid reform. In the federal budget year that starts Oct. 1, hospitals will face significant losses through payment cuts from Medicare and Medicaid without new revenue from Medicaid reform meant to offset those cuts. This will remove the opportunity for growth in both the health sector and throughout the economy, and it will weaken hospitals’ ability to provide the services our communities deserve and depend on.

The House and Senate have indicated they will establish interim committees to study Medicaid during the next few months before the legislature reconvenes in January 2014. We are determined to carry out the public discussion necessary to prepare for legislative action next year. Between now and then, we will continue to build partnerships and educate all parties about the necessity of and the opportunity presented by Medicaid reform. The needs and the stakes are too serious for inaction. Inaction is not an option.

Lawmakers, health care providers and all Missourians need to focus on what we can accomplish. By next year, we can — and we must — build a better Medicaid system for Missouri.



Herb B. Kuhn is president and CEO of the Missouri Hospital Association in Jefferson City.