The Joplin Globe, Joplin, MO

November 29, 2012

Gov. Nixon notes support for state Medicaid expansion

By Wally Kennedy

— Gov. Jay Nixon announced his support Thursday for an expansion of Missouri’s Medicaid program via the federal Affordable Care Act to provide health care coverage for an estimated 300,000 Missourians who do not have that coverage.

About the expansion, Nixon said, “It’s the smart thing to do, and it’s the right thing to do.”

State Republicans immediately criticized the plan, saying neither Missouri nor the nation can afford the federal health care act. Lt. Gov. Peter Kinder said the Medicaid expansion would be “ruinous.” House Speaker Tim Jones called it a “big-government program” that would “increase the burden on future taxpayers.” And Senate leader Tom Dempsey said Nixon’s plan is “very unlikely” to pass.

Nixon said he supports a Medicaid expansion for adults earning up to 138 percent of the federal poverty level, as allowed by the Affordable Care Act. A family of four living at 138 percent of the federal poverty level in 2012 makes $31,809 a year.

Because federal funding would cover 100 percent of the costs for calendar years 2014, 2015 and 2016, expanding health care coverage to those 300,000 uninsured Missourians would involve no state tax dollars for those years, Nixon said.

But the state would have to begin paying a 5 percent share in 2017, and it would gradually increase to 10 percent by 2020. It’s that additional future cost to the state that is opposed by Republican legislative leaders responsible for passing a state budget.

The expansion is supported by the Missouri Hospital Association and local hospitals because it would reduce the number of uninsured.

Noting that the Missouri Chamber of Commerce and Industry has endorsed the expansion of Medicaid in Missouri, Dave Dillon, spokesman for the Missouri Hospital Association, said in a telephone interview Thursday: “The business community realizes that if we don’t expand coverage and continue to have a large number of uninsured people, we end up paying a big portion of that tab.

“The business community realizes what can be saved by individuals and businesses by reducing the number of uninsured.”

Currently, hospitals are reimbursed for treating people who have no health insurance. Under the Affordable Care Act, payments to hospitals that serve the uninsured will be reduced. If those payments are not offset by an increase in federal funds to cover the cost of that care, hospitals will have to bear those costs. That would result in the high cost of caring for the uninsured being passed along to employers and individuals who would have to pay higher premiums for their health insurance.


Gary Pulsipher, president of Mercy Hospital Joplin, and Paula Baker, president of Freeman Health System, on Thursday said they support the Medicaid expansion.

Said Pulsipher: “While we are cognizant of the potential costs associated with the expansion of Medicaid, the cost of uninsured Missouri citizens is higher, both in the availability of their health care and the quality of their life.

“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. Southwest Missouri stands to fare even better than other parts of the state from this proposal.

“Further, those citizens who are insured can expect a premium that is around $2,000 lower than it will be if Medicaid is not expanded during this time period. We encourage our legislators to carefully consider this proposal, the increased jobs it would support, and the additional coverage for the most vulnerable in our society.”

Baker 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.”

Baker said the expansion of Medicaid would have a favorable financial impact not only on Freeman but on the entire state economy, by adding 24,000 jobs and by bringing more than $8 billion in federal funds to Missouri through 2019.

Baker said the Affordable Care Act calls for reductions in Medicare and Medicaid payments. The expansion of Medicaid would offset those reductions.

Is Freeman gearing up for this expansion?

“Absolutely,” Baker said. “We are actively recruiting physicians and nurses. Freeman is well poised and equipped to handle this.”


Herb B. Kuhn, president of the Missouri Hospital Association, said: “The economic activity created by adding $8.2 billion in federal spending to Missouri’s economy will generate nearly $856 million in state and local taxes throughout seven years. And, at a six-year cost of $333 million to the state, Medicaid expansion would be a net gain for state revenue.”

A Missouri Hospital Association study that was done by the University of Missouri suggests that the expansion of Medicaid in the state could create 24,000 jobs in 2014.

Locally, Medicaid expansion would create 1,769 jobs in 2014 in Barry, Barton, Dade, Jasper, Lawrence, McDonald and Newton counties, according to the study. The overall economic impact of those jobs in the seven-county area would be $654.5 million, if the projections hold true.

Under a Supreme Court ruling earlier this year, each state can decide whether to expand Medicaid to adults earning up to 138 percent of the federal poverty level, as called for under the federal health care law.

“If we take a pass on billions of health care dollars — dollars that come out of Missourians’ paychecks — that money will go to some other state,” Nixon said in a conference call Thursday with Capitol reporters. “They’ll get the benefit, and we’ll get the bill. That’s not smart, and that’s not right.”

Nixon highlighted his support for the Medicaid expansion by holding news conferences Thursday at medical centers in Kansas City, St. Louis and Springfield.

THE ASSOCIATED PRESS contributed to this report.