The Joplin Globe, Joplin, MO

August 4, 2013

Residents show support for Medicaid expansion during summer hearings

By Eli Yokley

COLUMBIA, Mo. — Webb City native Derek Benham is one of the nearly 100 Missourians who took time this summer to address a legislative panel on the issue of Medicaid expansion in the state.

Benham, a second-year medical student at the University of Missouri, told a panel appointed by lawmakers at a hearing in Columbia last weekend that expansion would help uninsured working Missourians who end up having to use places such as the MedZou Community Health Clinic in Columbia where he works.

In his testimony, Benham said his clinic, like other free clinics throughout the state, serves the “working poor,” some of whom, he said, “provide for their children before seeking their own health care.”

“As a conservative, I strongly believe that we should attempt to find private-sector solutions to society’s problems,” he said in an interview after testifying. “However, there is not always a private-sector solution. Far too often this country gets caught in a political knot, with demagoguery and partisanship encroaching where service and leadership once stood.”

What is known as the House Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform heard similar comments from doctors, advocates for the disabled, hospital executives and the uninsured. The working group is one of three committees created by state lawmakers after the Republican-led Legislature repeatedly rejected Medicaid expansion proposals in the spring session.

‘Common ground’

Another of those who spoke was Barton County cattle rancher Darvin Bentlage. He drove to Columbia to be heard in the debate over Medicaid expansion.

Bentlage said he is a 57-year-old survivor of hepatitis B who does not have private health insurance because he doesn’t want to go deeper in debt, having already taken out a $700,000 farm loan.

Missouri has 850,000 residents like Bentlage who are uninsured.

“We’re not asking for handouts,” said Bentlage, of Golden City. “We’re just asking to help each other. That’s what people do, especially in rural communities. ... I don’t care if you’re Republican or Democrat. There’s a common ground somewhere.”

While the overwhelming majority of those who spoke in Columbia and at three other hearings in the state favored expanding Medicaid, and although Democrats led by Gov. Jay Nixon also are pushing for it, Republicans have thrown up a number of red flags.

The chairman of the House interim committee, Noel Torpey, R-Independence, and several others on the panel said that repairing what he called a “broken” Medicaid system is equally if not more important than broadening access.

Although Republicans blocked Medicaid expansion this spring, House Speaker Tim Jones, R-Eureka, called it a two-year issue and said “reforming” Medicaid to make it available to more people “truly in need” would be the focus of the General Assembly next year.

“We see — and I believe Missourians see — expansion without reform as a massive misuse of taxpayer dollars on a program that provides inferior access to health care and poor health outcomes,” Jones said. “If we dump hundreds of thousands of additional uninsured people into that system and give them a magical plastic card and simply say, ‘Well now you have free health care,’ we will further drive an already broken system into a bankrupt state.”

Medicaid cutoff

Missouri’s Medicaid program is currently aimed at children, people with disabilities, low-income parents, the low-income elderly and pregnant women.

The current income cutoff for Medicaid in Missouri for custodial parents is $4,475 annually, which represents 19 percent of the poverty level.

Democrats and Nixon want to change that, raising the eligibility limit to 138 percent of the federal poverty level, or $32,499 for a family of four.

According to a study by the University of Missouri and the Missouri Hospital Association, that would expand the program to about 300,000 Missourians.

Under President Barack Obama’s 2010 Affordable Care Act, the federal government would cover 100 percent of the program for the first three years for states if they expand adult Medicaid eligibility to 138 percent of the poverty level.

While the federal government would fully cover the cost of the expansion in fiscal years 2014, 2015 and 2016, states would be responsible for a 5 percent share of those costs in 2017, with an increase to 10 percent by 2020.

The annual cost of expanding Medicaid has been estimated at $2.3 billion, meaning Missouri taxpayers would be picking up $230 million in costs after 2020, but many Republican lawmakers fear that would not be the end of it. They worry that the federal government, which is already saddled by $17 trillion in debt, will shift more of the financial responsibility to states.

Already, 16 states, including Kansas, have completely rejected expansion, citing costs and other concerns.

State Rep. Tom Flanigan, R-Carthage, was selected earlier this year by Jones to serve on a legislative panel tasked with reviewing options to the Medicaid challenges. Flanigan said his committee is waiting to receive a report from the working group.

“I think it’d be a good idea to reform it before you expand it. But when you have a system that affects that many people, you have to take a look at how it is put together and how it is implemented,” he said in an interview last week, noting that currently the $8 billion program is administered by four different state agencies.

“I’d like to see it all come from one place so you’re not all across the board administratively.”

State Rep. Charlie Davis, R-Webb City, said he agrees with the idea of making substantive changes to how the program is administered before adding additional enrollees.

“The Medicaid system is designed for the neediest of us — not the working individuals,” Davis said. “We need to fix something before we do a blanket expansion.”

Rural challenge

The challenge of taking care of those who are uninsured is not a Kansas City-St. Louis problem. Nearly half of the state’s uncompensated medical care costs come from non-metro areas and rural Missouri.

Statewide, more than 893,000 Missourians participated in the program in 2012.

Speaking at a hearing in Springfield earlier in July, Dr. Charles Bentlage, of Joplin, medical director of Access Family Care, told the committee that expansion would help patients receive continuity of care, in which they could see one doctor instead of showing up at multiple locations such as emergency rooms and urgent care sites. Access has locations in Joplin, Carthage, Anderson and Cassville.

“That can best be done in a Medicaid setting,” he said.

“These patients are going to get care somewhere, but if they don’t have access to care readily, they end up going to an emergency room, which is the most expensive kind of care there is.”

Bentlage also said that kind of treatment offers fewer benefits for those with long-term chronic problems, such as diabetes and obesity.

About 40 percent of the patients who go to Access clinics are covered by MO HealthNet, Missouri’s Medicaid program.

Don McBride, CEO of Access Family Care, said many of the rest are uninsured.

“Anything the state decides to do must push Missourians toward wellness, especially if it increases eligibility into the program,” he said. “Costs can only be reduced through a strong chronic care management program and increasing wellness.”

THE ASSOCIATED PRESS contributed to this report.

Hospitals jeopardized

MISSOURI HOSPITALS handle about $1.1 billion in uncompensated medical care each year, according to John W. Bluford, president and CEO at Truman Medical Centers in Kansas City. Without expansion of Medicaid, he argued, hospitals providing care to the uninsured are left on the hook for the cost of low-income patients. “It jeopardizes the hospitals of the state,” he said.