The Joplin Globe, Joplin, MO

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April 10, 2013

Governor continues effort for expansion of Medicaid in Missouri


CARTHAGE, Mo. — The current legislative session ends next month, but Missouri Gov. Jay Nixon said Wednesday he still is pushing for lawmakers to approve measures to expand Medicaid in the state.

He told a gathering at Mercy McCune-Brooks Hospital in Carthage that expanding the state Medicaid rolls by 300,000 would help those working Missourians and boost the state’s economy.

Work on a state budget is under way in the Missouri Senate; the House has passed a budget that does not include Medicaid expansion.

But the governor on Wednesday cited recent meetings with Republican leadership, which holds the majority in the House and Senate. And he noted that a House committee recently endorsed a bill that would expand coverage — though not to the level sought by the governor — and implement reforms designed to reduce costs.

Committee action on the measure is “a real and concrete step forward,” Nixon said to a large crowd of community and business leaders gathered at the hospital.

The governor said he continues to push for Medicaid expansion by asking residents to urge their legislators to support the plan. More than 50 chambers of commerce and other business groups support the expansion, and Nixon noted that the first endorsement came from the nearby Springfield Area Chamber of Commerce.

“They understand that it will improve the economy and add good jobs,” he said, noting a University of Missouri study predicting that the expansion would create 24,000 jobs in the first year.

Before the news conference, Nixon met privately with hospital officials and local leaders from the city, chamber and other groups. But in an area where Republican politics dominate, some after the session offered a measured reaction.

Chambers of commerce in Joplin and Carthage have not endorsed the expansion, and Pat Goff, president of the Carthage chamber, said the organization continues to study the issue. He said developments are being closely monitored by the group’s governmental affairs committee, noting that Republican state Rep. Tom Flanigan, of Carthage, and Sen. Ron Richard, of Joplin, have “standing invitations” to the meetings.

“If we get to the point we feel like the issue is clear, we’ll take a recommendation to our membership,” Goff said. “We understand there are positives, but there is a downside too.”

Flanigan, vice chairman of the House Budget Committee, has said Missouri would not be able to afford the longer-term costs of the expansion, when the state would have to start picking up a share of the expenses. Federal funds are to cover costs during the first three years as an incentive under the federal Affordable Care Act to get states to expand Medicaid requirements to cover more people.

Richard on Wednesday referred questions to Sen. Kurt Schaefer, R-Columbia, chairman of the Senate Appropriations Committee, who said Nixon is asking for “a blank check to expand the population of an already-broken (Medicaid) program.”

“Whatever the future costs are,” Schaefer said, “it will have to come from general revenue and public education, because that’s the only place the money is available.”

Nixon has said the expansion would provide health care coverage for Missouri residents who work but are not paid enough to afford health insurance. He said other states are signing on, after recognizing the economic benefits from an expansion that would bring $5.7 billion more in federal funds back to the state.

“It’s a loss we can’t afford, and inaction will mean fewer jobs, more crowded emergency rooms and higher insurance costs,” Nixon said.

Not having insurance “is stressful and frustrating,” said Christy White as she was leaving after treatment for bronchitis at Access Family Care in Joplin on Wednesday.

She said her husband’s job offers health insurance, but they have not been able to afford their share of the coverage. She stays home with their four young children who have Medicaid coverage.

White said she has tried to find affordable coverage but has been unable to because of pre-existing medical conditions, so the Medicaid expansion would be a help.

Mabelstet Roach, of Joplin, also a patient at Access, said she tried to qualify for Medicaid more than a year ago but was told that her income — from a restaurant job and a small pension — was too high.

Roach, 62, said she is collecting Social Security. She said Medicaid coverage would help her with treatment for asthma and other medical problems. She said she lives with a friend to cut down on housing costs, adding, “If it wasn’t for that, I’d be having to choose between food and medicine.”

Bob Copeland, chief executive at Mercy McCune-Brooks in Carthage, said the absence of consistent health care translates to sicker patients and higher health costs.

“If people don’t have to use the emergency room for their primary care, it’s a savings for everyone, including those paying for insurance coverage,” he said.

Hospitals in the state strongly endorse the Medicaid expansion as a way to offset losses from cuts in the amount they receive in federal funds for treating uninsured patients.

Doug Culver, chief financial officer at the Carthage hospital, said hospitals also are facing cuts as a result of the federal sequestration. Those cuts will amount to about $500,000 annually, and will leave the hospital looking for ways to cut costs and seek out higher reimbursements from insurance carriers, he said.


FOR THE NINE MONTHS ENDING MARCH 31, costs of uncompensated care at Mercy McCune-Brooks Hospital totaled $4.7 million, including $837,000 designated as charity care, according to hospital officials.

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