What Medicaid Expansion meanings for Missourians, hospitals and the state budget

When Missouri passed Medicaid expansion in early August, hospitals had a lot to celebrate. Advocates say the influx of federal dollars could boost the state economy and create thousands of jobs.

Posted: Aug 27, 2020 10:06 AM
Updated: Aug 27, 2020 1:14 PM

(ST. JOSEPH, Mo.) Covid-19 has brought a new urgency and focus to Medicaid expansion.

With millions facing unemployment and loss of health insurance, the governor of Kansas has urged state lawmakers to expand coverage. It's one of just 12 states that have opted not to.

When Missouri passed Medicaid expansion in early August, hospitals had a lot to celebrate.

Mary Becker is the Senior Vice President of the Missouri Hospital Association, one of the groups pushing for expansion.

“We’re talking about really saving lives,” Becker said. “We have been advocating for Medicaid expansion since it became an option in the Affordable Care Act because there are people that are left in a gap.”

About 230,000 Missourians fall into the coverage gap, meaning that they make too much money to get Medicaid and too little to qualify for tax credits to buy coverage through the marketplace.

"You can only earn about $5,000 a year and be a custodial parent to qualify for Medicaid in Missouri,” Becker said. “If you are a single adult you are out of options."

Under the Affordable Care Act, states can "expand" Medicaid coverage so that more people qualify. If they pass it, then the federal government picks up 90 percent of the tab. States kick in the other 10 percent.

“The opponents to Medicaid expansion, the big fear is that we can't afford to do this but the good thing is we are not a pilot program,” Pat Dillon, Chief Government Issues at Mosaic Life Care said. “There's been 37 other states that have done this.

Dillon also said the sticker price may be jarring, but it costs more for us not to do it.

“They let their health go long and they get really sick and they show up in an emergency room and it's a much more expensive kind of care when they have to come to our emergency room,” Dillon said.

“A physician who said ‘I just admitted a woman who is uninsured with stage 4 breast cancer,’” Becker said. “He said she had just refused to come in because she didn't want to have a medical bill so it's just examples like that that physicians in hospitals see time and time again.”

Take for example the $1.5 billion a year that Missouri hospitals foot in unpaid medical bills, with northwest Missouri paying about $87 million of those bills.

A billion dollars could go a long way to supporting rural hospitals, Missouri has lost 10 since 2014.

“Half of the rural hospitals out there operated at just a bottom line or negative margin where they’re not hardly making money if any at all,” Dillon said.

Advocates also say the influx of federal dollars could boost the state economy and create thousands of jobs.

“The increase in funding would increase an average of 16,330 jobs a year in that four year period,” Becker said. “923 of those are in the northwest region.

Most importantly, they say this will save lives.

“There's a lot more people that are unemployed now,” Dillon said. “There are an awful lot of people that may not go back to work, so we’re going to have a group of people out there that may have to take advantage of this that maybe wouldn't have even thought about this six months ago." 

With Missouri voters approval, Missouri lawmakers have until July 1, 2021 to implement Medicaid expansion.

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