Medicaid expansion would help Missouri's patients, hospitals
The Kansas City Star
A strong case for an expansion of Missouri’s miserly Medicaid limits can be made from the emergency room of Bothwell Regional Health Center near downtown Sedalia.
It was hopping on an otherwise quiet Monday morning. A mother cradled a sick child in one room. In another, a middle-aged man reclined on a hospital bed. Seats in the small waiting room were all occupied.
About 24,000 patients a year visit the 12-bed unit. Almost one in five has no health insurance.
“These people perceive themselves as hardworking individuals,” said JoAnn Martin, administrator of the Pettis County Health Center. She sees the patients on the front end when they visit her clinic for screenings and advice.
“They work in low-paying jobs where health insurance is not a benefit,” Martin said. “They won’t go to a doctor because they don’t want a bill and sometimes they end up in the hospital emergency room, where the bill is just insurmountable.”
John M. Dawes, president and CEO of Bothwell Regional Health Center, feels that problem keenly. His hospital provided $15 million worth of care and community services in 2011 for which it was not paid. The federal government and other sources helped with the tab, but the hospital still ended up not reimbursed for $2.5 million.
Towns like Sedalia and hospitals like Bothwell are at the crux of Missouri’s pressing debate over Medicaid expansion.
The hospital, with a staff of 840, is the city’s second largest employer. Its staff and clinics enable the people of west-central Missouri to obtain high-quality health care without traveling to the bigger hospitals in Columbia and Kansas City. To meet the growing needs, Bothwell opened new cancer and cardiovascular care units in 2011, and recently opened a wound clinic.
Expanding Missouri’s very low Medicaid limits would guarantee financial security for Bothwell and contribute to a healthier population. An additional 4,200 persons in the hospital’s service area would gain the ability to see a primary care doctor on a regular basis and be treated at the early stages of medical problems, rather than seeking crisis care in the emergency room.
“It is really about access,” Dawes said. “We do know that if you have some sort of coverage you will seek treatment. We have some accountability to help people stay well.”
As many as 300,000 persons would gain access to health insurance if Missouri would raise its eligibility requirements from the current threshold of 19 percent of the federal poverty level to 133 percent, which is the level called for in the federal Affordable Care Act. The federal government would pay the full cost of the expansion for the first three years, and never less than 90 percent.
In return for financing the Medicaid expansion, Washington is going to phase out its “disproportionate share” payments to hospitals. That’s money it channels to hospitals to help cover losses incurred from treating uninsured patients. And this money is going away, whether a state like Missouri does or does not raise its Medicaid limits.
Democratic Gov. Jay Nixon is pushing for the expansion, as are Missouri’s leading business and health care groups. Their hurdle is convincing Republican lawmakers who control the General Assembly, and who almost uniformly abhor “Obamacare.”
Resistance is strongest in rural parts like Pettis County, where Sedalia is located.
“It’s not a prudent thing for us to do as a state,” said Rep. Stanley Cox, who represents the area. He fears Washington would renege on its promise to fund the expansion, and he is loath to contribute to the national debt.
But rural Missouri has the most to gain from the expansion. It would dramatically reduce the ranks of the uninsured and bring millions of health care dollars into lagging economies. And it would keep rural hospitals solvent.
Like all of Missouri’s hospital administrators, Dawes dreads a scenario whereby the legislature would refuse to participate in the Medicaid expansion, even as the federal government stops sending disproportionate share payments his way.
“We’d be faced with some very difficult decisions,” Dawes said. “It’s going to make or break our ability to expand, to provide technology, to increase our workforce.”
For smaller, more remote hospitals, the choice is even more crucial. No one wants to alarm a community, but administrators have been quietly telling lawmakers that closure might be a possibility if they aren’t compensated for treating uninsured patients.
A healthy future for Missouri hinges on what the legislature decides on the Medicaid expansion.
Opponents’ fear that the U.S. government might someday stop providing its financial share is hypothetical, even farfetched. Washington’s inclination has been to add people to Medicaid, not subtract.
The worries of Dawes and his patients are grounded in reality. Lack of health insurance leaves families, hospitals and communities in a state of peril, and that will only get worse.
Constituents and business leaders must help reluctant legislators overcome their doubts.