For Missouri GOP, it's ready, fire, aim on Medicaid expansion
Barb ShellyAs The Star’s Jefferson City correspondent Jason Hancock relates in this story, Republican lawmakers in Missouri are standing firm in their opposition to expanding Medicaid limits as called for in the federal health care law.
House Speaker Tim Jones; newly elected Senator Ryan Silvey, the former House budget chair; and Rep. Jay Barnes of Jefferson City are among the GOP contingent which has said an expansion is a non-starter.
Of course, they have decided this without trying to find out what an expansion would actually cost the state, or if the state might actually save money by expanding the limits.
Politicians assert that expanding Medicaid limits to 133 percent of the poverty level would cover an additional 255,000 adults and cost the state of Missouri $431 million over six years.
That data comes from a report by the Kaiser Commission on Medicaid and the Uninsured. But those aren’t official numbers. State budget analysts and several groups outside of Missouri government are currently trying to come up with accurate numbers of how many people would realistically be involved in a Medicaid expansion.
And then there are the offsets to consider. As we noted in an editorial a week ago, Missouri currently spends millions of dollars on mental health care that likely would be absorbed in a Medicaid expansion. The same goes for the $28 million to provide health coverage for low-income blind people, which some Republicans tried to get rid of in the last legislative session.
There are other offsets, as well. The Affordable Care Act requires states to begin providing health insurance for former foster children from ages 18 through 26. Missouri will have to absorb that cost whether or not it expands Medicaid limits, and most of that population would likely fall within 133 percent of the federal poverty level.
As this piece by Star reporter Alan Bavley points out, Missouri spends money to litigate appeals from citizens who are turned down for Medicaid. Often the state is on the losing end. Expansion of the limits would make most of those appeals unnecessary.
One of the biggest offsetting factors is the money the state and federal governments now pay hospitals to treat patients without insurance. The federal share of that match is supposed to be phased out as the Affordable Care Act takes effect. And the state match would be expected to lessen, also, as hospital treat fewer uninsured patients.
Hospitals who serve large numbers of uninsured patients are sounding warnings that they couldn’t survive financially if the uncompensated care payments go away and Missouri’s Medicaid limits remain at 19 percent of the poverty level. Hospitals would be required by law to treat people, but have no means of recouping any of the cost.
And lawmakers shouldn’t lose sight of the fact that the federal government would pay 100 percent of the cost of an expansion at first, and never less than 90 percent. That would mean billions of dollars coming into Missouri to pump up its health care sector, with a resulting increase in jobs.
Missouri Republicans, who are very much in charge in the legislature, detest the Affordable Care Act and are worried about taking on future costs. But they really should find out what the costs will be before making up their minds.
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