Why expand Medicaid? Let us count the reasons
The Kansas City Star
Missouri and Kansas lawmakers are hard at work on their budgets, and so far neither legislature has factored in an expansion of their states’ Medicaid programs, which would be financed next year by the federal government.
There is still hope. Missouri Republicans are working on an idea to use the federal money to purchase private insurance for low-income citizens, though some of what they’re proposing may not pass federal muster. Kansas Gov. Sam Brownback continues to leave the door open, if only by a crack.
Time is running short, however. And the states and citizens will lose so much if leaders allow their abhorrence of “Obamacare” to overrule good sense.
Here is some of what is hanging in the balance:
- Health care for nearly 300,000 persons in Missouri and more than 150,000 in Kansas
The two states have among the lowest Medicaid eligibility limits in the nation, and childless adults are shut out altogether. Expanding Medicaid to 133 percent of the federal poverty level — as called for in the Affordable Care Act but made optional by a U.S. Supreme Court decision — would enable hundreds of thousands of people to see a doctor when they are ill instead of waiting and eventually turning up in a hospital emergency room.
- Financial security for hospitals
Currently the federal government compensates hospitals for serving uninsured patients. Under the new health reform law, those payments are being phased out, and Medicare payments are also being cut. The Missouri Hospital Association estimates hospitals in the state will experience $4.2 billion in cuts between now and 2020. A Medicaid expansion would make up for much of that.
Otherwise, hospitals would likely recoup some of the estimated $3.5 billion cost of uncompensated care by increasing commercial premiums. That would amount to a hidden health care tax on employers and individual policy holders. Even with that, hospitals would have to cut services and lay off staff. Small rural hospitals would take the hardest hit.
- Jobs, jobs, jobs
The Affordable Care Act calls for the federal government to pay the full cost of a state’s Medicaid expansion the first three years, and never less than 90 percent after that.
Credible studies show that a full Medicaid expansion would bring $8.2 billion in federal dollars to Missouri by 2020, creating 22,000 sustainable jobs over seven years. Researchers estimate Kansas would receive more than $3 billion and benefit from more than 4,000 new jobs.
Federal money would help expand both states’ health care networks, creating jobs for doctors, nurses, front-office workers and technicians. The economic activity would be expected to generate $856 million in state and local taxes in Missouri and $112.5 million in Kansas.
- Care for the mentally ill
Mentally ill persons make up a large share of the population that would benefit from a Medicaid expansion.
In Missouri, it’s estimated at about one-sixth. A Medicaid expansion would enable cash-strapped states to cease their feeble attempts to treat the uninsured mentally ill with money from their general funds, and use insurance to do a much better job.
People could get help sooner and receive treatment on a more continuous basis. They would be seen less frequently in hospital emergency rooms and jails.
On the flip side, states that don’t expand Medicaid can expect to see hospitals cut back on their numbers of psychiatric beds, because of the high rate of uninsured patients in the mentally ill population.
The recent debate on gun safety has prompted many politicians to call for better care of the mentally ill. This is their chance. Expanding Medicaid would greatly help the mentally ill. Denying them insurance would make an already terrible situation ever worse.