From the Missouri Viewpoints Archives:

Publication date: February 08 2013

Expanding Medicaid in Missouri: Healthy Growth or Fiscally Irresponsible?

Expanding Medicaid in Missouri?

A Healthy Growth or Fiscally Irresponsible?


By Mike Ferguson


Governor Jay Nixon is taking his pitch directly to the people of Missouri because Republicans in the State Legislature arent interested in what hes selling when it comes to health care.


Nixon wants the state to accept over $5 billion in federal funds to expand the Medicaid roles. Expanding coverage would put an estimated 300,000 Missourians on the program. The federal government is offering to pick up the entire tab for the first three years and cover 90% of the cost after that.


On Missouri Viewpoints, Jennifer Bersdale from Missouri Healthcare for All says the decision to accept the money should be simple for lawmakers. Those are funds that have already been allocated for Missouri so its really, for the state, a decision of do we take those funds or send them to another state?


Governor Nixon has made that same appeal over the past couple weeks.


The national spending discussion is part of this state discussion. Former State Representative Carl Bearden now runs United for Missouri, a conservative advocacy group. He doesnt agree with that reasoning from the Governor and other expansion supporters, including Bersdale.


It doesnt operate like road funds it doesnt operate like a lot of other federal funds where, if you dont take them, they can transfer them. Medicaid is based on the number of people you have on your program, how many people are receiving services, what services they are receiving and you get reimbursed for that regardless of what any other state does.


Bearden, the former Chairman of the House Budget Committee, also argues that Medicaid shouldnt be the system the state looks to for protecting the low income and those who are currently uninsured. Thats because of what he says are inefficiencies in the system and an increasing number of doctors who refuse to accept Medicaid patients because of recent reductions in the amount government will reimburse doctors for treatments.


If you are on Medicaid today you will have a very difficult time finding a doctor who will take your Medicaid services because they simply cannot afford to. They cant take all the patients and so it doesnt do any good to have a card if you cant cash in on the card.


Instead, Bearden hopes for a more innovative approach, like using government health benefits in a way similar to food stamps. That, he argues, allows the consumer to use the funds in a way thats best for them through insurance premiums, co-pays, prescriptions or outpatient services.


Basically, Bearden and most other conservatives say they want government, especially the federal government, less involved in our health care decisions.


But what does that mean for the uninsured now?


Bersdale argues that, imperfect or not, expanding Medicaid now accomplishes a simple goal. This is really a small investment for the state in getting hundreds of thousands of people access to health care.


Access to health care on the governments system, she argues, would provide immediate life saving treatments and medications to an estimated six percent of those who would be added to the roles. That number is from a University of Missouri study.


To me, that is worth a small investment on the part of the state. To save those lives because I think that is our most important goal as a society.


The debate extends beyond actual health care coverage. Supports of expanding Medicaid say growing the state system through the federal funds would infuse up to 24,000 jobs into the states economy. That, they argue would have a residual effect of preserving several rural hospitals that wont have enough revenue to continue operating otherwise.


Bearden disputes the studies that project that kind of economic impact while also pointing out that Medicaid spending at the state level is directly tied to what they believe is dangerous overspending by Congress and the President.


Bersdale isnt impressed with that argument, saying Congress decision to spend the money has already been made and Missouris decision to accept the funds or not cant impact Washington.


We know that Washington is having a lot of conversations about debt reduction and deficit reduction. Thats really not on the table here. If we dont take the Medicaid expansion here in Missouri, the savings dont go to debt reduction.


Thats a view that Bearden does not share.


Theres no such thing as a free lunchthe federal money is not free, it comes from us as taxpayers and over 40% of it is borrowed, so theres no free lunch.


There is a cost to the state even through the time when supposedly the federal government is picking up the whole tab. That could range anywhere from a billion to three billion dollars, according to the Kaiser Family Foundation.


Republican leaders, including Speaker of the House Tim Jones and Lieutenant Governor Peter Kinder, have already said on Missouri Viewpoints they are opposed to the expansion. The proposal is unlikely to make it through the Legislature this session, prompting the Governor to take the idea directly to Missourians in hopes they can apply pressure on Republicans that he cant.


On the web:


Missouri Medicaid Coalition:


United for Missouri:




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