Medicaid expansion vote in Missouri coming next week

SPRINGFIELD, Mo. (KY3) -

It’s not often you see doctors making house calls, but expanding Medicaid brought out a group of Springfield doctors going door-to-door last November to help collect signatures to put the issue on the ballot.

Their house calls paid off as enough signatures were collected to put Medicaid expansion to a vote of the public in the Show-Me-State next Tuesday, August 4.

Medicaid is a government program that provides medical insurance to groups of low-income people and those with disabilities.

The Affordable Care Act expanded Medicaid to individuals who in 2020 have an income of approximately $17,600 or less and to less than around $36,000 for a family of four. The qualifying incomes are set by percentages so they can vary.

In Missouri, a single adult doesn’t qualify for Medicaid and a family of four must make less than $5,500.

A total of 37 states have expanded Medicaid benefits, while Missouri is among the 13 that hasn’t. And with the federal government covering 90 percent of the costs, those who support the expansion say the Show Me State is missing out.

“We’re already taxed for this,” said Steve Edwards, the President/CEO of CoxHealth. “The Affordable Care Act started these taxes. Missourians are being taxed for this. So it’s about $8 billion of federal funds we have said ‘no’ to.”

Those against Medicaid expansion point to the fact that the state will still have to chip in its share and is already among the top five states for general revenue spent on Medicaid (according to research from Pew Charitable Trusts).

With Governor Mike Parson estimating the state will need an additional $88 million in general revenue through 2021 because of the coronavirus, and with massive budget cutbacks already taking place, those against Medicaid expansion are wondering where the additional funds will come from.

“We’re trying to add an unsustainable program to our unsustainable budget,” said Dr. Ken Spangler, a former emergency room physician who’s against the expansion.

Supporters counter that the COVID-19 outbreak is just one more reason Medicaid expansion is needed.

“It expands Medicaid for the working poor,” Edwards said. “And when we’re in the middle of this pandemic we know that these have been the essential workers for us. The people who’ve been helping us and putting themselves at-risk.”

But Spangler says his extensive time in the medical industry has left him with the view that the entire Medicare system needs to be overhauled.

“Because Medicaid pays so poorly, pays so late, and refuses payment so frequently it’s estimated there would be $150 million in revenue loss which equates to 2,700 jobs lost,” he said. “And you’ve seen huge hospitals like Mercy laying off a lot of people recently. I also have been in many hospitals where we knew people coming through the door did not match the Medicaid card. We reported them and reported them and were finally told it’s not our job to police the Medicaid rules. Every time we’ve seen Medicaid expansion we’ve seen the volume in our emergency rooms go up and up and up. I was acutely aware of the people who were overwhelming our emergency service for things that they would have never gone to a doctor for. Even if they’d have to pay five bucks. We need to look for waste, abuse and fraud and we need to prosecute every case.”

Edwards points to studies that have been done in states who have expanded their Medicaid system.

“There have been more than a dozen studies that have shown it pays for itself,” he said. “Montana in their first year had a $50 million positive impact to their state budget, Virginia last year had about a $400 million positive impact. If someone told me ‘If you invest a billion and we’ll give you nine billion back’ and you can’t make that math work, we need new leadership.”

Edwards also brought up the importance of expanded Medicaid to rural hospitals.

“Rural hospitals have a lot working against them and we’ve lost 10 to 15 hospitals in the last several years,” he said. “Economics of rural areas are struggling. They’re the ones that are most at-risk. Those rural hospitals are often the biggest employer in their towns so they’re a lynch pin to a healthy economy. This funding can help them.”

Like many disagreements, this is a highly partisan issue with most Democrats for it and most Republicans against it. But there have been some exceptions.

“Eighteen Republican governors have signed this into law,” Edwards pointed out. “It seems like a non-partisan issue to me.”

“I don’t see it as a partisan issue,” Spangler said. “It’s a physical issue.”

If the expansion does pass, it’s estimated that more than half of the 564,000 Missourians who don’t have insurance right now will be able to get it.

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