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Columbia Missourian

Missouri House Democrats file bill to expand Medicaid coverage

By Fedor Zarkhin
February 18, 2013 | 8:27 p.m. CST

JEFFERSON CITY – Less than a week after House Republicans outlined a spending plan that omitted Gov. Jay Nixon's proposed Medicaid expansion, House Democrats filed a bill that would do just that. 

If Missouri expands Medicaid eligibility to 138 percent of the federal poverty level — as the House bill filed on Monday proposes — the federal government will pay for all of the expansion from 2014 to 2017 and would gradually reduce its share of the bill to 90 percent by 2020.

An estimated $8.2 billion would come to the state from the federal government to pay for the expansion in the first seven years.

Democratic legislators and the governor have said Medicaid expansion is the single most important issue this legislative session. Republican legislators, however, oppose expansion because they aren't convinced the federal government will fulfill the commitment to pay its share of the cost.

The CEO of a rural hospital and a retired pastor were on hand to voice support for the bill. They said that if Medicaid isn't expanded, rural hospitals, the uninsured and Missouri's economy will suffer.

Retired pastor John Bennett, representing Missouri Faith Voices, was indignant about the consequences of a lack of health care coverage. He cited a Families USA study that claims that nine Missourians per week died in 2010 because they didn't have health insurance.

"That is a moral abomination," he said. 

Expanding Medicaid would insure about 300,000 low-income Missourians who are currently ineligible for Medicaid, according to estimates cited by the governor and House Democrats. 

The bill's sponsor, Minority Floor Leader Rep. Jacob Hummel, D-St. Louis, stressed the potential economic impact of expanding Medicaid. Citing an MU study, he said expansion would create 24,000 jobs in 2014. And because of a provision in the Affordable Care Act, failing to expand Medicaid would cost the health care industry 5,000 jobs, he said.

When the Affordable Care Act was passed, it was assumed that Medicaid expansion would remove the need for federal funds to pay for treatment of uninsured patients. Because of a provision in the act, Missouri will stop receiving that federal money in 2014. Hospitals will have to pick up the cost of treating uninsured patients if Medicaid isn't expanded.

The Pemiscot Memorial Hospital's CEO Kerry Noble said his hospital would be put in jeopardy because it would lose about $1 million in federal dollars – out of a total $50 million budget – if Medicaid isn't expanded. MU Healthcare, meanwhile, would lose $5 million to $6 million per year, MU Healthcare Media Coordinator Jeff Hoelscher said.

But Speaker of the House Rep. Tim Jones, R-Eureka, said the idea that rural hospitals could be in financial jeopardy was a scare tactic.

"If we're going to work on a system that's better, it has to be good for Missouri taxpayers, not just for Missouri hospital executives," Jones said. "It has to be good for Missourians who need good health care, not just for hospitals to continue to build more wings."

He said it wasn't guaranteed that the federal government will pay for 90 percent of the newly-insured from 2020 onwards and that the federal government doesn't always live up to its financial obligations.

Instead of expanding Medicaid, lawmakers should reform it, Jones said. Specifically, he said more health care should be provided to those who "really need it," he said, meaning seniors, the disabled and children. 

It is up to Jones to refer the bill to a committee. When asked, he did not dismiss the idea of moving the bill.

Supervising editor is Karen Miller.