WHAT OTHERS SAY: Missouri Medicaid expansion is too important to die

Monday, April 22, 2013 | 2:49 p.m. CDT

A brutal form of cynicism lies behind the latest excuse offered by Missouri Senate Republicans for refusing to even discuss an expansion of the state Medicaid program. The proposal would extend health insurance to poor people and bring thousands of jobs to the state by leveraging billions of dollars in federal investment.

Sen. John Lamping, R-Ladue, was one of several senators to use the word “dead” to describe House Bill 700, sponsored by Rep. Jay Barnes, R-Jefferson City. The bill would both revamp the state’s Medicaid program and seek to take advantage of the promised federal money to pay for it.

If it’s dead, why did it die?

In his 2014 budget filed earlier this month, President Barack Obama proposed delaying $500 million in spending cuts called “disproportionate share” payments. These are the federal payments to hospitals that pay for at least some of the health care costs of the millions of Americans who are uninsured, but end up in hospital emergency rooms for care.

It’s a horribly inefficient system that is being phased out under Mr. Obama’s Affordable Care Act. The payments will be unnecessary because millions more Americans will have insurance. The spending on the front end saves us all money on the back end.

Mr. Obama is seeking to delay the cuts specifically because of the intransigence of some state lawmakers, like the Republicans in Missouri, who have ignored both the moral and economic imperatives to find a way to provide insurance to more Americans. If states are slow to implement the Affordable Care Act, then cutting the disproportionate share payments will be devastating to hospitals, specifically those in rural areas, that will still have to spend millions of dollars on uncompensated care. Those proposed cuts have put pressure on reticent rural lawmakers afraid that major employers in their regions could lose jobs.

It’s key to understanding the moral bankruptcy of the Missouri Republican Party that this is the only motivation that might have persuaded them to keep the Medicaid expansion proposal alive.

Senate Republicans weren’t moved by empirical evidence that uninsured people are more likely to die than those with insurance. In 2009, a Harvard Medical School study found that 45,000 Americans die premature deaths every year in part because they lack health insurance. They weren’t moved by several studies showing that the infusion of $2 billion a year in federal funds each of the next three years will create thousands of health care jobs as hospitals and other health-care professionals increase staffing and investment to help serve more than 260,000 newly insured Missourians. They weren’t moved by the fact that if those 260,000 Missourians remain uninsured, an average insured family of four will pay about $1,688 more a year for health care to cover those costs.

They weren’t even moved by an opportunity to reform Missouri’s Medicaid system and leverage the federal money to move more poor people into the private insurance system.

No, what “killed” the Medicaid expansion bill was Mr. Obama’s proposed budget, a budget that Congressional Republicans called dead on arrival. The circular logic is stupendous in its deception.

First, Republicans blame Mr. Obama for the Affordable Care Act, even after he models it after many of their ideas. Then they spend two years doing their best Walter Mondale impersonation, repeating over and over again, “Where’s the budget?” When the budget is released, of course, they declare it dead. But in Missouri, those same Republicans seize one line of the budget and say, “See? Medicaid expansion is unnecessary!”

Meanwhile, they’re spending their time making sure more Missourians will be in poverty. Not only will poor folks continue entering the health-care system through the expensive door of the emergency room, they also face GOP tax-cut legislation that will further shift the costs of nearly everything toward poor people.

Perhaps we enjoy tilting at windmills, but we refuse to believe that the Missouri legislature is so bereft of people with a moral commitment to their fellow man that this sort of nihilism can continue ad infinitum.

Why, we recall being impressed when Mr. Lamping told us, back when he was running for office in 2010, that he is guided by the principle set down by St. Ignatius Loyola, the founder of the Jesuit order, that those entrusted with power should make “no decision without considering the impact on the least in society.”

The Medicaid expansion effort is too important to allow it to be blocked, particularly for the Senate’s specious reasons. Gov. Jay Nixon, a Democrat, has done his level best traveling the state, hand in hand with business leaders, most of whom have traditionally supported republicans, to rally support for this important legislation. But it hasn’t been enough.

It’s time for those business leaders to take a stand. Write some big checks for Democrats and see who comes running. Let Republicans like Mr. Lamping know that their careers are over if they don’t get serious. Let Mr. Nixon know you’ll help him round up the votes to beat back overrides if he starts vetoing every bill that comes to his desk.

Medicaid expansion isn’t about Mr. Obama and it’s not about some consultant-driven debate about future electoral success.

The more people in Missouri who have health insurance, the fewer of them will die. This is literally a life-and-death issue.

Copyright St. Louis Post-Dispatch. Reprinted with permission.

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Jimmy Bearfield April 22, 2013 | 4:51 p.m.

"They weren’t moved by the fact that if those 260,000 Missourians remain uninsured, an average insured family of four will pay about $1,688 more a year for health care to cover those costs."

With expansion, the average insured family still has to pay more because the ACA doesn't magically make people who cannot afford insurance today capable of affording it tomorrow. Put simply, you cannot get blood from a stone. Those who can afford insurance will still have to pick up the tab. What part of this doesn't the P-D editorial board get?

"The payments will be unnecessary because millions more Americans will have insurance. The spending on the front end saves us all money on the back end."

The P-D editorial board needs to come down from its ivory tower and spend time with people already on Medicaid. Lots of them use the ER for tummy aches, the clap and everything else because it doesn't come out of their pocket.

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