COLUMBIA — Barton County cattle rancher Darvin Bentlage drove 400 miles roundtrip this weekend to put a human face on the contentious, confounding and convoluted debate over Medicaid expansion in Missouri.
A 57-year-old survivor of Hepatitis B who said he eschews private health insurance to avoid adding more debt to his $700,000 farm loan, Bentlage came to Columbia to implore a 52-person panel of citizens and Missouri lawmakers on Saturday to cast aside partisan differences and help out the state's poorest and neediest residents. Missouri has 850,000 uninsured residents.
"We're not asking for handouts," the Golden City resident said. "We're just asking to help each other. That's what people do, especially in rural communities. ... I don't care if you're Republican or Democrat. There's a common ground somewhere."
For more than six hours, the House Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform heard a similar refrain from dozens of speakers — doctors, disability advocates, hospital executives, the uninsured. The working group is one of three special committees created by state lawmakers after the Republican-led Legislature repeatedly rejected Medicaid expansion proposals in the 2013 session.
Committee chairman Noel Torpey, R-Independence, and several others on the panel said that repairing what he called a "broken" Medicaid system is equally if not more important than broadening access. Gov. Jay Nixon, a Democrat, supported an expansion plan that would have provided government-backed insurance to 300,000 people without coverage at annual cost of $2.3 billion; the state would be responsible for 10 percent of those costs.
House Speaker Tim Jones, R-Eureka, emphasized the urgency of pursuing such fixes when he unveiled the interim committees in June.
"We see — and I believe Missourians see — expansion without reform as a massive misuse of taxpayer dollars on a program that provides inferior access to health care and poor health outcomes," Jones said.
"If we dump hundreds of thousands of additional uninsured people into that system and give them a magical plastic card and simply say, 'Well now you have free health care,' we will further drive an already broken system into a bankrupt state."
The battle over Medicaid expansion is playing out across the nation, as state lawmakers fear they'll be saddled with added costs they don't think the federal government will be able to cover. Expansion supporters counter that reducing the number of uninsured will decrease overall health costs by reducing preventable illnesses, which in turn would mean savings for the privately insured.
The Affordable Care Act allots full funding to through 2016 to states that expand adult Medicaid eligibility to 138 percent of the poverty level. That cutoff covers individuals earning $15,850 or less annually or a family of four with an annual income of $32,500.
States would be responsible for a 5 percent share of those costs in 2017, with an increase to 10 percent by 2020.
The current Medicaid cutoff in Missouri for custodial parents in $4,475 annually, which represents 19 percent of the poverty level. Adults without children at home are not eligible for the insurance.
Dr. Andy Quint, medical director for the Family Health Center in Columbia, said his clinic provided care to about 3,500 uninsured patients last year. Most of the clinic's uninsured patients would qualify under the broader Medicaid eligibility standards, he said.
"Not having health insurance means not seeking care for problems until they become intolerable," he said. "What I'm left with is prescribing pain pills and hoping my patients can keep going until they reach retirement age.
Saturday's session was the committee's third. It will share its findings and recommendations with a separate House committee that will look to craft proposals for the 2014 legislative session. Additional sessions are scheduled in Kennett on Wednesday and Cameron on Aug. 7.