COLUMBIA — When legislators find themselves frustrated by a particularly touchy problem, their default reaction is to form a special committee and take testimony. So it was earlier this year with the Missouri legislature and Medicaid expansion.
As you’ll recall, Gov. Jay Nixon recommended – even urged – that the legislature take the steps specified in the Affordable Care Act, more popularly known as Obamacare. That would have led to Medicaid coverage for upward of 400,000 currently uninsured Missourians, with the feds picking up the entire bill for three years and 90 percent of it thereafter.
A study by the university’s School of Medicine calculated that the expansion would, while improving health care for the newly enrolled, create 24,000 new jobs over a 6-year period, generate more than $800 million in new taxes and save the holders of private insurance close to $1 billion in lower premiums once they don’t have to cover the costs of the uninsured. The expansion would more than pay for itself.
This was as close to a pure win-win situation as you’re ever likely to see.
So, of course, the Republicans who control the legislature refused. Indeed, the proposed legislation that House Republicans supported would have actually reduced the number of children covered.
When the Senate declined to consider the issue, House Speaker Tim Jones created not one but three interim committees to take the public’s pulse and come up with recommendations. Mr. Jones made it clear that he was more interested in “reforming” the program than in expanding it.
Last Saturday morning, in the meeting room of the Columbia Public Schools administration building, dozens of speakers told the awkwardly named Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform the same things members had heard at two previous hearings.
In the three hours I listened, not a single witness expressed support for the Republican approach. Alan Zagier of the Associated Press sat through the whole six hours; and I judge from his report, which the Missourian published Sunday, that nobody did after I departed.
Instead, physicians, patients insured and uninsured, hospital managers, disability advocates and at least one preacher variously pleaded, reasoned or argued that expanded coverage would yield great benefits at reasonable cost.
Joe Hardy, the first speaker, identified himself as a Howard County farmer and retired teacher. He pointed out that a failure to adopt the expansion is likely to cost the state jobs and imperil our smaller hospitals. He reminded the committee that this “huge impact” would fall most heavily on the state’s rural areas, where the population tends to be older, poorer and sicker. He didn’t note that those rural areas are mostly represented by Republicans.
Dr. Andy Quint, medical director of the federally supported Family Health Center in Columbia, told the committee that about half his patients have Medicaid and about one-quarter are uninsured. The uninsured, he said, are more likely to skimp on preventative care, more likely to not fill or stretch out prescriptions, less able to take advantage of expensive tests or high-tech treatment.
His uninsured patients are the most likely to turn to emergency rooms for treatment or wind up hospitalized for conditions that could have been prevented. Hospital care, he pointed out, is the most expensive kind.
Most are the working poor. In fact, he said, most personal bankruptcies are the result of medical bills.
He summed up, “Without health insurance, people suffer needlessly and die prematurely.” Expansion of Medicaid, he said, “is the right thing to do medically, morally and economically.”
Contrary to the Republican refrain that reform must trump expansion, several physicians agreed, as one of them put it, that Medicaid actually “works pretty well.”
The CEO of a medical center in West Plains testified that his center, which serves 11 Ozark counties, provided $10.1 million worth of uncompensated care in 2012. He didn’t add that the costs of such care are typically recouped by higher charges to patients with private insurance, which is more generous with its payments than Medicaid or Medicare.
The West Plains center is participating in one of the several pilot programs already underway in the state that are aimed at improving outcomes and cutting costs.
Now the hearings are over. The public has spoken. The question is whether the Republican legislators were listening.
I worry that we can guess the answer.
George Kennedy is a former managing editor at the Missourian and professor emeritus at the Missouri School of Journalism.