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GUEST COMMENTARY: Undeniable need for Medicaid expansion

Monday, August 19, 2013 | 1:44 p.m. CDT; updated 6:44 p.m. CDT, Monday, August 19, 2013

During the last few months I have had the privilege of working with a group of legislators and citizens who have traveled the state to listen to Missourians about one of the most important issues of our time.

This group, which is made up of citizens from all walks of life, has delved deeply into the issue of Medicaid expansion and whether the state should accept federal dollars to provide coverage to some of our poorest households. While the committee will release its own report in the coming months, the answer to this question has become so obvious from my service on this committee and from the testimony we have heard that I have published my own findings.

My “Missouri Medicaid Report” states in no uncertain terms that Missouri must move to expand Medicaid in order to improve the quality of life for all Missourians.

If you have followed the news at all in the past year, you have seen where the majority party in the Missouri General Assembly has made it clear it has no taste for an expansion of this safety program that is meant to provide care to those who need it most. While the federal government has offered to pick up the tab on this program for the first several years of expansion, and then 90 percent of the cost for many years after that, the leaders in both the Missouri House and Senate have said they do not want to extend coverage to some of our poorest Missourians.

Their excuses have ranged from a basic philosophical disagreement with the expansion of a government program to a perceived threat to state funding for services like education if the federal government can’t make good on its promise to pay. On the other side of the argument, our governor has pushed vigorously for an expansion of the program and continued to lobby for the House and Senate to take action on this important issue. This standoff helped to prompt the creation of the working group that has studied this issue during the interim.

Now, after weeks of travel and testimony, we have mountains of facts and figures that point to the undeniable need to expand our Medicaid program. The most important number to keep in mind is that expansion would lead to an additional 159,260 Missourians in the program in 2014. Keep in mind these are individuals and families who otherwise would have no access to quality care, and many of these people are in the St. Louis area. Nationwide, approximately 27.4 million Americans would be newly insured under expansion by 2016, and 16.2 million would be newly enrolled in Medicaid.

It’s important to understand that expansion targets our poorest households and offers individuals who have no other means to obtain insurance a way to finally receive proper health care. Expansion addresses the glaring problem that approximately 42 percent of all non-elderly adults with incomes below 138 percent of the poverty level, which represents an annual income of $15,856 for a single person and $32,499 for a family of four, lack insurance. When we recognize the fact that 2 out of every 5 of our poorest citizens have no insurance, and no way to receive affordable care, it makes it impossible to argue against expansion.

Beyond the basic need to provide our neediest citizens with access to care, we have learned that expansion would bring with it a number of other benefits. The University of Missouri published a study showing that expansion would produce an additional 24,000 jobs in 2014, increase state labor income by $7 billion between 2014 and 2020, and generate an additional $856 million in state taxes in that same period of time. In addition, expansion would greatly reduce the costs currently associated with providing care to the uninsured.

Nationally, uncompensated care for the uninsured had a price tag of $56 billion in 2008, and with medical inflation that cost would increase to $80 billion in 2016. These are significant numbers because state and local governments pick up 30 percent of these costs. Meanwhile, expansion allows states to greatly reduce the number of uninsured and with it the cost of uncompensated care.

And remember, the federal government is paying for almost all of the expansion, which means that states would in fact save money as their spending on uncompensated care would decrease by $18.1 billion because of Medicaid expansion. These are savings that even fiscal conservatives cannot deny.

Even though the numbers and dollar signs can be important when talking about this issue, it is crucial that we not lose focus on the fact that the question of Medicaid expansion is really about people.

It is about making sure that individuals and families have access to the preventative care they need to live longer and healthier lives. It is about ensuring a higher quality of life for the hundreds of thousands of Missourians who right now have no insurance, including the tens of thousands of uninsured people right here in St. Louis. It is about saving an estimated 155,362 precious human lives each year across the nation. And it is about making the right choice for our state and for our nation as we attempt to do what is truly best for the people.

Without proper health care, a large portion of our population will never have the opportunity to pursue their dreams or to break free from the clutches of poverty. If we want to empower people and give them the opportunity to be healthy, productive citizens, we must expand Medicaid to provide care to those who need it most. Anything else is an injustice to the people who have elected us to serve with their best interests at heart.

Rep. Joshua Peters, D-St. Louis, represents Missouri's 76th House District, which includes the northern part of St. Louis.


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