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WHAT OTHERS SAY: Iowa's Medicaid waiver should push Missouri GOP to act

Friday, December 20, 2013 | 4:19 p.m. CST

Another of Missouri’s border states, with a Republican governor no less, is a step closer to expanding Medicaid and reaping the economic benefit of billions of dollars flowing into its state.

For those pushing to bring more health care to the working poor of the Show-Me State and the massive economic benefits that an infusion of $8 billion in federal spending would bring, this is a very important development.

This month, The Washington Post reports, the federal Department of Health and Human Services told Iowa that it was prepared to approve its request for a waiver that would allow it to expand Medicaid in a way different than what is called for in the Affordable Care Act.

Instead of merely adding people making less than 138 percent of the federal poverty level to the state’s Medicaid rolls — the simplest and least expensive solution — Iowa wants to do what other Republican-led states have proposed. It wants to expand Medicaid to people making 100 percent or less of the federal poverty rate, and then offer subsidies for those between 100 percent and 138 percent of poverty to purchase private health insurance through the state insurance exchange.

Why does this matter in Missouri?

It’s very similar to the Medicaid expansion proposal developed by state Rep. Jay Barnes, R-Jefferson City. Mr. Barnes understands what Gov. Jay Nixon, a Democrat, understands, what the Missouri Chamber of Commerce understands, what researchers at MU understand: Bringing $8 billion in federal investment to one of Missouri’s most important business sectors isn’t just the right thing to do morally; it creates jobs.

As long as the Missouri legislature flounders and fails to adjust the state’s health care system to the new federal reality, our tax dollars will go elsewhere, to border states like Iowa, Arkansas, Illinois, Kentucky and Tennessee, or the 21 other states smart enough to expand Medicaid with the federal government paying the freight.

It boggles the mind that Nixon and the legislature would commit the state to giving up about $2.4 billion in taxpayer dollars to lure up to 8,000 jobs from Boeing, when by just saying yes to the infusion of $8 billion in federal dollars over just three years almost three times as many jobs will be created if you apply the same economic multipliers.

In one case, Missouri taxpayers are literally paying a company for the right to locate their jobs here, thus limiting the economic impact those eventual jobs will have.

In another case, the federal government is willing to pay Missouri to give more poor people access to quality health care services, and thus create jobs in an industry that generates about $19 billion in economic activity per year in the state.

Barnes’ recent analysis of his proposal shows that, if implemented, the Medicaid expansion could save money in the state’s general revenue budget for the next eight years. That’s five years into the period in which the state takes over some of the cost of expansion.

Create jobs. Save the state budget. Provide health care for those who need it.

What is the Missouri legislature waiting for?

If this was called Boeingcare instead of Obamacare, the Legislature would have acted long ago.

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


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