DAVID ROSMAN: Arguments against expanding Medicaid have no real basis

Wednesday, January 22, 2014 | 6:00 a.m. CST; updated 12:32 p.m. CST, Wednesday, January 22, 2014

COLUMBIA — What is it with the Republican caucus under the Gray Dome? Why are they preventing Missourians from acquiring health insurance and gaining some $1 billion in federal aid to pay for Medicaid (MO HealthNet) expansion?

I had the pleasure of listening to Rep. Stephen Webber, D-Columbia, last week concerning the legislative “disagreement” about the Affordable Care Act provisions.

The passage of Senate Bill 661 would expand Medicaid to include 220,000 to 300,000 Missourians (depending on who is counting) who are not eligible for a subsidy to purchase insurance under the ACA but make too much money to be on the current MO HealthNet rolls.

Webber mentioned four issues the Republican caucus seems to have issues with regarding the Affordable Care Act and MO HealthNet expansion. Allow me to discuss each.

1. “The federal government has no role in providing health care.” If this is correct, then programs such as the Department of Veterans Affairs and Medicare need to be abolished. In fact, the VA is a perfect example as to why we need the federal government to provide health care to its citizens.

By providing medical care to our troops and their families, the VA has established itself as one of the most important services for those coming home from military service. My father is a prime example of the benefits. Even in his dying days, he is receiving care, ranging from his day and evening hospice nurses to his hearing aids.

2. “Where will the funding come after 2021?” This is a legitimate question, but that funding is only 10 percent of the entire Medicaid bill for the state. There are other programs that state and federal governments fund more than five and 10 years without concerns for the budget.

According to the Cost and Savings from Potential Changes to Missouri Medicaid Eligibility and Transformation report, presented by Rep. Jay Barnes, R-Jefferson City, the state would save more than $750 million through fiscal year 2021 by eliminating duplicate payments and accepting the funding from the federal government.

3. “Money will be taken from social services and education to pay for the increased Medicaid load.” Again, looking to the Barnes report, by expanding access and allowing the federal government to take a bigger slice of the pie, the savings to the state will be more than $43 million after fiscal year 2021. Again, these are Republican numbers.

4. “Medicaid is broken.” I am still waiting to hear what is exactly “broken” with MO HealthNet.

Yes, there is fraud in the MO HealthNet system, but there is fraud in any system that helps those in need. This is not limited to the federal and state programs but to private insurance as well.

When I was an insurance administrative hearing officer for the state of Colorado, I heard cases daily that concerned some form of fraud by consumers, agents, claims adjusters and doctors, as well as from companies. There is fraud in Medicare and fraud in the VA health care system. This is not likely to ever be eliminated, though it seems to be the basis of an argument against expansion.

Here are the downsides of not expanding MO HealthNet to cover those falling into the 100 percent to 138 percent of the poverty gap, according to the Barnes report.

1. There will be a loss of an estimated 1,000 jobs in Missouri.

2. The 220,000 to 300,000 uninsured people will be using the systems already in place to care for those who cannot afford health insurance — hospital emergency rooms. If you have been listening to the news reports or have had the unfortunate experience of waiting for hours to see a doctor for your broken arm, you know how much that system needs help.

3. $1 billion. We are already paying higher tax rates to cover the expansion of MO HealthNet so why not get the money back into the state?

The Missouri Chamber of Commerce supports expansion. Hospital associations support expansion. Business supports the expansion. The only group that seems to be against the expansion is, in Webber’s words, the Republican caucus. Their only reasoning is that the expansion is attached to the Affordable Care Act.

It is time to tell members of the state legislature to take down the roadblocks and get our money back into the state economy. Tell them to pass SB 661, which will provide “for the expansion of MO HealthNet services beginning on Jan. 1, 2015.”

David Rosman is an editor, writer, professional speaker and college instructor in communications, ethics, business and politics.

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Ellis Smith January 22, 2014 | 8:41 a.m.

I'm going to beg off commenting on this subject on the grounds that, after residing a large portion of my adult life in Missouri, I am no longer a resident.

As I noted a long time ago, my only experience with VA hospitals was positive. My father, a World War I(!) veteran, was hospitalized for about six months late in his nearly 100 year life.

For the VA it appears that hospital venue is a significant factor in the level of care patients receive. Some venues are better than others.

Thinking about my father causes me to remember my paternal grandmother and the interesting old sayings she used. One, which I've translated here into English, says:

"Every fool is pleased with his own folly."

No doubt that's true, but there's also no requirement that others must be pleased with the fool's folly.

(Report Comment)
Michael Williams January 22, 2014 | 8:41 a.m.

"The only group that seems to be against the expansion is, in Webber’s words, the Republican caucus."

You write as if our representatives in Jeff City stand alone as the "only group". That they act independently of us....the voters.

Not so. Many of us let them know our views quite often.

Do you deny that representatives in Jeff City are expressing the wishes of a majority of the voters who elected them?

You see, one result of winning an election is: The winner sets the rules.

As you well the federal level.

We may indeed end up joining the "free" Medicaid experiment that really isn't free in spite of the Rosman rhetoric. Eventually. As for me, I'd prefer to wait and see how the ACA and Medicare play out in other states, first.

PS: I thought the projected number of created jobs in Missouri was 24008 (UMC data), not 1000.

Also, what's with the "$1 million" in #3 above? Where'd the "million" come from?

(Report Comment)
Michael Williams January 22, 2014 | 9:10 a.m.

I mis-read the sentence concerning 1000 jobs LOST in my PS. Never mind. I still don't know where the "millions" came from, tho.

(Report Comment)
Skip Yates January 22, 2014 | 12:46 p.m.

Comparing the VA with Medicade/Medicare is comparing apples and oranges. Mr Rosman's family may have used it; but,he doesn't know much about the workings of it. Most people don't. VA healthcare is earned by service and it isn't necessarily free except for "service connected" injuries/disability. There are several levels of care. Any vet can go there and in cases where the issue is not service-connected, the first payer is the patients own health plan or medicare. The reason many go there is out of pocket expenses and/or medications are considerable less than that which would be charged at a civilian facility. A veteran that goes there has to fill out an annual form that asks if he/she is covered by Medicare, parts A and/or B, the name of their insurance company and the name of their supplemental insurance company, if any. And, if they are covered by Medicade. A lot don't use the VA because the care isn't quite as "personalized" as you might find in a commercial facility in some opinions. One comment I've heard more than once is we go to the VA for care and Boone to die. That being said, Truman VA hospital in Columbia is an excellent facility despite the huge patient load.

(Report Comment)

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