2016 will be the third year that Missouri goes without Medicaid expansion, as Republicans have stayed firmly against it in the General Assembly.
A new report from the White House, "Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid," uses data from all 50 states to estimate the actual impact of non-expansion. The estimates are particularly striking in Missouri, where Medicaid coverage has an income threshold for adults that is far lower than other non-expansion states.
According to the report,
Missouri will miss out on $1.37 billion in federal funding to pay for Medicaid expansion in 2016 alone.
Non-expansion leaves about 190,000 Missourians in a "coverage gap": They make too much to qualify for the state's current program, but too little to use income-based subsidies to buy insurance on the private exchange. For a family of four, that means their income falls between $4,400 and $33,500 a year.
Use of preventive care services like cholesterol screenings and mammograms would have increased, and 45,000 additional people would have had access to a usual source of clinic care in 2016.
8,600 fewer Missourians would have been faced with catastrophic out-of-pocket costs for health care in typical year.
Missouri hospitals would have avoided $200 million in uncompensated care costs.
These figures are in line with what others have estimated and show that a lack of access to health care can hurt a state's economy, said Washington University economist Tim McBride.
"These are the most vulnerable people in the state, and they face enormous difficulties with financial security and financial debt. When they don't have the coverage they won't get health care, which makes their problems worse and adds to all of our costs," McBride said. He also chairs the oversight committee for Missouri's existing Medicaid program.
Missouri state Sen. Rob Schaaf, R-St. Joseph, did not agree with the findings.
"It's just another slanted report designed to garner support for expanding health welfare," said Schaaf, who is also a family practice physician and believes the Affordable Care Act should be "scrapped."
Schaaf said his opposition to Medicaid expansion this year focused on this reason, among others: Though the federal government fully funded Medicaid expansion for the first three years, Missouri would have to contribute some of its own funds beginning in 2016, which would increase gradually and be capped at 10 percent of the program's cost by 2020.
"We can't afford it. Can we trust the federal government to have the money to pay for this program into the future?" Schaaf said. "It's going to cost us $220 million at the current rate."
In addition, Schaaf said he thinks the law has been an "obscene financial windfall" for hospitals and insurance companies and believes federally funded health clinics should be where people go for care if they cannot afford insurance. (Thanks to funding through the Affordable Care Act, access to FQHC's has grown significantly in recent years.)
But supporters of expansion say Missouri's 10 percent contribution to Medicaid expansion is worth it. That includes Lynn Nelson of Vinita Park, who could not afford individual health insurance for many years because of a pre-existing condition. After the passage of the Affordable Care Act, she purchased a plan on Healthcare.gov — but remembers the pain of needing care and not being able to afford coverage.
"I understand that it's a Republican-controlled legislature, I understand that. But many of their constituents are suffering. I just think they're closing their ears to them, and I don't know how they do that," Nelson said.
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