Covering the Gap: The Uphill Battle for Medicaid Expansion in Missouri

Apr 3, 2015

Citizens gather at the Missouri State Capitol in Jefferson City as part of a Medicaid expansion rally earlier this session.
Credit Steve Fines / KSMU

Five years following the passage of the Affordable Care Act, roughly 300,000 Missourians still don’t have proper access to health care.

“In my current situation I do not qualify for Medicaid,” Loux said. “I don’t have any children in the home, I am a single female and I don’t qualify even with health issues.”

Springfield resident Shelly Loux for a time was homeless after losing her job due to health issues.

“Four years ago was the first time that I have ever been so sick that I could not take care of myself,” Loux said. “I’ve always been able to get a job and take care of myself and four years ago as I was getting older, I found myself in a situation where I was pretty vulnerable.”

Democratic State Representative Stacey Newman of St. Louis County says that two-thirds of seniors in Missouri that live in poverty are women.

“So there are even specific groups of people, particularly senior women, that need healthcare access,” Newman said.

In recent months organizations across Missouri have rallied in support of the Medicaid expansion asking the Missouri General Assembly to debate the issue. However, their voice is falling on deaf ears in the state’s Republican-led legislature.

Republican State Representative Nate Walker, of Kirksville, says that to expand Medicaid without any reform will not happen.

“The leadership in both the house and senate has said the Medicaid expansion is not a priority,” Walker said.

Ryan Silvey is a Republican senator from Clay County.

“The way that Obamacare proposes to solve the problem is just throw everyone on Medicaid,” Silvey said. “Financially unsustainable there’s no way the state can afford to do that moving forward.”

Sen. Silvey has created legislation that will expand Medicaid for veterans and their families up to 138 percent of the federal poverty level. A second bill would convert MO HealthNet, a division under the Missouri Department of Social Services that administers Medicaid, to a block grant system.

Blocks grants were created in 1966 as a means to provide services while reducing federal obligations by limiting the amount of federal dollars entering the state. Furthermore, there’s no provision to increase the federal allotment of the block grants during natural disasters, an economic downturn or pandemic.

“There were a lot of people saying it’s a great deal, the feds pay so much and the state only has to pay a little bit,” Silvey said. “The 10 percent the state has to pay is still $200 million of general revenue. So regardless of what the percentage is, we don’t have an extra couple hundred million dollars lying around with nothing to obligate it too.”

However, according to the Missouri Budget Project, expanding Medicaid will save the state $81 million the first year and more than $100 million annually thereafter.

The Commonwealth of Kentucky approved expansion of its Medicaid rolls in accordance with the provisions of the Affordable Care Act in 2013. Gov. Steve Beshear ordered the expansion by executive decision and Circuit Judge Philip Shepherd later upheld the order.

According to a study conducted by Deloitte Consulting LLC and the University of Louisville’s Urban Studies Institute, reality was better than projected. In 2014, 375,000 Kentuckians received healthcare access under the Medicaid expansion, 12,000 jobs were created, there was more than $1 billion in new revenue to health care providers, a 55 percent reduction in uncompensated care, and more than a $500 million offset in general fund savings. Medicaid expansion is projected to add 40,000 jobs and $30 billion to the Kentucky economy through 2021.

Republican gubernatorial candidate Matt Bevin said he will overturn the Medicaid expansion in Kentucky if elected in 2015. The other gubernatorial candidates, James Comer, Hal Heiner and Will Scott said they will eliminate the state run marketplace; eliminating subsidized health insurance under the Affordable Care Act.

On March 11th Gov. Jay Nixon spoke at the Springfield Career Center advocating for Medicaid expansion with reforms based upon four principals. They include protecting taxpayers, rewarding work, helping small business and promoting personal responsibility. He also believes Medicaid recipients should contribute to health care costs via co-pays and cost sharing.   

Currently Missouri adults with no children don’t qualify for Medicaid, and a mother with two children must make no more than $10 a day to qualify. Some advocates of the Medicaid expansion believe it’s a moral obligation.

“I think that we all need to realize that people need people,” Loux said. “Rich or poor, atheist or Christian, we all need each other.”

The two remaining organizations that oppose Medicaid expansion in Missouri are the Republican Party

Medicaid expansion rally at Missouri Capitol.
Credit Steve Fines / KSMU

and the Missouri Century Foundation, a fiscally conservative 501(c)(4).

Silvey’s legislation was referred to the Veterans’ Affairs and Health Committee. However, it is unlikely that Medicaid will be expanded this legislative session.

Democratic State Senator Paul LeVota offered an amendment to Senate Bill 210 on Tuesday to expand Medicaid to Missourians with incomes at or below138 percent of the federal poverty level. The amendment failed on a party line vote.