Denbo to politicians: Use ‘pragmatism’ not ‘absolutism’

Missouri legislators appear to be willing to turn down millions of federal dollars to show their disdain for so-called “Obamacare,” but doing so will harm the state’s rural hospitals, including Phelps County Regional Medical Center, the hospital’s Board of Trustees heard Wednesday night.

“We’ll be impacted. All hospitals will be,” CEO John Denbo said after the board watched a public television program, “Health, Money and Politics: Missouri’s Medicaid Debate.”

That program, which can be seen at or, summarized the decision facing the Legislature regarding expansion of Medicaid, the state-run healthcare program for poor and disabled people.

The current debate affects everyone, Denbo noted, for actions taken, or not taken, now will decide the cost and availability of health care in rural Missouri in the future.

Although 60 percent of Missourians are part of insurance plans where they work, 21 percent of Missourians have no coverage.

The Affordable Care Act calls for the federal government to finance fully the expansion of Medicaid in the state by paying 100 percent from 2014 to 2016. States would incrementally pick up a share of that cost each year. By 2020, Missouri would be paying 10 percent of the expansion.

The U.S. Supreme Court has ruled the expansion is optional, and some states have already stated they’re not going to participate. Missouri appears to be headed in that direction, too.

If Missouri were to participate, it might add as many as 300,000 poor or disabled Missourians to the program.

Right now, Medicaid recipients can make no more than 19 percent of the federal poverty. The expansion would allow individuals making 138 percent of the federal poverty level to participate in Medicaid. For a family of four, that would be $26,344.

Gov. Jay Nixon, a Democrat, favors the expansion and says he’ll sign the Legislation to enact the expansion in Missouri. Nixon said, and it is recorded in the Channel Nine program, that Congress has passed the Obamacare act, the president has signed it and the Supreme Court has upheld it. It’s a fact of life now, he said.

The program also included a visit to the Salem Memorial District Hospital and interviews with Administrator Dennis Pryor and Dr. Vicky Gulley, who also operates a clinic in Newburg.

Pryor said the Salem hospital could lose $1 million, which would greatly hamper that institution’s continued operation.

The Missouri Hospital Association and the Missouri Foundation for Health have released a report about the expansion's economic impact.

"Expansion of Medicaid in Missouri is projected to generate an additional 24,008 jobs in Missouri in 2014," the report stated. "In one year, this is more than the employment of Missouri’s 10 Fortune 500 companies in the state. It also is 12.8 percent of the total unem­ployment number in Missouri in 2011."

The Affordable Care Act also calls for cuts to payments to hospitals. These cuts, along with increased business taxes, will pay for the Medicaid expansion.

The program noted that if Missouri declines to participate, that money will, instead of coming to Missouri, go to other states.

But Speaker of the House Tim Jones, a Republican from Eureka, has called the expansion “reckless” and “unsustainable.”

Sen. John Lamping, a Republican from Ladue, also appears on the Channel Nine program to speak against the expansion.

“I do not know what world Mr. Lamping or Mr. Jones live in, but it isn’t here,” PCRMC CEO Denbo said at the board meeting afterwards.

Without the Medicaid expansion and with the cuts called for in the act, a loss of 9,000 jobs in Missouri is likely, and most of those will be in rural areas.

“What legislator wants to put his district back into recession?” Denbo said.

Denbo encouraged board members and anyone else concerned about the hospital’s financial future to contact area legislators, including Rep. Keith Frederick and Sen. Dan Brown, both of Rolla, to encourage them “to carefully study this issue and be open-minded.”

He said this is an issue that calls for lawmakers: “not to be totally focused on absolutism.”

“We would like for the Legislature to act out of pragmatism, not on some strict absolutist principle,” Denbo said.