Expanding Medicaid to more Missourians will make the Affordable Care Act even more affordable, participants in a “community conversation” heard Tuesday.

Expanding Medicaid to more Missourians will make the Affordable Care Act even more affordable, participants in a “community conversation” heard Tuesday.
Ryan Barker, vice president of health policy at the Missouri Foundation for Health, was the guest speaker at the event held at Rolla Presbyterian Manor and sponsored by the foundation and Your Community Health Center, the new federally qualified health clinic in Rolla.
“Health insurance marketplaces and Medicaid expansion” were “two coverage mechanisms” provided by the Affordable Care Act to provide insurance to uninsured Americans, Barker said.
The Affordable Care Act, sometimes called Obamacare, was expected to cover 32 million of the 48 million uninsured people in the United States. There are approximately 794,000 uninsured Missourians.
Last June the U.S. Supreme Court ruled that the “individual mandate,” requiring everyone to buy insurance coverage, is constitutional, but the court also ruled that the federal government could not force individual states to expand Medicaid by taking away federal funding for Medicaid. That made Medicaid expansion optional, and so far Missouri has opted not to expand it.
The federal government would pay 100 percent of the cost for the first three years, if Missouri would expand Medicaid coverage to people, families and individuals, who make under 133 percent of the federal poverty line and aren’t on Medicare.
In 2013, that would be $15,282 for a single person, $20,628 for a family of two, $25,975 for a family of three and $31,322 for a family of four.
Currently, those eligible for Medicaid are children up to 18 years of age who make 300 percent of the federal poverty level, parents who make 18 percent of the federal poverty level, pregnant women who make 185 percent of the federal poverty level, blind people who make 100 percent of the federal poverty level, elderly people who make 85 percent of the federal poverty level and disabled people who make 85 percent of the federal poverty level. Childless adults are ineligible.
Expanding Medicaid to childless adults and parents making 133 percent of the federal poverty level would not cost the state anything for the first three years, Barker said; then the federal government would diminish its payments gradually to 90 percent by 2020 and thereafter.
Doing this would put anywhere from an estimated low of 159,000 more Missourians to an estimated high of 267,000 on Medicaid in 2014. That number would grow to 308,000, possibly 383,000, by 2022.
“The coverage gap” is the way Barker described the place where low income parents and childless individuals find themselves. They aren’t covered by Medicaid and they can’t afford the Obamacare insurance. Barker said a significant number of these families and individuals are in rural Missouri.
Opponents of Medicaid expansion, mostly the Republicans in the General Assembly, say neither the country nor the state can afford the expansion, that Medicaid needs reform not expansion and that Congress could change its mind about the 90 percent to 100 percent support of the expansion.
Proponents of the Medicaid expansion say it will eliminate the coverage gap for the low-income working Missourians who have no insurance, will save the state’s general revenue, will create jobs and more state revenue and will benefit large employers.
Barker noted the Missouri Chamber of Commerce has announced a position in favor of expansion because it will help large employers fulfill their obligation to provide affordable insurance to their employees.
Barker also noted the state will have an overall savings of $983 million in the general revenue from fiscal year 2015 to fiscal year 2022.
Also to be considered are DSH (disproportionate share hospital) payments, money the federal government gives to hospitals to offset the cost of treatment in emergency rooms to people without insurance.
With Obamacare, those DSH payments decrease with the idea that insurance and Medicaid would eliminate the need for the payments. Without Medicaid expansion, Barker said, the need remains, yet the reduction in DSH payments continues.
Barker quoted a Salem Memorial District Hospital official as saying that if Medicaid expansion does not occur this year, that hospital will have to close its emergency room. The next closest ER would be Phelps County Regional Medical Center.
Barker said the Missouri House is currently considering House Bill 1901 that would reform and expand Medicaid.