With Missouri’s 97th General Assembly convened as of Wednesday, January 9, one debate on the slate is whether to accept the federal government’s proposed Medicaid expansion.
The U.S. in June pushed the decision to the states. The Gov. Jay Nixon-approved, Affordable-Care-Act expansion calls for a Medicaid eligibility increase to include residents ages 19-65 within an effective 138 percent of the federal poverty level. Audrain County health officials have opted in to the increase. However, Missouri’s conservative-led legislature has been less than receptive to the idea.
Dave Neuendorf, president and CEO of the Audrain Medical Center, said the key to expanding Medicaid is getting more residents heath coverage.
“We think its a favorable thing for hospitals that we expand Medicaid through the Affordable Care Act,” Neuendorf said. “It would have a significant impact on the state of Missouri.”
He said providing more residents with health coverage would help alleviate the burdensome costs of hospitals treating uninsured patients. Neuendorf said more patients would likely seek care before a health problem developed into a serious issue, as well. He added the expansion would also increase hospital employment and revenues via more health coverage in the rural community, which dominates the state.
According to a November University of Missouri School of Medicine Department of Health Management and Informatics report, Missouri’s central region — which includes Audrain County — was estimated at gaining 2,422 jobs in 2014 through the possible expansion.
The report added that an additional 218,165 residents would be eligible for health coverage with an estimated 159,260 actual enrollees in 2014, assuming 73 percent of those eligible would enroll.
The number of additional eligible residents is expected to climb to 220,932 by 2020 with an additional 161,281 actual enrollees.
The report noted the central region stands to gain an estimated $681,967,169 of labor income with about $223,928,080 in federal, state and local taxes generated by 2020.
Statewide, according to the report, 24,008 jobs would be created in 2014 for an increased labor income of $6.9 billion through 2020. Within the six-year period, $856 million in state and local taxes would be generated with nearly $1.4 million in federal taxes.
“It creates a bit of economic stimulus,” Neuendorf said. “We think it’s a good deal, and we hope our legislature considers it.”
A separate analysis by the Missouri Office of Administration Division of Budget and Planning estimated the state earning $46, 573,344 in revenues in 2014, increasing to $139,572,528 by 2016 before declining in 2017.
The federal government offered to chip in 100 percent of the expansion costs from 2014 to 2016, according to the MU report. Federal funding would then decrease to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent by 2020.
When Missouri starts chipping in on the cost in 2017, the budget office’s analysis calls for a $112,906,918 gain in revenue when the state pays an estimated $30,112,261 for newly eligible enrollees. An estimated $117,617,393 would be paid in by the state in 2020 when Missouri is responsible for 10-percent of the expansion’s cost. Revenue increases in 2020 are estimated at $27,933,566.
Current Medicaid eligibility calls for:
• Up to 19 percent of the FPL for parents
• Below 185 percent of the FPL for pregnant women
• Below 85 percent of the FPL for disabled individuals
• Up to 85 percent of the FPL for residents age 65 and older
• Up to 85 percent of the FPL for blind individuals
• Up to 100 percent of the FPL for Medicare beneficiaries
• Below 300 percent of the FPL for children under the age of 19
Tenth District Representative Jay Houghton, (R) Martinsburg, soon to represent the new 43rd District, said the possible expansion is too much.
“I would say its going to be a hot-button topic during the general assembly,” Houghton said.
With the two times Missouri voted down national health care, he said the state needs to adopt its own form of a health exchange.
“They have put the states between a rock and a hard place,” he said. “If we set up our own exchange in Missouri, we will have more controls on the parameter with who qualifies.”
“I’m not sure what is going to happen but something needs to be done,” Houghton added.