Do you know about the “coverage gap”?

Do you know about the “coverage gap”?
Medicaid expansion would allow about 300,000 Missourians to have health insurance. They earn too much for Medicaid (Missouri has the lowest income eligibility of any state), but not enough to afford private insurance. They remain in in the “coverage gap.”
The Affordable Care Act (ACA, aka Obamacare) expects states to insure these persons by expanding eligibility for Medicaid. It is a critical moral and financial requisite for Missouri, but Republicans call it a “nostarter” and have refused to have open debate.
This endangers the lives of our low-income neighbors. About 700 Missourians die each year because of this, countless others suffer needlessly without proper medical care, and others do not receive cost-effective preventative care (
When fully implemented in 2020, expansion will require a 10 percent match for federal dollars. Republicans claim that this would cost too much and would compromise funding for other crucial services such as education.
They fail to reveal the financial benefits of expansion. If you do not consider the overall impact of expansion, it is easy to fall victim to their rhetoric of “it’s going to cost too much, our budget is already strapped, and we can’t afford it.”
The University of Missouri did an extensive study in 2012 regarding the ACA’s impact on our state economy (University of Missouri and Dobson DaVanzo & Associates, “The Economic Impacts of Medicaid Expansion in Missouri”). The study concluded that additional costs of Medicaid expansion would be greatly outweighed by the increased revenues that would result.
Two 2015 studies by the Robert Wood Johnson Foundation and the Kaiser Family Foundation came to similar conclusions. In states that have expanded Medicaid, including neighbors Arkansas and Kentucky, budget officials consistently were able to show that expansion has resulted in savings, revenue gains, ability to shift revenues to previously underfunded services like mental health and positive growth in health-care jobs.
Our legislators claim to support job creation, yet adamantly block this proven opportunity.
Republicans continue to talk about how much the match would cost. Focusing solely on the cost of that completely ignores the projected income.
If you look at savings to be gained through expansion, in addition to federal supplements and added tax revenue, you begin to see the bottom line. The comparison of cost to benefits is clearly in favor of expansion, is  the reason many other states have chosen to expand and is why the Missouri Chamber of Commerce is in favor.
Other economic considerations include the fact that, under the ACA, hospitals lose federal dollars for unsupported care because expanded Medicaid is supposed to cover previously uninsured patients. Missouri Republicans’ refusal to make this change will be particularly hard on rural hospitals and may result in reduction of services and even some closings.
The Missouri Hospital Association (MHA) has estimated a loss of 5,000 jobs and $3.5 billion by the end of 2019 if our legislators don’t act. In contrast, in states with expanded Medicaid, hospitals are saving money because uncompensated care has decreased significantly.
The Department of Health and Human Services reported that hospitals saved more than $7 billion in 2014 because more than 16 million previously uninsured people had coverage under the ACA. Further, 70 percent of these savings were realized in 29 states that had expanded Medicaid (
Without expansion, costs of unsupported care continue to be passed along as increased premiums. As long as legislature balks, insured Missourians will eat these costs.
It is easy to see why expansion has been endorsed by the MHA, the Missouri Foundation for Health and the Missouri Primary Care Association. It also is easy to see why people buying insurance want to stop paying higher premiums just so our legislators can remain hardliners against Obamacare.
We cannot blindly accept Republican arguments on this issue. We cannot just look at one piece of the financing and arrive at the bottom line. Items on the income and savings side of the ledger also must be calculated.
Ask your legislators to start considering the whole story about Medicaid expansion, have honest debate, and move Missouri ahead on this important moral and fiscal issue.

Sherry L. Buchanan, Ph.D., of Joplin writes a column for the Daily News.