Missouri voters can improve health care for a quarter million of their fellow citizens, help the state’s economy, give rural hospitals a better chance to survive and probably save the state money when they vote on expanding Medicaid coverage – Amendment 2 – on the Aug. 4 ballot.
Medicaid expansion has made sense – fiscally and morally – for years, but sheer spite directed at Barack Obama has kept the Missouri General Assembly from acting. Expanding Medicaid coverage to those below or just above the poverty level was seen as a key part of Obamacare. But that part ended up getting left to the states, and Missouri, not for the first time, chose to be a laggard.
Among other things, this has meant many Missourians of modest means have qualified for federal health-care subsidies but people who are even poorer – mostly those working one or two jobs without health coverage – are left with nothing. That’s indefensible. In Jackson County, 29.6 percent of adults in that low-income rung have no health insurance, according to the Missouri Budget Project.
Now advocates have collected enough signatures to get an amendment to the Missouri Constitution on the ballot. It’s an imperfect solution given the need for flexibility to navigate the complexities of health-care policy, but it’s obvious after roughly a decade of Jefferson City inaction that this is the only way the problem will be addressed.
The math is straightforward. Advocates say about 300,000 people would be newly eligible – that’s one Missourian in 20 – and about 250,000 would likely sign up. The federal government, which has collected Missourians’ taxes for this all along, would pick up 90 percent of the cost of the newly covered and as well as other costs the state is currently covering.
A study commissioned by the Missouri Foundation for Health says the state would come out $72.4 million ahead in fiscal year 2022 and that figure would rise significantly – $1.11 billion by 2026. That study also points to thousands of jobs the state would get from the economic development caused by this change.
Hospitals for years have struggled with the care they give to those who are without any insurance – no private insurance, no Medicaid, no Medicare – and are unable to pay. The problem is acute at struggling rural hospitals, but the metro area’s one safety-net hospital, Truman Medical Centers, gets a $9.88 million-a-year subsidy from Jackson County taxpayers, much of it to offset those costs. One-fifth of TMC’s patients have no coverage, and the hospital wrote off $40 million in uncompensated care last year for Eastern Jackson County alone. Paying hospitals for their work is simply the right thing to do, and it would greatly help stabilize their finances.
And there’s this: People with health insurance use it. That means a nagging medical issue is less likely to become acute. Those acute problems land a person in the least efficient and most expensive place to deliver primary care – the emergency room. Keeping that traffic out of the ER saves everyone money, and it reduces human misery.
Millions have benefited from Obamacare. There’s no reason why many of the poorest should continue to be excluded.