Report cites Iowa in making case for Medicaid expansion

April 30--CEDAR RAPIDS -- Iowa and Missouri share a border, but the states have taken very different approaches to Medicaid expansion.

Iowa has expanded it while Missouri has not, costing that state's hospitals money and harming the quality of life for its residents, according to Families USA, a not-for-profit group based in Washington, D.C., that pushes for access to health care.

The group on Wednesday profiled two women, one from Iowa and one from Missouri, to illustrate how the Medicaid expansion is helping, officials said.

Iowa is one of the 29 states that have expanded Medicaid. The Iowa Health and Wellness Plan, which started in January 2014, has more than 120,000 enrolled, according to the state's Department of Human Services.

Missouri, along with 20 other states, has not expanded the program -- leaving about a quarter million people in the "coverage gap," how Families USA refers to those who are not eligible for Medicaid but don't make enough to be able to buy subsidized insurance on the health exchange.

States choosing to not expand the program site cost concerns, as the federal government shoulders 100 percent of the cost for the first three years only. This will slowly step down to 90 percent in the years following.

The Missouri woman, Echo Garrett, 36, works part-time at a Burger King and has no health benefits after losing a full-time job in 2013. Garrett, who lives in Cape Girardeau, has chronic health conditions -- asthma and osteoarthritis, which forced her to take three weeks off from work in September.

"I hurt 24/7," she said on a conference call with reporters. "I'm not looking for a handout. I just want access to affordable health care."

Her story contrasts with Deb Stehr, a 55-year-old living in Lake View in northwestern Iowa. Stehr obtained health insurance in 2014 through the Iowa Health and Wellness program. Since then, Stehr, who had been uninsured for 37 years, was able to visit the emergency room for treatment after an animal bite became infected, and can now afford medication for her high blood pressure.

A March report from the U.S. Department of Health and Human Services found the number of uninsured or self-pay hospital admissions and emergency department visits has fallen substantially in states that chose to expand Medicaid.

The report found that Medicaid-expansion states saw significantly greater reductions in uncompensated care costs in 2014 -- $5 billion in expansion states compared with $2.4 billion in non-expansion states.

Uncompensated care is the unreimbursed cost of care hospitals provide to people who are uninsured or underinsured.

If Missouri had extended Medicaid in 2014, it would have saved an estimated $385 million in uncompensated care costs by 2022, the Families USA report found. According to the Iowa Hospital Association, Iowa hospitals saw a 32 percent decrease in charity care between 2013 and 2014. In Cedar Rapids, Mercy Medical Center saw a 4 to 5 percent increase in Medicaid patients in 2014 along with a 1 percent decrease in the number of uninsured patients it cares for.

Mercy has seen a drop in the amount of uncompensated care it provides, Mercy officials said in February, but the trend of more patients having plans with large out-of-pocket maximums means the hospital still is awarding a quite a bit of charitable care.

UnityPoint Health-St. Luke's Hospital said there has been a 50 percent decrease of in the number of self-pay patients treated between 2013 and 2014. The hospital also saw a 30 percent increase in individuals covered by Medicaid.

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