'I would ask him if my life mattered': Fury follows Gov. Parson's Medicaid decision

May 14—JEFFERSON CITY — Bill Thompson doesn't even know exactly how much medical debt he's accumulated.

The 50-year-old, who works at Burger King in Independence for minimum wage, doesn't have health insurance and has run up at least $10,000 in bills he can't afford to pay. His employer offers a health plan, but it's too expensive.

Medicaid expansion was supposed to change that. But Gov. Mike Parson on Thursday announced Missouri won't implement the voter-approved program after the General Assembly refused to fund it.

Thompson, who campaigned for expansion last year, was looking to the program as the way he and his wife, a home health aid, would finally have coverage as they grow older. Those hopes are now on pause for him and the more than 275,000 other Missourians who would qualify.

"I would ask him if my life mattered to him and I would ask him if these other Missourians' lives matter to him," Thompson said of Parson. "The decision that he's made makes it clear that he doesn't."

Medicaid expansion supporters reacted with fury to Parson's decision, which all but assures a high-stakes and possibly protracted court battle over its future. Voters approved a state constitutional amendment in August raising eligibility for the program to adults making up to 138% of the federal poverty level, or $17,700 a year for a single adult. The governor's directive was swiftly condemned as an anti-democratic dismissal of the will of the people.

The anger coincided with a growing acknowledgment that 10 months after the election and nearly a decade of campaigning, hospitals, clinics, doctors and other advocates for expansion will have to wait even longer to see their vision become a reality. The amendment requires expansion to begin in July, but with the issue in court there is no guarantee that expansion will prevail.

"I think we knew from the beginning that things were not guaranteed to go well and I don't think anyone in the hospital community were already banking on this being approved," said Dave Dillon, a spokesman for the Missouri Hospital Association. "On the other hand, it is — after a decade worth of advocacy to move forward — It is another kind of sad moment for Missouri."

"We're disappointed in the governor's actions," he added.

Parson claims few choices

Parson said early Thursday that his administration had notified the federal Centers for Medicare and Medicaid Services, or CMS, that Missouri was dropping expansion. The state had previously filed paperwork with the agency that would have set the framework for increasing eligibility in July.

Some opponents of the program praised his decision.

"We are deeply encouraged to see Gov. Parson stand up and do what's right to protect Missouri taxpayers from unsustainable and reckless government spending," Jeremy Cady, director of Americans for Prosperity-Missouri, said in a statement.

The announcement came after the Republican-dominated General Assembly sent him a budget without funding for expansion. It would have cost the state at least $130 million a year, causing some conservative lawmakers to balk, but would have come with $1.6 billion from the federal government.

Parson said when the legislature refused to fund expansion, "there weren't a lot of choices left" for his office.

"The same people that wanted it argued [in court] the fact that there wasn't a funding mechanism to it," Parson told reporters Thursday after the announcement. "So it's just a problem. It's going to have to be decided in a court."

But expansion supporters said Parson had other options available, including expanding eligibility as scheduled in July and calling a special session later in the year to pass additional funding. Richard von Glahn, policy director at Missouri Jobs with Justice, said residents and providers had been "taking the governor at his word" for the last several months.

"He has said he was going to uphold the Missouri Constitution and honor the votes of Missourians. And his decision to withdraw the state plan amendment is really a betrayal to his own word and to the people of this state," said von Glahn, whose group helped arrange an interview with Thompson, a member of Stand Up KC, on Thursday.

In Jefferson County, resident Melinda Hille's experience with chronic illness illustrates the stakes of the fight.

At an April rally for expansion at the Capitol, Hille said she fell into the Medicaid "coverage gap" as she was changing jobs in 2015. While waiting to be hired full-time as a machine operator, a job that would come with health insurance, she was diagnosed with Type 2 diabetes.

The disease has put her in and out of hospital, sometimes on a ventilator. It requires multiple, daily insulin injections. Unable to qualify for Medicaid, she bounced around low-cost clinics and reused insulin needles to make them last.

"I've worked all my life, and now, I can't work, I can't do anything," she said. "Every day I have to fight to stay alive ... I have to be able to afford this stuff, this isn't like I'm gonna wake up tomorrow and be healthy."

More recently, Hille said she's found a patient assistance program at Barnes-Jewish Hospital in St. Louis and drives the hour each way weekly, still paying for the prescriptions.

"I just don't want anybody else to have to go through the hell that I went through these past seven years," she said.

Medicaid decision a 'crushing blow'

At a free medical clinic for the poor in rural southern Missouri, the holdup on Medicaid expansion has been a "crushing blow," said Dr. Jon Roberts, who serves on the Good Samaritan Care Clinic advisory council.

He formed the clinic with a group of local residents in 2004, relying heavily on volunteer work from nurses in the area and donations from Mercy St. Francis hospital, where Roberts had worked as a physician.

It sits in Mountain View, about 100 miles east of Springfield, and regularly serves about 100 diabetic patients from some of Missouri's poorest counties. Many of the patients devise a patchwork of part-time jobs to make ends meet, Roberts said, and before the pandemic dozens lined up outside for free Monday night clinics.

Both volunteer work and donations slowed down during the pandemic, so Roberts said when Medicaid expansion passed last August, "We felt like we were blessed."

"We could keep going until July and then most of our patients are going to be taken care of through the expansion of Medicaid," he said. "We felt a relief that if we close our doors, our diabetic patients, most of them would be taken care of."

"Wow," he said Thursday when he learned of Parson's announcement. "It's a sad day for the working poor and Missouri."

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