Red states expand Medicaid, will Missouri follow?

Nov. 11--Politicians in Nebraska, Utah and Idaho never showered much praise on former President Barack Obama's Affordable Care Act.

But voters in those three deep-red states bucked local political convention when they approved ballot measures last week to expand Medicaid, which is a signature provision of Obamacare.

"I strongly support expanding health care to folks who need it," Idaho's Republican governor, Butch Otter, said in a statement prior to last week's vote. "It's good sense and it's the right thing to do."

Now, some are wondering if Missouri will consider a similar measure. Missouri Republicans have resisted calls to expand the government program since the ACA went into effect, citing the long-term budget risks as Medicaid costs continue to rise. After Tuesday's election, Missouri and Kansas are among 14 states that have not expanded Medicaid coverage, primarily for low-income adults.

"There are a lot of people that did not want to see the Affordable Care Act be successful," said Linda Judah, executive director of the Social Welfare Board, which provides clinic services to low-income patients in Buchanan County. "The bottom line is it's what we have right now. It's about how the Legislature wants to pay for health care in the state of Missouri."

Under most estimates, 87,000 Missourians would get coverage if Medicaid was expanded to 138 percent of the poverty level. The expansion attempts to provide insurance to those who fall in a coverage gap because they don't qualify for Medicaid or the Obamacare subsidies designed to offset the cost of private insurance. The cutoff amounts to around $16,753 for a single person and $34,638 for a family of four.

Judah described many in the Medicaid-gap population as the working poor who avoid preventative care and go to the emergency room when they have a medical issue.

"In the end, we all pay for it because the hospitals have to raise their rates," she said. "We all pay in the end if those services aren't being delivered or accessed appropriately."

In Kansas, Gov.-elect Laura Kelly, a Democrat, has promised to sign a Medicaid expansion bill if the Legislature passes one. Missouri lawmakers were cool to the idea, with one Republican expressing concerns about the cost and noting that the state's voters banned online health-care exchanges -- another aspect of the Affordable Care Act -- in 2012.

Another lawmaker -- newly elected state Rep. Brenda Shields -- said she would like to see how expansion is working in other states.

"I think it's something we have to go back and look at again," said Shields, who represents a district that spans St. Joseph's South Side to northern Platte County.

Judah said Missouri tax dollars already pay for Medicaid expansion in other states. The federal government picked up 100 percent of the expansion cost when the ACA went into effect, but states are expected to pay 10 percent by 2020.

"It just makes sense for Missouri to expand Medicaid," she said. "Through the next decade, we will have paid $7.3 billion, through our taxes, to other states to provide Medicaid to their folks."

Voters in Montana rejected a Medicaid-expansion measure Tuesday. That Montana proposal was tied to a proposed increase in the state's tobacco tax.

Greg Kozol can be reached at greg.kozol@newspressnow.com. Follow him on Twitter: @NPNowKozol.

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