The Missouri Legislature failed to act on Medicaid expansion before it recessed this year and the decision to not take action had to be political – here’s why I think so.
The Missouri Legislature is conservative and Republicans hold the majority. Medicaid expansion is a spin-off of the Affordable Care Act which was the defining act of a Democratic President. The thing is, from a purely objective view it appears as if the Democratic President may actually be more conservative than the Republican State Congress.
For years the federal government has been compensating hospitals in the form of “disproportionate share”, or DSH, payments for the care provided to the uninsured. The ACA is doing away with DSH payments to hospitals under the premise that Medicaid expansion will cover more people so DSH payments are no longer needed.
Medicaid expansion would insure people up to 138% of the poverty level which means working folks, hard-working folks, would be eligible for coverage. Current Medicaid limitations tend to restrict it to the non-working, the very poor and the disabled.
By providing Medicaid to the very poor and often disabled nothing is done to prevent people from falling into this situation in the first place. An argument can be made that there’s an incentive not to work. Conservatives often tout that when you support those who are poor and dependent you are unintentionally incentivizing them to remain dependent. By not expanding Medicaid we potentially run the risk of someone unemployed remaining unemployed because employment could prevent them from having health care coverage if the job they’re seeking doesn’t have benefits. Denying Medicaid to an able-bodied man or woman potentially discourages the able-bodied person from taking a job without health care benefits, even if the alternative is not to work at all.
A system that rewards work and provides benefits for trying harder rather than penalty is a conservative mindset but it also requires an admission that there may have been something in the ACA that was worthwhile.
I’m not bashing conservatives, in fact, my beliefs tend to fall in the conservative arena. The difference is I try to listen to reason and logic and not let blind politics alter my view because it apears that a Democratic President is incentivizing work and our conservative legislature is fighting a plan to reward work over dependence. It seems an argument could be made that expanding Medicaid is a conservative solution.