I spent a few minutes the other day penning an email to one of my local state legislators to express my views on Medicaid Expansion in Missouri. I’m in favor of expansion for several reasons.
First, twenty-six other states have chosen to expand Medicaid which means that tax dollars from Missouri are paying for Medicaid services in other states. I’d prefer that Missouri tax dollars were spent helping people who contribute to the taxes generated in Missouri.
Second, there are people in Missouri who do not have access to affordable health coverage and Medicaid expansion will provide them the opportunity to seek primary care services and be healthy and productive.
Third, the ACA reduces payments to hospitals for uncompensated care and expansion of Medicaid was intended to offset these cuts. It was later determined that states could choose to opt in or out of Medicaid expansion. Hospitals in states that choose not to expand Medicaid are at an even greater financial disadvantage when providing uncompensated care. The hospitals in Missouri that provide uncompensated care to our most vulnerable citizens are at risk because those reimbursement cuts from the ACA, on top of reduced payments for uncompensated care, may make it difficult to keep the doors open. In many communities hospitals are the obvious safe haven for health care but they are also the primary employer and economic engine.
Here’s an excerpt of the response I received from my email to the legislator: “In 2005, Medicaid was cut in our state to remove able-bodied adults from the program. From these cuts, Missouri avoided financial turmoil from an out-of-control Medicaid program. Expanding Medicaid again would likely, within a few years, put Missouri in the same difficult budgetary situation as 2005.
Finally, it is important to remember that these federal dollars are not free dollars. Just like state spending, federal spending is made possible through taxes paid by you and me. In its current situation, the federal government is in no place to be giving large sums of money to the states to expand Medicaid. By giving states money to expand Medicaid, the federal government continues to go further into debt. Missouri can take the lead in being fiscally responsible by telling the federal government that we will not expand Medicaid.”
I’m all for limiting governmental spending and spending tax dollars wisely but I don’t understand the two sentences of the response I bolded above.
The ACA did two things that affected able-bodied Missourians. Insurance exchanges were established to help make health insurance affordable for those who do not have access to insurance through an employer. The cost of the insurance is subsidized by the Federal Government based on income. Expansion of Medicaid was intended to help those who previously did not qualify for Medicaid have access to health coverage because they do not qualify subsidies through the newly established exchanges. We are talking about able-bodied Missourians, the working poor, who currently make too much to qualify for Medicaid but not enough to qualify for subsidies through the exchange. In essence people are being penalized for working and paying taxes.
If the taxes paid by you and me are to be used wisely, wouldn’t it be wise to use those taxes to help people in Missouri. Expanding Medicaid in Missouri will encourage people to continue to work, increase tax contributors, retain health care jobs and make people healthier. Sounds like a wise use of funds.
In the end the money is being spent by the federal government whether we like it or not. I would prefer my money be spent in Missouri to help my friends and neighbors.