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Missouri fears Medicaid expansion will bankrupt state

As neighboring states struggle with bankruptcy, some say brought on in part by Medicaid expansion, Missouri Republican lawmakers would rather fix the system than add another entitlement funded by taxpayers.

Half of regional states, including Missouri, are pushing back on efforts to greatly expand Medicaid to include 19-to-64 years old who earn up to 138% of poverty level.

That hasn’t turned out too well for Illinois.

Illinois, even after receiving billions in Federal aid under the Obama administration is on the verge of bankruptcy, in part because of skyrocketing Medicaid expansion it adopted in a Democrat legislature and signed into law by previous Democrat Governor Pat Quinn.

The problem for Illinois is the secret that proponents of expansion are unwilling to talk about. When expansion occurs, the Obama administration promised to fund 90 percent of the cost. And they did. But that is not indefinite. After several years, Federal funding begins to disappear leaving the state with a billion dollar welfare expense. Illinois is now paying for 50 percent of the cost, well over $1 Billion, and that number will continue to climb.

Current Illinois Gov. Bruce Rauner, a Republican, told The State Journal-Register in a recent interview that he is concerned about the impact of the expansion on Illinois taxpayers and disturbed by the trend of more people getting publicly financed health insurance rather than employer-sponsored coverage.

Quinn said the expansion “basically has dramatically increased costs for taxpayers, and it has increased the number of folks who are getting health care at the expense of taxpayers rather than through working, and I think that’s a wrong trend.”

Expansion was a component of the Affordable Care Act (ACA) passed unanimously by the Democrat Congress during the Obama administration but was found unconstitutional by the Supreme Court in 2012.  The high bench found the Medicaid expansion portion too intrusive on states.

Since that time, some states have increasingly chosen to expand the federal welfare program on their own as the Supreme Court decision left the option open.

The number of states opting in grew from 33 to 36 plus the District of Columbia in the recent general election when voters in Nebraska, Utah, and Idaho, passed ballot measures to implement expansion.

Missouri, Kansas, Oklahoma, and Tennessee are the last regional states standing but things could change in Kansas with the election of a liberal Democrat governor.

Kansas lawmakers passed Medicaid expansion in 2017, but then-Governor Sam Brownback vetoed it for budgetary reasons and the legislature didn’t have enough votes to override the veto.   A similar measure failed to advance during the state’s 2018 legislative session, although it passed one chamber.  Newly elected Democratic Governor Laura Kelly, who’ll take office in January, supports Medicaid expansion, and has vowed: “to advocate for and sign legislation to expand Medicaid in her first year.”

If Kansas follows through on Kelly’s pledge, Missouri and 12 other states, mostly in the south, would become more pronounced outliers.

Republicans in Missouri, who hold supermajorities in both legislative chambers, have been openly hostile to Medicaid expansion since the option became available.  The party could be reinforcing its opposition with recent appointments to key positions.

Many of their concerns involve budgetary concerns as area states that have passed expansion are now on the verge of bankruptcy.

House Republicans overhauled their leadership, opting to place O’Fallon Republican John Wiemann for the second-in-command position of Speaker Pro-Tem.  He also has a master’s degree in healthcare administration and sponsored a bill this year which expanded Medicaid providers to include chiropractors.  The measure passed into law with bipartisan support.

But Wiemann says he opposes Medicaid expansion and favors free-market solutions.   He predicted other states would retreat from Medicaid expansion earlier this year.  “You’re going to start seeing a reversal of that,” said Wiemann in January.  “A lot of the state’s that have done Medicaid expansion, they’re starting to regret that they’ve done that.”

After having previously voted to expand it, Montana voters just went to the polls choosing not to renew its expanded Medicaid arrangement which was scheduled to sunset in 2019.  The Montana ballot measure to end it was seen as a huge defeat for proponents of Medicaid expansion because it highlighted the little known facts surrounding it–exploding tax burdens on taxpayers.

Missouri Republican Governor Mike Parson appointed term-limited outgoing House Speaker Todd Richardson to be Medicaid Director on November 1.   Richardson stated at a press conference that they’re focused on reforming Medicaid, not expanding the program.  “My focus is not going to be on expanding the Medicaid eligibility,” said Richardson.

Missouri has some of the strongest eligibility requirements of all states to dissuade abuse of its Medicaid program.  In addition to pregnant women, it currently covers low-income seniors, blind and disabled people, uninsured women, children, and parents who earn 19 percent of the poverty level. Some see that as pretty generous while others want anyone in a certain income level between 18 and 64 covered.

Because of Missouri’s level of poverty, the federal government covers 64.6% of Medicaid costs, where roughly 1/6 of the state’s 6 million residents are on the program.  State contributions to the program vary from state-to-state, but federal support is higher in those that have higher poverty levels. It also means when that federal aid goes away, the state will be left holding the bag.

Medicaid and the CHIP program currently cost the U.S. almost half-a-trillion dollars annually.

If Missouri were to expand Medicaid, the federal government would cover 90% of costs as of 2020 and a slightly larger percentage in 2019.  At 90%, Missouri would have to chip in $200 million annually on top the federal contribution of $1.8 billion to pay for expansion.  FamiliesUSA estimates that 293,000 people would be newly eligible for coverage if the state were to expand the program. When the federal aid drops to the level of Illinois, Missouri taxpayers would have to then foot a $1 billion price tag…per year.

Democratic State Representative Deb Lavender of Kirkwood attempted to attach an amendment to expand Medicaid to a bill during a special session of the legislature this year.  The legislation to broaden the use of treatment courts as an alternative to criminal charges for certain offenders included language pertaining to Medicaid.  But Lavender’s amendment was deemed out of order and rejected as not being in the scope of the governor’s call for a special session which was specific as it related to treatment courts.

Lavender notes the fact that voters in three states just passed Medicaid expansion should be a signal for Missouri to place a measure on the ballot.   “I think that gives some strength to maybe some Missouri organizations that are looking for Medicaid expansion that they see some way forward with maybe a ballot initiative here as well,” said Lavender.

Missouri and outstate Medicaid expansion proponents, realizing it may not happen legislatively, have already begun the process to put it to a statewide vote by referendum in 2020.

–Missourinet News Service contributed to this article.

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