During this week’s Capitol report, I would like to address the issue of Medicaid expansion and specifically a meeting that I attended at Texas County Memorial Hospital.
My office received an invitation from Texas County Memorial Hospital’s CEO Wes Murray requesting that I attend the summer board meeting to discuss health care policy and its effect on our local hospital. I was glad to have received the invitation and attended the meeting.
I would like to clarify some statements that, I feel, have been taken out of context and have resulted in some misinformation.
Medicaid expansion is a hurdle in which we must find a solution. Our current health care system is unsustainable long term, and we must work to find a Missouri solution that will give the most citizens access to health care. Some of our neighbors here in the 33rd Senatorial District have problems with access to health care, timely health care, or the specialists they may need. I feel like expansions of our current health care system would not truly fix access to care, and the other issues that have brought us to this point in our state’s health care debate.
How did our system get to this point? One of the key elements involved in the passage of the 2010 Affordable Care Act (ACA), also called ObamaCare, involved shifting a large portion of uninsured people to Medicaid. The notoriously long bill has prompted over 20,000 pages of accompanying regulations, and has been changed 42 times (as of July 2014) through legislative, administrative, and court actions. Many companies and industries (and even Congress) have been exempted from participating or complying with executive orders. An infamous U.S. Supreme Court decision in 2012 cited a "penalty" as unconstitutional, but upholding the federal ability to tax.
Another key provision in the 2012 opinion dealt with the expansion of Medicaid across the country, in saying that the federal government cannot penalize states for not participating; thereby making Medicaid Expansion "voluntary" on a state-by-state basis. The portion of the ACA that was set to eliminate the Disproportionate Share Hospital (DSH) payments remained unscathed in the court's opinion, which relates to the "reimbursement reductions" and declining revenue that has been a major topic of contention and discussion for many hospitals, in regard to the revenue that they are no longer seeing.
Missouri is one of the 34 states has have chosen not to set up a "state" exchange and has also not expanded Medicaid coverage, along with 24 other states, to those below the 138 percent of the Federal Poverty Level (FPL). While expanding Medicaid is considered a "voluntary" option, like virtually all other federal mandates, regulations, or programs, this is tied to federal funds that are promised in the event that Missouri would reach an agreement with the federal government concerning expanding Medicaid.
As a senator, and as a health care consumer, I understand the confusion and frustration of the employees at TCMH and other hospitals across our state that have been told "Missouri's legislators are at fault; we have to expand Medicaid, or the hospital will close," or "Passing Medicaid expansion will help our economy." When reviewing the big picture, there are some very valid reasons for NOT expanding Medicaid, such as:
- We would be endangering schools by expanding Medicaid when our budget won’t allow it. Schools will take a hit as will social services recipients and those with mental disabilities as seen in our governor’s cuts and withholds. I will not jeopardize the future funding of education or other important social programs such as mental health services and Meals on Wheels.
- MO HealthNet or SCHIP (State Children’s Health Insurance Program) has been available to all children under 19 years of age who don’t have or can’t afford insurance and who meet the family income qualifications.
- Obstetric clinics, services for the deaf and blind, some rehabilitative services and other forms of treatment could see a cut in budgets if we expand Medicaid, because there won’t be enough to cover every benefit.
The governor is withholding funds now, including funds appropriated by the Legislature that would have expanded dental coverage under Medicaid, saying Missouri can’t afford the budget passed by the General Assembly. He is holding up tax breaks under the guise that the money is not there.
How can we possibly expand the Medicaid program if his findings are factual?
Access to coverage does not equal access to care, or quality care, and in those states that have expanded coverage, access to care, quality of care, and affordability has suffered, while the costs have surpassed all expectations. In Arkansas, the cost increase has been so enormous that it has exceeded the Federal "cap" (as written in the expansion agreement) and the taxpayers of Arkansas are responsible for that difference. The startling reality is that under Medicaid Expansion, hospitals actually lose more money each year to undercompensated care for those on Medicaid than to uncompensated care for those without insurance. With the reduced mandatory costs of Medicaid, many doctors simply can't afford to accept patients covered by Medicaid, which results in too many patients for too few doctors; which is again opposite of the reported or intended effect of improving health outcomes through access to coverage. Fewer choices for the patient directly translates into lower quality care.
One of the biggest threats that Medicaid expansion poses is to our state budget. Our state is constitutionally required to have a balanced budget. While the federal government promises to pay 100 percent for the first three years, the cost burden is shifted to the states. Will newly added individuals be dropped from coverage? If not, then which sector of state service(s) will then have to be reduced due to the newly created costs that must fit within our budget? Social services? Education? These are questions that remain unanswered and are potential scenarios that would hurt all Missourians.
In Missouri, expansion cannot happen without the support of the majority of legislators voting in favor of it. For a bill to pass the House of Representatives, it is only required to have 82 votes. In the Senate, 18 votes are required to pass a piece of legislation. On any issue and regardless of political party, if a senator feels compelled to the point of shutting down the Senate and the piece of legislation, they can speak until the bill is killed. One senator is all it takes. There are senators who have publicly committed to a filibuster on any legislation that attempted expansion. There is no one person, representative or senator, who can be blamed for Medicaid not being expanded. Passing any piece of legislation requires votes. And if the votes are not there, nothing can be done until they are and a bill passes and is signed into law.
As a member of the Senate Veterans Affairs and Health Committee. I supported and voted for Sen. Gary Romine’s (R-Farmington) Senate Bill 739 which would have modified some provisions of MO HealthNet. Unfortunately the bill did not pass due to a filibuster conducted by several senators. I sponsored Senate Bill 524, to which was added language expanding the Medicaid program, with some restrictions. The bill was voted “do pass” by the House, and was referred to the House Rules Committee, which is protocol, but was never taken up by the committee and died in the House Rules Committee.
I even pledged my support in drafting a piece of legislation with Sen. Ryan Silvey, R-Kansas City, which would support reasonable and affordable plans to expand Medicaid while including deductibles and sliding scale payments based off of income. We are all working toward a solution. That much I can promise you.
I do agree there needs to be a solution for access to health care in our state. But there needs to be reform before we go forward with expansion. I support a reasonable, affordable, bill to expand Medicaid. It must include deductibles and sliding scale co-pays based on income. This is the same position I’ve held for two and a half years; my voting record will bear that out.
I do not think we should put a patch on a problem that will continue to plague us, our children and grandchildren. We have to fix Medicaid, not simply expand it. If there is any way Missouri can pay for and support a change in our current health care plans, I will support it.
I fully appreciate the medical care our hospitals provide and the economic impact they have on our local communities. |
