Medicaid cuts could lead to job losses

Faced with the possibility that access to health care may be reduced or eliminated for some Missourians, area health professionals are seeking options for their patients.
Missouri Gov. Matt Blunt’s proposed cuts, contained in SB 539, would save the state $625 million for the fiscal year that begins July 1, by reducing the eligibility threshold for the disabled and elderly. That threshold, currently set at the federal poverty level of $9,570 per year for an individual, would drop to $7,082 per year.
Proposed cuts in Medicaid would result in the loss of $379 million in federal matching funds to the state and a loss of $737.4 million in economic activity and 10,130 jobs in the state, according to a recent study from St. Louis University.
The study, “The County Level Economic Impact of Proposed Cuts in Medicaid Spending in Missouri,” was written by Heather Bednarek, Ph.D., and Muhammad Islam, Ph.D., professors of economics at SLU, with Joel Ferber, a managing attorney with Legal Services of Eastern Missouri.
The study predicts that Greene County alone could lose $220.1 million in economic activity and 3,142 jobs.
But Jessica Robinson, Blunt’s press secretary, said the governor’s office maintains that the study doesn’t look at the big picture.
“That study does not take into account at all where that money might go – where the savings might go,” Robinson said. “ It doesn’t take into account the fact that some of these (patients) will be picked up by private insurers.”
Robinson said that her office is working with the study’s authors to determine how they came to some of their conclusions.
“We can’t look at the study in terms of what it is because it truly only looks at one section of the economy,” she said.
Robinson added that the reality is, regardless of savings or cost, the state’s budget can’t support social welfare in its current design.
“These programs have lived outside of their means, and so Gov. Blunt’s recommended changes would create reform to the system and create a system that would be sustainable, not only for fiscal year 2006, but also sustainable into the future. The only way to support not making any changes is through a tax increase, and not just a tax increase this year, but a tax increase next year and the year after that and the year after that. There were tough choices that the governor had to make.”
The bill received preliminary Senate approval March 15. Changes could occur to the bill through May, Robinson said, and the new system, if passed, would take effect by June 30, 2008.

Self-pay or no pay
At Doctors Hospital, where 40 percent of revenue comes from Medicaid, Communications Director Alexis Brown doubts patients losing Medicaid could afford to foot the bill for services. Instead, emergency rooms may be busier, seeing patients for symptoms usually seen by family physicians or for illnesses that have progressed.
Emergency rooms in most hospitals, she said, are loss leaders. “You can’t deny someone medical services if they come into the emergency room,” Brown said, adding that waiting until an illness has progressed results in more expensive treatments for those individuals. “So they’re going to have to pass those costs on to people who pay by insurance, people who are private pay, and it’s going to affect the general population.”
Part of that burden is already carried by area hospitals. CoxHealth provided $39.1 million in uncompensated care. CoxHealth reported $1 billion in gross patient care revenue for the fiscal year ended Sept. 30, 2003, the most recent year available. Those numbers include Cox North, Cox South, Cox Walnut Lawn, Cox Monett, Primrose Place Health Care Center, Burrell Behavioral Health, Oxford HealthCare, Home Parenteral Services and Ferrell-Duncan Clinic.
St. John’s Community Benefit Report for the fiscal year ending June 30 shows that St. John’s provided charity care – free or discounted care to patients who can’t afford to pay and are not eligible for public programs – for 19,928 patients at a cost of $7.6 million. Medicaid subsidies – the unpaid cost of providing care to Medicaid patients, representing the shortfall between the cost of care and payments from the government – benefited 84,511 patients at a cost of $46.8 million.
“If the Medicaid cuts occur and people are removed from Medicaid benefits, I think we’ll certainly see an increased number of individuals seeking care at emergency rooms,” said Dr. John Duff, vice president and administrator of Cox North. About 16 percent of patients – both inpatient and outpatient – seen at CoxHealth in Springfield are uninsured, and about 35 percent rely on Medicaid, he added. Potential lost revenue data was not available. “It’s hard to get your arms around exactly what the impact will be in terms of the number of patients that would be affected within Springfield,” he said.

Doing without
Some affected by Medicaid cuts may do without care. The five dentists at Jordan Valley Community Health Center are busy trying to see the 3,300 adults on the clinic’s waiting list before they could potentially lose benefits.
The planned budget cuts have caused a “dramatic increase” in the number of adults trying to access dental care at the clinic, which Executive Director Brooks Miller said treats a client base that is 65 percent children and 35 adult Medicaid recipients.
“We’re going to back off on the kids for a while and try to get as many adults in as we can and get them taken care of,” Miller said, adding that if children are in need of urgent dental care, they will be seen.
“I do not have the resources to pick up the shortfall that these people are going to be experiencing,” Miller said. “Unfortu-nately it puts a lot of people in a difficult situation.”

To work or not to work
Dewayne Long, executive director of the National Alliance for the Mentally Ill of Southwest Missouri, is concerned about the possible elimination of Missouri Assistance to Workers with Disabilities, a program that allows disabled working people to earn up to 250 percent of the federal poverty level and still receive Medi-caid coverage.
If cut, 17,795 Missourians would be affected, according to the Missouri Department of Social Services. Of those individuals, 9,529 would lose coverage immediately, 4,753 would move to spend-down or increase spend-down, and 3,513 would be moved to another Medicaid category.
At Long’s office, 50 percent of the staff participates in the program, which he said is valuable not only in providing income to the workers, but also self-worth.
“For a person that’s disabled to be able to work 10 or 15 hours a week, it provides them a little extra money so they can pay their rent and buy their food, help with the co-pays on their medicine, it helps their self esteem, it makes them feel like they’re contributing to society and yet they’re still able to get their health care through Medicaid,” he said. “The state proposes to eliminate that program, so people will not be able to work, not be able to make a contribution to the economy or a contribution to society, their self-esteem will be affected and they’ll still have Medicaid. So they’ll have to make a choice between working and losing their health care or not working so they can have health care.”