The most important issue facing the 2014 Missouri Legislature is whether to expand state health care coverage to working people earning up to 138 percent of the federal poverty level. I say “working people” because the vast majority of the 226,525 uninsured Missourians who fall between 19 percent of the federal poverty level – the current limit for Medicaid coverage in Missouri – and 138 percent are employed at low-wage jobs.
The Affordable Care Act provides that, if states extend Medicaid coverage to include those uninsured in this population, the federal government will pay 100 percent of the Medicaid cost through 2016, decreasing to 90 percent in 2020 and beyond.
The U.S. Supreme Court ruled the ACA is constitutional, but Congress could not force states to expand Medicaid eligibility. The negative financial consequence of this decision was negligible in states that chose to expand Medicaid to cover the working poor, but devastating to hospitals in states such as Missouri, which thus far have refused to accept federal money. Missouri’s hospitals will lose federal uncompensated care subsidies and, without state Medicaid expansion, will see no increase in Medicaid reimbursement.
This revenue shortfall will have a tragic economic effect on rural hospitals throughout Missouri. In my community, the failure of the state legislature to act will cost Columbia’s hospitals about $30 million. Our hospitals will be hurt, but they will survive. The same cannot be said for many smaller, rural hospitals.
Various corporations and organizations have reached substantially the same objective conclusions:
• The cost to our hospitals, and ultimately to our economy, of not expanding Missouri health care coverage will reach $3.5 billion by 2019.
• Expansion would have a direct positive effect of at least $40 million per year on the state general revenue budget, excluding the impact of increased secondary economic activity.
• The St. Louis Regional Chamber of Commerce forecasts the 10-year impact of not expanding coverage would be equivalent to eliminating more than 5,000 jobs.
• Expanding Medicaid in Missouri would result in an additional 20,000 jobs, increasing employment income by more than $5 billion.
• Without Medicaid expansion, the payment to hospitals for uncompensated care would be reduced by about $11 billion by 2019, resulting in substantial cost shifts in the business community, according to the St. Louis chamber.
Many politicians who oppose health care expansion are fond of saying the government should behave more like a business. I agree. The two largest statewide business groups, the Missouri Chamber of Commerce and Industry and Associated Industries of Missouri, both support expansion, as do a growing list of more than 40 local chambers [including Springfield].
Opponents suggest somehow expansion will cost our general revenue money and ultimately erode support for education. In my role on the House Interim Committee on Medicaid Transformation, we have learned if one objectively evaluates the costs and benefits of expansion, the inescapable conclusion is expansion actually saves money in the general revenue budget. Expansion makes more, not less, general revenue available for education. If opponents disagree, they have an obligation to present the facts to support their supposition.
—Rep. Chris Kelly, D-Columbia, House Interim Committee on Medicaid Transformation
This installment of Springfield Business Journal’s Architects & Engineers Project Report showcases 26 endeavors by area design and engineering professionals.
