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Advocates Try to Build Business Case for Missouri Medicaid Expansion

By John Reichard, CQ HealthBeat Editor

April 24, 2014 -- Although the number of states expanding their Medicaid programs under the health law appears to have pretty much stalled at 26, the option remains an active issue in five others—Missouri, Virginia, Pennsylvania, Utah, and Indiana—according to a Kaiser Family Foundation analysis.

Last week, the left-leaning group Families USA tried to make the case for an expansion in Missouri by releasing a report portraying Medicaid as helping to build a more vibrant economy in the state. But widening the federal-state health program for the poor to include some 300,000 uninsured Missourians this year will be a difficult challenge, acknowledged Missouri Hospital Association President Herb Kuhn, whose organization also is pushing hard for the expansion.

The Families USA report said that 60 percent of the Missourians who would benefit from the state's Medicaid expansion "are working and are employed in occupations that most people rely on daily and are critical to the state's economy." The analysis quantified the types of occupations where coverage would have some of the greatest impact, in an apparent effort to counter perceptions that those who would benefit aren't pulling their own weight in society.

The report said that of the 300,000 state residents who are uninsured and would qualify, 60 percent are employed or were employed within the past year, 20 percent are not in the workforce and the remaining 20 percent are unemployed.

Of the 300,000, the report said:

  • 34,000 people are employed as fast food and other food service workers, cooks and waitresses.
  • 24,000 are in sales, working as cashiers, retail salespeople, and travel agents.
  • 22,000 are in cleaning and maintenance, including housekeepers, janitors and landscapers.
  • 21,000 work in office and administrative support jobs like hotel desk clerk, office clerk, or messenger.

"Circumstances can make you virtually penniless and Missouri will still deny you help to get basic health care really demands that the state expand the Medicaid program," said the group's executive director Ron Pollack.

The group said Missouri's existing Medicaid program provides coverage only to parents whose family income must be no more than $4,750 a year. "Under Missouri's program, there is no health care provided for families without dependent children, regardless of how low their income may be," the group stated.

Also backing the expansion is the state's Chamber of Commerce, which has hired former Republican Sen. Christopher S. "Kit" Bond as a lobbyist to help the cause.

Kuhn, who held a top Centers for Medicare and Medicaid Services post during the George W. Bush administration, said in a recent interview that the challenge facing expansion advocates in the red state consists of developing an innovative package in tune with conservative values. Democratic Governor Jay Nixon, is advocating the increase in Medicaid eligibility in a state legislature where Republicans control both chambers.

"The partnerships continue to develop," on behalf of expansion, Kuhn said. The state Chamber of Commerce along with 75 local chambers are making the economic argument, which notes that the state is giving up $2 billion in annual federal payments, or $5.5 million a day, by not expanding. "The drumbeat gets louder all the time," Kuhn said.

Passage ultimately hinges on getting an approach that fits the state—on "what can they make uniquely theirs. A lot of it is individual responsibility," Kuhn said.

The key ingredients are going to be assuring financial sustainability since Missouri will have to pick up 10 percent of expansion costs at the end of the decade. Backers also must develop "innovative" health care delivery models to better coordinate care and an approach that relies on private coverage, Kuhn said.

There's interest in following the so-called Arkansas model, in which those entering the state's expansion program do so through private health plans that contract with Medicaid. But how soon and whether the right mix will be found is unclear.

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