Wait times for Missouri residents trying to get health insurance through Medicaid have grown so long that the federal government is poised to intervene. This development would be concerning under any circumstances. But it’s especially so in a state where the Republican power structure has spent years undermining the program at every turn. Gov. Mike Parson’s administration must address this issue directly and transparently to assure Missourians that this is a matter of bureaucratic morass and not intentional sabotage.
Medicaid is the joint federal-state health-insurance program for low-income Americans. Missouri, like many Republican-controlled states, for years resisted expanding its Medicare system to cover more residents, as envisioned by the Affordable Care Act, even though the federal government would foot most of the bill. There were all kinds of putative explanations offered for this, but the real one was obvious: The better Obamacare worked to provide coverage to Missourians, the better it would be politically for Democrats — and Missouri Republicans couldn’t have that. So they worked to ensure that some of their own most vulnerable citizens continued to go without health care coverage.
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By 2020, Missourians had had enough of the Legislature’s partisan subversion, and approved Medicaid expansion by referendum. Even then, some legislative Republicans tried to hobble it, but expansion was ultimately accepted as the new policy of Missouri.
That disturbing backstory should be kept firmly in mind as Missourians ponder why it is that the wait time for approving new Medicaid applications in Missouri now stands at more than 100 days — well over twice the 45-day target set by federal guidelines. As the Post-Dispatch’s Kurt Erickson reported, official predictions back in June that the already-high wait times would shrink going forward turned out to be the opposite of true. Those wait times have instead increased. Some 34,000 Missourians are still waiting.
The understaffing that’s affecting all of state government is being partly blamed, and it certainly may have a role. But there’s no ignoring the fact that, in a red state in which the power structure has always opposed Medicaid expansion, expansion is again being stymied.
If the state misses a federal deadline of bringing the wait time down by the end of September, it could mean financial sanctions from the feds. Normally, that would be a strong motivator for the state to get its act together. But given the recent history of this issue in Missouri, it’s difficult to dismiss the possibility that chipping away at Medicaid funding is exactly the goal that some state Republicans have in mind.
That may sound like a cynical analysis, but these are cynical times. We would welcome being proven wrong on this issue, which Parson could do by focusing resources on this crucial program and reducing these wait-times for vulnerable Missourians.