When state lawmakers balked at medical marijuana and ethics reform, Missouri voters took the initiative and approved ballot measures on both issues.
The 2020 election cycle could bring a similar boost to efforts to expand Medicaid, an issue that has met with resistance in Jefferson City since the passage of the Affordable Care Act.
A coalition called Healthcare for Missouri is gathering signatures for a ballot initiative to expand Medicaid to cover more of the working poor, as allowed under the ACA. The proposal is finding a friendly audience at Mosaic Life Care, were the hospitals’ leadership has encouraged its caregivers and employees to sign the petition.
“We know that’s always a little dicey when we do that,” said Pat Dillon, Mosaic Life Care’s chief government and community relations officer. “Because there’s some folks who may not agree with this, but the value to health care itself and the value to our system is something that’s important to us.”
Medicaid expansion was allowed under the ACA to cover adults who lack private insurance but earn too much to qualify for the state/federal program that helps pay medical costs for low-income families. A U.S. Supreme Court ruling in 2012 made Medicaid expansion voluntary for states.
So far, 37 states have expanded Medicaid either through a legislative vote or a ballot initiative. Missouri’s Republican legislative majority has refused to do so, in part because the 10 percent state match would increase the cost of a program that already consumes a significant portion of the state budget.
Missouri’s Department of Social Services, which administers Medicaid in Missouri, accounts for about 20 percent of the state’s general revenue outlay. That’s second only to the Department of Elementary and Secondary Education. A spokesperson said the Department of Social Services has no comment on the ballot initiative but would provide a cost estimate if necessary.
In the past, the state has emphasizing efficiency and eliminating fraud in Medicaid, which goes by the name of MO HealthNet in Missouri, rather than expanding the program.
“We will embrace innovative ideas to maximize current resources, think outside the box and use new technologies to address this issue,” said Todd Richardson, director of MO HealthNet, at a program last year announcing a Medicaid Fraud and Abuse Task Force.
One year later, the Republican majority has little stomach for Medicaid expansion in Missouri. State Rep. Brenda Shields, R-St. Joseph, said she doesn’t think the Legislature will take up the issue in the 2020 session. It will be up to the voters, if the petition gains enough signatures and winds up on the ballot.
“I think you will see hospitals get behind it,” Shields said.
The Missouri Hospital Association is one member of the coalition trying to get Medicaid expansion on the statewide ballot. In St. Joseph, Dillon doesn’t think Mosaic’s advocacy crosses a line for a tax-exempt hospital because employees are urged to sign the petition but not required endorse it. Nonprofit hospitals in Joplin and Springfield are on record as supporting the petition.
“If we think it’s a value to the community, we’ll say, ‘Hey, we’re behind this’,” he said. “Does that mean we encourage all of our people to vote for it? No. We just say as an organization we think this is valuable.”
The expansion of Medicaid would impact the financial position of hospitals, especially in rural areas where there are fewer patients with private insurance. The Kaiser Family Foundation estimates that around 200,000 Missouri adults would get coverage if Medicaid was expanded to 138 percent of the poverty level.
Mosaic estimates it would save about $13 million a year in uncompensated care if more patients were moved to Medicaid. The issue is about more than a hospital’s bottom line, according to Dillon.
“Without any kind of coverage, of course, they don’t seek medical help when they need it right away,” he said. “And so very often, you come for much bigger issue. More chronic, more severe issues have become costs to the hospitals, costs to the state and just not a good quality of life for our folks.”
Last year, voters approved Medicaid expansion in Nebraska, Idaho and Utah.