It’s not the unemployed who would benefit the most if Missouri expanded its Medicaid program through the Affordable Care Act.
It’s the cooks and waitresses, cashiers and cab drivers, housekeepers and parking attendants — people working low-wage jobs — who would be most likely to gain health care coverage, according to a report released Thursday by a group of Medicaid expansion supporters that spans the political spectrum.
The study comes as these supporters of broadening eligibility for Medicaid make their last push to get approval through a contentious state legislature.
Some lawmakers have raised concerns about the program’s future costs and who would benefit from Medicaid expansion.
“A lot of people, frankly, look at social programs and assume the people using them aren’t working. These are working people, the working poor,” said Brendan Cossette, director of legislative affairs for the Missouri Chamber of Commerce and Industry, which released the report jointly with the Missouri Health Advocacy Alliance. “I can guarantee you everybody in the legislature knows one of these folks.”
But with less than a month to go before the General Assembly adjourns, there’s no indication Medicaid expansion will move forward.
Through the Affordable Care Act, states can choose to expand eligibility for their Medicaid programs to include residents with incomes up to 138 percent of the federal poverty level, about $16,100 for an individual. The federal government picks up the full cost of the expansion for the first three years; after that, federal support tapers to 90 percent. Missouri, along with Kansas, is among 23 states that have not expanded Medicaid.
In Missouri, more than 350,000 uninsured people could gain health care coverage if the state expanded its Medicaid program, says the report by the liberal health advocacy group Families USA. Of those, 60 percent, more than 200,000, are currently working or have worked in the past year. About 20 percent are not in the workforce; they include students, people with disabilities and nonworking spouses. The remaining 20 percent are unemployed.
Families USA, which is based in Washington, based its numbers on an analysis of U.S. census data from 2010 to 2012.
The largest group of workers who would gain coverage through Medicare expansion in Missouri — about 34,000 — are in the food-service industry, the study found. An additional 24,000 are in sales and 22,000 in cleaning and maintenance.
“These are people who work really hard. They don’t make a lot of money,” said Andrea Routh, executive director of the Missouri Health Advocacy Alliance. They often work for small businesses that can’t afford to offer health insurance, or they work several part-time jobs and don’t qualify for coverage, she said.
Cossette said there is a “very compelling business and economic case” for expanding Medicaid. The federal Medicaid money would pump $5 million a day into the state’s economy, he said. And “healthier employees are happier and more productive.”
In 2005, Missouri pared back its adult Medicaid eligibility levels to the lowest income thresholds allowed under federal law — 19 percent of the federal poverty level, or about $4,500 for a family of four.
Missouri’s Medicaid program currently covers about 830,000 people at an annual cost of nearly $9 billion, most of which comes from the federal government.
While Missouri Gov. Jay Nixon, a Democrat, has come out in favor of Medicaid expansion, the state’s Republican-led legislature has repeatedly rejected Medicaid expansion proposals over the past two years.
And it shows little desire of embracing one now.
Critics of the idea have raised concerns about the long-term costs to the federal and state governments. Lawmakers should focus on ways to make the Medicaid program better, they contend, not necessarily larger.
That’s especially true in the Missouri Senate, where a group of Republicans has vowed to use the filibuster to kill any measure that adds people to the Medicaid rolls.
“There is no path for Medicaid expansion to occur in Missouri this year,” Sen. Brad Lager, a Savannah Republican, said during Senate debate last month.
“I’m one that’s willing to stand as long as we need to in order to make sure that it doesn’t happen,” added Sen. Dan Brown, a Republican from Rolla.
That opposition hasn’t stopped some Republicans from pressing forward with expansion plans linked to a broader overhaul of the program aimed at winning over skeptical colleagues.
Rep. Noel Torpey, an Independence Republican, has crafted a proposal that would provide Medicaid coverage to Missourians whose incomes fall below 100 percent of the federal poverty level. Those with incomes between 100 and 138 percent of the poverty level could use federal funds to purchase private insurance through the health care exchange.
Torpey’s bill also would mandate that recipients be employed; expand the use of managed-care to cover children and parents; offer incentives for people to keep their health care costs down; and prohibit recipients from relying on emergency rooms for primary care.
In the Senate, Republican Ryan Silvey of Kansas City has proposed a similar idea. But instead of work requirements for Medicaid recipients — which many believe would not be allowed under federal law — he implements them for other social welfare programs, such as food stamps.
Silvey’s plan also tries to address another concern among Republicans, that the state will be on the hook for millions of dollars in additional Medicaid expenses once the federal government pares its funding from 100 percent to 90 percent for the expanded enrollment.
Missouri can expect to save money by switching some people whose health care is covered by state funds into the new federally funded Medicaid category. Silvey’s plan would stockpile those savings to help cover future costs. If that falls short, the state’s reimbursement rate to hospitals would be reduced.
Both Silvey and Torpey think enough support exists in the General Assembly for their bills to win passage.
“If it came up for a vote today, it passes,” Silvey said of his proposal. “No doubt in my mind.”
Routh and Cossette also are optimistic for Medicaid expansion this year.
“I think there are a lot of Republican legislators who are ready to vote on this, but we’ve got to get it to a vote,” Routh said.
But with just three weeks left in the 2014 legislative session, the entrenched opposition in the Senate means the likelihood that vote will actually take place this year remains remote.Employed but uninsured
Top nine occupations of those who would benefit from Medicaid expansion in Missouri:
• Food service (fast food, cooks, servers): 34,000
• Sales (cashiers, retail clerks, travel agents): 24,000
• Cleaning and maintenance (housekeepers, janitors, landscapers): 22,000
• Office and administrative support (hotel desk clerks, office clerks, messengers): 21,000
• Transportation (bus drivers, taxi drivers, parking attendants): 18,000
• Construction (carpenters, laborers, painters): 18,000
• Personal care (barbers, child-care workers, personal care aides): 15,000
• Production (butchers, laundry workers, tailors): 14,000
• Health care support (home health aides, nursing aides, dental assistants): 12,000
• All other: 31,000
Source: Families USA