Barbara Shelly

Missouri’s irrational hostility to Obamacare keeps people stuck

Advocates for Medicaid expansion joined protesters of Ferguson events in the Missouri Capitol Rotunda.
Advocates for Medicaid expansion joined protesters of Ferguson events in the Missouri Capitol Rotunda. The Associated Press

Members of the Missouri General Assembly received a list this week. It contained the names of more than 1,000 hospitals, ministries, local chambers of commerce and health groups, all pleading with lawmakers to expand the state’s ridiculously low Medicaid eligibility limits.

Whoever compiled the list may have spent more time on the quest than the legislature will in honest debate this year. While 28 states have expanded the threshold under which people can qualify for Medicaid, and other states are looking for ways to do so, Missouri is going backward. The mood in the Capitol has shifted from skepticism two years ago, to very cautious optimism last year, to outright hostility.

Even Kansas is seeing tentative movement. Negotiations among Gov. Sam Brownback’s staff, key lawmakers and the Kansas Hospital Association have produced a bill that would make it easier for the governor to expand the KanCare program to include more low-income citizens.

But in Missouri, where 300,000 working adults exist in a coverage gap, talk about “transforming” Medicaid into a broader but better system has all but ceased.

“It’s very different this year,” said Joseph Pierle, the chief executive of the Missouri Primary Care Association. “Last year there was real momentum. This year you can’t even have a conversation about it.”

Indeed, many GOP lawmakers seem fed up with hearing about the people who make too much to qualify for Medicaid but too little to get subsidies in the Affordable Care Act’s insurance marketplaces.

“We’re still trying to get through the political discussion so we can have a policy discussion,” said Sen. Ryan Silvey of Kansas City, North, who is the only Republican pushing the issue right now.

One can point to specific obstacles. The new GOP House speaker, John Diehl, shows even less interest in expanding Medicaid than his predecessor. There remains in the Senate a clique of conservatives trenchantly opposed to any expansion of government services. But underlying it all is a disregard for the working poor that borders on contempt.

Currently in Missouri, a person can make no more than 19 percent of the federal poverty level, or $4,000 a year for a single parent with three children, to qualify for Medicaid. That rules out most people who work low-wage jobs, which usually come without health benefits.

I have not yet met a legislator who could explain cogently how low-wage workers are supposed to purchase health insurance at market rates when they can barely provide food for their families. Their best advice, “get a second job,” only shows how little they know or care about swing shifts, erratic scheduling, transportation obstacles and sick kids at home.

This week the state of Kentucky released an independent audit on its first year of Medicaid expansion. It showed that 310,887 people signed up, and the rate of uninsured citizens dropped from 20 percent to 12 percent. Medical facilities opened, expanded and hired people. State government was spared the direct expense of treating prisoners and the mentally ill. Worker productivity improved.

The bottom line, according to Deloitte Consulting: Kentucky will be richer by $919 million by 2021 because it expanded Medicaid.

Findings like that ought to catch the eye of Missouri legislators, but they haven’t.

Neither has an analysis by McClatchy newspapers that Missouri will forfeit $17.8 billion in federal funding from 2013 to 2022 by not expanding Medicaid, while its residents will pay $7.3 billion to fund Medicaid expansion in other states.

The pleas of 1,000-plus advocates and the hardscrabble stories of people in the gap have not made a difference either.

They are stuck, because their state government is stuck. And the way it looks now, it will take wholesale changes in the 2016 election to get Missouri moving on an expansion that makes eminent sense.

Reach Barbara Shelly at 816-234-4594 or On Twitter @bshelly.