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Missouri Republican politicians put the squeeze on middle class and working taxpayers all the time – just consider their reckless tax cut for the rich, a taxcut that will decimate Missouri’s coffers with little benefit for the ordinary Joe. They’re willing to risk tax dollars any old day when it comes to serving their rich patrons or pandering to their base – here you can reflect on the potential costly court cases that will result if Brian Nieves’ gun law nullification bill manages to squeak through. Or think about the beaucoup bucks that will be spent paying for ID cards and other nonsense if Republicans manage to get their way about voter ID – money spent to solve an imaginary problem (although the actual problem Republicans hope to address – voting Democrats – may not be so imaginary).  

By far the worst example of such waste can be found in the GOP’s to-the-death opposition to the Obamacare Medicaid expansion. You know that by refusing to expand Medicaid they’re not only depriving poor Missourians of health insurance that will, for many, be a matter of life and death, but they’re depriving the state of billions in federal Medicaid support. You also know that failing to expand Medicaid will cost the state many potential new jobs in the health sector. Hospitals will also bear the cost of the GOP Obamacare tantrum when they have to continue to treat the uninsured who don’t qualify for either Missouri Medicaid or the Obamacare exchanges in their emergency room, but with considerably smaller federal subsidies to do so. Many might actually be forced to close.

But these costs are all old news. There’s yet another potential strain on the state budget, if Republicans remain obdurate. Obamacare’s coverage mandate along with the publicity about insurance coverage has led many previously uninsured people who are eligible for Medicaid to sign up for coverage, people that Wonkblog’s Jason Millman identifies as “woodwork enrollees,” as in folks coming out of the woodwork. So how does this potentially strain Missouri’s budget? Here’s how:

From a state budget perspective, there’s an important difference between the woodwork population and those newly eligible under the Medicaid expansion. Under the Affordable Care Act, the federal government pays 100 percent of the costs for the Medicaid expansion population through the end of 2016, with the state share gradually increasing to no more than 10 percent. New woodwork enrollees are funded under the traditional Medicaid structure, in which the federal government on average pays 57 percent of the cost – though the federal share varies by state.

In Missouri the actual percentage paid by the state is 64% so the cost will be higher than average, although Millman speculates that fewer folks may come forward in states that don’t have their own exchanges since there’s been less healthcare outreach push to enroll the citizens of in those states. Millman goes on to say that:    

States knew the woodwork effect was coming and had time to prepare for it, since the ACA was passed more than four years ago. The big question is just how accurately were they able to predict its impact.

Except, of course, states like Missouri which is run by Republicans equipped with ideological and partisan blinders. It’s doubtful whether our feckless leaders could manage to plan their way out of a paper bag, much less plan for increased Medicaid enrollment – especially without the increased federal subsidy. These are, after all, the tax-cutting imbeciles who ignored all the contrary evidence and cost the state budget somewhere between $600 to 800 million dollars and $4.8 billion dollars yearly, depending on who you believe.