The Missouri Medicaid environment:

Missouri’s GOP legislature has been adamant that they will never take up the Obamacare offer to provide health care coverage for poor Missourians by expanding Medicaid coverage. In fact, they’re trying to jump the gun on Trumpcare’s not-so-stealthy attack on Medicaid with SB28, which  would request “a global waiver from HHS to transform the state’s Medicaid into a block grant program, which would be federally capped and adjusted for inflation, state gross domestic product, population growth and other factors.” This move would , according to health care advocacy groups, “cut necessary funding for healthcare services for Missouri’s most vulnerable citizens.”

The Good News

Given this anti-Medicaid predisposition in the state, it’s all the more surprising to learn that, thanks to Democratic former governor Jay Nixon, Missouri took aggressive advantage of the provision in the Affordable Care Act (ACA) (a.k.a. Obamacare), the 2703 grant program, that allocated funds so that 25 Missouri community medical centers could experiment with providing a wide range of coordinated – mental, physical, dental and counseling – services in a community “health home” environment. The results in Missouri have been wildly successful:

According to a review by the Missouri Department of Mental Health, the results of the 2703 grant program in that state have been impressive. The more than 23,000 Missourians who have received care under the health home initiative met or exceeded six of nine benchmark goals for disease management after the ACA-supported expansion. For patients with diabetes alone (America’s most costly disease, at approximately $332 billion a year), the number with controlled blood glucose levels rose from 18 percent to 61 percent. The percentage of patients with hypertension and cardiovascular disease who controlled their blood pressure went from 24 to 67 percent, and their good cholesterol levels soared from 21 to 56 percent. On the cost side, hospitalizations and emergency room visits for this group dropped 14 percent and 19 percent respectively. This saved the state $31 million just in the first year of the program, and the savings have continued, according to Natalie Fornelli, manager of integrated care at Missouri’s Division of Behavioral Health. In 2015, Missouri’s health home program won the American Psychiatric Association’s Gold Achievement Award for community health services. The program is now considered a national model.

The Bad News:

Under Trumpcare, the funding that supports these programs is likely to disappear:

At the national level, the fate of the 2703 program is also in doubt. It’s possible that, as Republican lawmakers in Washington and the Trump administration wrestle with the complexities of repealing and replacing Obamacare, they’ll conclude that failing to continue the 2703 grants will likely cost more in tax dollars than it saves, even as it would deprive hundreds of thousands of poor, mentally ill Americans the coordinated treatment that can save their lives. But, as Sidney Watson, a professor at the Saint Louis University School of Law and an expert on health care access for the poor, observes, Trump’s new Health and Human Services secretary, Tom Price, “has expressed a lot of skepticism about the Medicare and Medicaid demonstration centers.”

Tom Price? Skepticism? No kidding. They guy believes in freedom. Freedom to die, that is. As Politico notes, Price’s “vision for health reform hinges on eliminating much of the federal government’s role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code.” He’s a member of the Association of American Physicians and Surgeons, a far right fringe medical group that declares Medicare “evil” and “immoral.” You can bet that they and their most prominent member, Tom Price, don’t think much of Medicaid either. The better a federal health program does, the more these fools believe it saps our moral fiber, inculcates dependency and undermines physician freedom – the  whole right wing drill, in other words..

Those of you who are calling your representatives and senators and begging them to save our health care, forget about the truly awful AHCA and maybe just fix Obamacare’s relatively minor problems, might also want to bring up the 2703 program and its proven success here in Missouri. Surely the Republicans can’t be so stupid that they’ll argue with success.  Or, on second thought, maybe they will.There is that whole Dump and Dupe AHCA effort. If that isn’t arguing with success – Obamacare increased the ranks of the insured by 20 million, after all – then I don’t know what is.