It begins with education.

Medicaid expansion has been facing stubborn opposition from the republican majority in the Missouri General Assembly. Yet, the Missouri Medicaid Coalition, an umbrella group, continues to organize in support of Medicaid expansion at the grassroots level across the state.

This evening in Warrensburg the Johnson County Democratic Club hosted Martha Stevens from the Missouri Rural Crisis Center for an informational presentation on Medicaid expansion and on behalf of organizing for its expansion.  

Martha Stevens of the Missouri Rural Crisis Center speaking on Medicaid expansion on behalf of the Missouri Medicaid Coalition.

According to the Missouri Rural Crisis Center, because Medicaid expansion in Missouri has been blocked in the General Assembly:

Two hospitals in Missouri have already closed, costing 1,800 rural employees their jobs, while other hospitals are being forced to cut back on services. [….]

Without Medicaid Expansion, Missouri hospitals would lose approximately $3.5 billion by the end of 2019.

68% of all rural physicians are older than age 50, and it’s harder to recruit physicians to rural areas because of the high risk of uncompensated care, due to a lack of Medicaid and insurance.

[….]

If Missouri hospitals continue to cut back or close, rural Missourians will be forced to travel larger and longer distances to have access to a hospital….

[….]

Again, who represents the rural areas of the state in the General Assembly? I thought so.

Previously:

HJR 40: let’s give voters an opportunity to put it in the Constitution (February 19, 2015)

Since the General Assembly won’t act on Medicaid expansion, right?

A joint resolution, introduced yesterday by Representative Jeremy Lafaver (D):

FIRST REGULAR SESSION

HOUSE JOINT RESOLUTION NO. 40 [pdf]

98TH GENERAL ASSEMBLY

INTRODUCED BY REPRESENTATIVE LAFAVER.

2224L.01I D. ADAM CRUMBLISS, Chief Clerk

JOINT RESOLUTION

Submitting to the qualified voters of Missouri an amendment repealing section 37 of article IV of the Constitution of Missouri, and adopting one new section in lieu thereof relating to the expansion of the MO HealthNet program.

Be it resolved by the House of Representatives, the Senate concurring therein:

That at the next general election to be held in the state of Missouri, on Tuesday next following the first Monday in November, 2016, or at a special election to be called by the governor for that purpose, there is hereby submitted to the qualified voters of this state, for adoption or rejection, the following amendment to article IV of the Constitution of the state of Missouri:

Section A. Section 37, article IV, Constitution of Missouri, is repealed and one new section adopted in lieu thereof, to be known as section 37, to read as follows:

Section 37. 1. The health and general welfare of the people are matters of primary public concern; and to secure them there shall be established a department of social services in charge of a director appointed by the governor, by and with the advice and consent of the senate, charged with promoting improved health and other social services to the citizens of the state as provided by law, and the general assembly may grant power with respect thereto to counties, cities or other political subdivisions of the state.

2. Effective January 1, 2017, individuals who meet the following qualifications shall be eligible for the alternative package of MO HealthNet benefits as set forth in subsection 3 of this section, subject to the other requirements of this section:

(1) Are age nineteen or older and under age sixty-five;

(2) Are not pregnant;

(3) Are not entitled to or enrolled for Medicare benefits under Part A or B of Title XVIII of the Social Security Act;

(4) Are not otherwise eligible for and enrolled for mandatory coverage under Missouri’s MO HealthNet program in accordance with 42 CFR Part 435, Subpart B; and

(5) Have household income that is at or below one hundred thirty-three percent of the federal poverty level for the applicable family size for the applicable year as converted to the MAGI equivalent net income standard, except the household income may be reduced by a dollar amount equivalent to five percent of the federal poverty level for the applicable family size as required under 42 U.S.C. Section 1396a(e)(14)(I)(i).

3. Except for those individuals who meet the definition of medically frail, the individuals eligible for MO HealthNet benefits in subsection 2 of this section shall only receive a package of alternative minimum benefits. The MO HealthNet division of the department of social services shall promulgate regulations to be effective January 1, 2017, that provide an alternative benefit package that complies with the requirements of federal law and subject to limitations as established in regulations of the MO HealthNet division.

4. Individuals eligible for coverage under subsection 2 of this section who meet the definition of medically frail shall receive all coverage they are eligible to receive under section 208.151, RSMo.

5. The MO HealthNet program shall not provide MO HealthNet coverage under subsections 3 and 4 of this section to a parent or other caretaker relative living with a dependent child unless the child is receiving benefits under the MO HealthNet program, the Children’s Health Insurance Program (CHIP) under 42 CFR Chapter IV, Subchapter D, or otherwise is enrolled in minimum essential coverage as defined in 42 CFR Section 435.4.

6. The department of social services shall establish a screening process in

conjunction with the department of mental health and department of health and senior  services for determining whether an individual is medically frail.

7. The department shall provide premium subsidy and other cost supports for individuals eligible for medical assistance under subsection 2 of this section to enroll in employer-provided health plans based on cost effective principles determined by the department.

8. As used in this section, the following terms shall mean:

(1) “Caretaker relative”, a relative of a dependent child by blood, adoption, or marriage with whom the child is living, who assumes primary responsibility for the child’s care, which may, but is not required to, be indicated by claiming the child as a tax dependent for federal income tax purposes, and who is one of the following:

(a) The child’s father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece;

(b) The spouse of such parent or relative, even after the marriage is terminated by death or divorce;

(2) “Child” or “children”, a person or persons who are under nineteen years of age;

(3) “Department”, the Missouri department of social services, or a division or unit within the department as designated by the department’s director;

(4) “MAGI”, the individual’s modified adjusted gross income as defined in Section 36B(d)(2) of the Internal Revenue Code of 1986, as amended, and:

(a) Any foreign earned income or housing costs;

(b) Tax-exempt interest received or accrued by the individual; and

(c) Tax-exempt Social Security income;

(5) “MAGI equivalent net income standard”, an income eligibility threshold based on modified adjusted gross income that is not less than the income eligibility levels that were in effect prior to the enactment of Public Law 111-148 and Public Law 111-152;

(6) “Medically frail”, individuals with:

(a) Serious emotional disturbances;

(b) Disabling mental disorders;

(c) Substance use disorders who are at high risk for significant medical and social costs;

(d) Serious and complex medical conditions; or

(e) Physical or mental disabilities that significantly impair their ability to perform one or more activities of daily living.

[emphasis in original]

The General Assembly still has to approve placing this on the ballot. Maybe it would have a chance if there was something in there about guns, a Canadian tar sand pipeline, or a bit of posturing on immigration.

Previously:

On improving practical utility (February 17, 2015)

HCR 17: What would Sarah Palin (r) think? (February 18, 2015)

On January 2nd Senator Ed Emery (r) made a request of constituents about their wish(es) for the new session of the General Assembly:

Ed Emery ‏@edemery

If you could choose one piece of legislation for the Missouri Legislature to pass this year, what would it be? Leave a comment below. 11:30 AM – 2 Jan 2015

Much social media hilarity ensued:

Jake McDaniel ‏@jacobmcdan

@edemery Medicaid expansion 11:55 AM – 2 Jan 2015

That’s never going to happen. Especially if Senator Emery (r) has a say.

Hal Higdon ‏@HalHigdon

@edemery Badly needed equity funding for community colleges. Thanks 12:50 PM – 2 Jan 2015

Probably not going to happen.

Andrew Shaughnessy ‏@andrewshag

@edemery Missouri Nondiscrimination Act (MONA) 12:50 PM – 2 Jan 2015

Probably not going to happen.

David Johns ‏@davidjohns11

Repeal of the death penalty. [….] 12:54 PM – 2 Jan 2015

Definitely not going to happen.

John Jackson ‏@JumpinJezebel

@edemery @eyokley Ethics, followed by a manditory redistricting committee for 2020 of neutral members with charges to encourage competition. 2:23 PM – 2 Jan 2015

Definitely not going to happen.

Darrell Boyer ‏@MrDBoyer

@edemery I would like to see only law makers that have taught to create legislation impacting education. 8:18 PM – 2 Jan 2015

That’s never going to happen.

rebecca l. gorley ‏@rebeccalgorley

@edemery Medicaid expansion for 300,000 Missourians! #MOMedicaid #moleg 9:38 AM – 5 Jan 2015

Brian K ‏@Briligerent

@edemery Missouri Medicaid Expansion. Thank you for asking.10:14 AM – 5 Jan 2015

Glic ‏@Glic

@edemery #MOmedicaid expansion 10:19 AM – 5 Jan 2015

Alison Dreith ‏@alidreith

Medicaid expansion! @edemery #moleg #MOMedicaid 10:21 AM – 5 Jan 2015

Seth Bundy ‏@SethBundyMO

@edemery – closing the coverage gap, strengthening rural hospitals & bringing our tax dollars home through #Medicaid expansion & reform 10:23 AM – 5 Jan 2015

Jillian Adams ‏@JillianRAdams

This Missourian wants #MOmedicaid expansion, @edemery. #moleg 10:55 AM – 5 Jan 2015

Jennifer Bernstein ‏@JenKBernstein

@edemery Please pass Medicaid Expansion this session. Lives are on the line. 11:09 AM – 5 Jan 2015

He did ask.

Sadly, Senator Emery (r) pre-filed the following bills before he asked that question of his constituents:

SB 27 – Emery – Modifies provisions relating to elementary and secondary education

SB 28 – Emery – Requires the State Board of Education to develop a simplified annual school report card for each school attendance center using a letter grade of A to F

SB 29 – Emery – Modifies provisions relating to the employment of teachers in school districts

SB 64 – Emery – Requires the State Board of Education to classify the school districts as either unaccredited, provisionally accredited, accredited, or accredited with distinction

SB 65 – Emery – Creates the Equal Opportunity Scholarship Program to grant scholarships to students from unaccredited school districts for certain educational costs

SB 66 – Emery – Requires the Senate to try all impeachments except for the impeachment of the Governor, which shall be tried by the Chief Justice of the Missouri Supreme Court

SB 85 – Emery – Authorizes certain social workers and licensed professional counselors to provide behavioral health services in the MO HealthNet program

SB 86 – Emery – Allows a court to place a person on electronic monitoring with victim notification if a person has been charged with, or found guilty of, violating an order of protection

SB 87 – Emery – Requires persons who submit petitions for political subdivision audits to reside or own property in the subdivision and allows for signatures to be rescinded

SB 92 – Emery – Modifies bond requirements for certain county offices

SB 93 – Emery – Creates the Campus Free Expression Act to protect free expression on the campuses of public institutions of higher education

SB 94 – Emery – Modifies retirement benefits for newly elected members of the General Assembly and statewide elected officials

SB 98 – Emery – Exempts capital gains on gold and silver from income tax and authorizes the storage of gold and silver in private repositories

SJR 4 – Emery – Requires the Senate, beginning January 1, 2017, to try all impeachments except for the impeachment of the Governor, which shall be tried by the Chief Justice of the Missouri Supreme Court

Nope, nothing about expanding Medicaid in there.

So there. A bill, prefiled yesterday for the 2015 session in the Senate by newly elected right wingnut Bob Onder (r):

SB 51 Relating to prohibiting governments from compelling individuals to purchase health insurance and participate in health care systems

Sponsor: Onder

LR Number: 0574S.01I Fiscal Note not available

Committee:

Last Action: 12/1/2014 – Prefiled

[….]

Current Bill Summary

SB 51 – This act modifies what is commonly known as the Health Care Freedom Act which was approved by the Missouri voters in 2010. The act restates Missouri’s public policy of allowing its citizens the freedom to choose or decline to choose any mode of securing health care services without facing a penalty and provides that it is against Missouri public policy to implement or operate a health insurance exchange in Missouri. The act also posits several findings of fact of how the Patient Protection and Affordable Care Act and implementing a state-based exchange would subject Missouri citizens and employers to penalties. The act further provides that if a health insurance issuer operating in Missouri accepts any remuneration that may result in the imposition of penalties contrary to Missouri’s public policy, then the Director of Insurance shall suspend the issuer’s license to transact business in Missouri. The suspension will stay in place until the issuer represents that it has returned the remuneration to its source and will decline any such future remuneration. The act further imposes a duty upon the Attorney General to seek injunctive relief and other appropriate remedies whenever the public policy set forth in the act is being violated.

This act is identical to SB 546 (2014) and SB 473 (2013).

[….]

You were expecting anything different?

Previously:

You were expecting anything different? (December 1, 2014)

It’ll be a cold day in the General Assembly… (December 1, 2014)

Now we’re just waiting on the Agenda 21, Sharia law and nullification bills (December 1, 2014)

Yard signs have been out in yards in west central Missouri:

“I Support Medicaid Expansion”

That would be almost everyone except for the right wingnut majority in the Missouri General Assembly.

Here’s why there’s no Medicaid expansion for Missouri

May 15

By BARBARA SHELLY

The Kansas City Star

Missouri had a path to Medicaid expansion this year

The governor and the state’s leading business groups wanted it. All of the legislature’s Democrats and a growing number of Republicans supported it. Retired U.S. Sen. Kit Bond, a Republican, lobbied tirelessly for it.

Barring an end-of-session miracle before 6 p.m. Friday, however, Missouri will not expand Medicaid eligibility this year. Nearly 300,000 working adults will spend another year locked out of access to affordable health care because their income level places them in a coverage gap.

Standing in the path of Medicaid expansion are a few self-righteous men in the Missouri Senate….

Letters to the Editor

May 07, 2014 12:00 am

Failing to expand Medicaid damages our public health systems

….When I arrived as the director of Health and Hospitals around 1990, not one nickel of our city dollars had ever been matched with federal Medicaid dollars. Over that 25-year period from 1965 to 1990, the state of Missouri left millions of dollars on the table because our local and state politicians either did not read or simply did not act on Medicaid law. The cash value of this inaction is calculable. However, more importantly, taking a pass on this opportunity has cost some of our fellow citizens their lives by damaging our community’s ability to develop more robust public health and health care systems that better meets the needs of our population.

Our state politicians are once again failing to act on national legislation (in this case the Affordable Care Act), which would bring federal Medicaid dollars to our state for both the urban and rural poor. This time around, no state match is needed for the first three years because the expansion of Medicaid to those at 138 percent of poverty level will simply bring our tax dollars back home to Missouri.

Failing to fully expand Medicaid will cause some hospitals and clinics to curtail services, and some will close. This time around the entire state will be affected. Some Missourians will lose their lives, and we will damage our public health and medical care systems.

Dr. William L. Kincaid  •  St. Louis

Former director of Health and Hospitals, city of St. Louis

“….Failing to fully expand Medicaid will cause some hospitals and clinics to curtail services, and some will close. This time around the entire state will be affected. Some Missourians will lose their lives, and we will damage our public health and medical care systems.”

A sign of our current time, for sure.

This morning, in Jefferson City, on the way from the state capitol building.

“I Support Medicaid Expansion”

Today TPM reports that former Florida govenor Charlie Crist, who is running against Medicare-fraud perpetrator Governor Rick Scott to regain the governorship of that state, spoke some home truths to MSNBC’s Chuck Todd about the consequences of failing to take advantage of Obamacare’s Medicaid expansion provisions:

About a million of my fellow Floridians are not getting health care today, and I am told by friends SEIU (sic), that means six people in Florida die every day as a result of that. Every day,” Crist said.

[…]

It’s not hard to figure that out. It’s common sense. Look at it. If people are sick, and they aren’t getting health care, what happens? They usually get sicker,” Crist said. “Or they die. I mean, those are just the facts, Chuck. That’s what happens. In addition to it, it’s economically stupid. As a result, we’re not getting $51 billion over the next 10 years for the health care institutions in Florida. So the people get better health care, so that kids don’t get sick, that we take care of people. That’s what public servants are supposed to do. That’s why I’m running against Rick Scott, because he’s not a good servant.”

The claim that six people will die daily if Medicaid is not expanded likely comes, as TPM noted, from a joint Harvard University and  City University of New York report published last month. You can quibble about the actual number – it’s an estimate after all – but the point is that people will die while ideologues posture and babble incoherently about “government dependency” and the “unsustainable costs” involved in directing federal tax dollars back to the home state.

What does this factoid mean for Missouri? Approximately 2190 yearly deaths that could have been prevented.

But we can take it farther. Most Republicans oppose expanding Medicaid and most Democrats support it. In the Missouri Senate, 24 members are Republicans; in the House, 106 representatives are Republicans, making a total of 130 Republicans running things in Jefferson City. We can do some rough math and conclude that if Medicaid is not expanded, each Republican in the legislature will be responsible for the death of 16.8 Missourians per year, give or take a few.

A crude, tongue-in-cheek exercise perhaps? But no matter, it’s a sure bet that there will be deaths as a result of the action – or rather inaction – of Missouri Republicans. And no matter how you count our dead fellow Missourians, they’ll amount to quite rack of trophies for each Missouri GOPer.

First sentence amended for clarity and a link was added.