Tag Archives: Medicaid

So, why hasn’t Medicaid Expansion happened in Missouri?

31 Sunday Mar 2019

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Good question.

From Representative Kip Kendrick (D):

Kip Kendrick @Kip_Kendrick
Missourians represent at least a quarter million of these individuals.

Kaiser Family Foundation @KaiserFamFound
Nationally, 2.5 million poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid.
They earn too much to qualify for Medicaid, but not enough to…

3:09 PM – 30 Mar 2019

Rep. Kip Kendrick (D) [2019 file photo].

The human toll, from the Kaiser Family Foundation:

Table 1: Uninsured Adults in Non-Expansion States Who Would Be Eligible for Medicaid if Their States Expanded by Current Eligibility for Coverage, 2017

State Total Currently Eligible for Medicaid Currently in the Coverage Gap (<100% FPL) Currently May Be Eligible for Marketplace Coverage (100%-138% FPL**)

Missouri 232,000 13,000 124,000 95,000

[emphasis added]

And:

[….]

The ACA Medicaid expansion was designed to address the high uninsured rates among low-income adults, providing a coverage option for people with limited access to employer coverage and limited income to purchase coverage on their own. In states that expanded Medicaid, millions of people gained coverage, and the uninsured rate dropped significantly as a result of the expansion. However, with many states opting not to implement the Medicaid expansion, millions of uninsured adults remain outside the reach of the ACA and continue to have limited options for affordable health coverage. From 2016 to 2017, non-expansion states saw a significant increase in their uninsured rate, while expansion states saw a decrease.

By definition, people in the coverage gap have limited family income and live below the poverty level. They are likely in families employed in very low wage jobs, employed part-time, or with a fragile or unpredictable connection to the workforce. Given limited offer rates of employer-based coverage for employees with these work characteristics, it is likely that they will continue to fall between the cracks in the employer-based system.

It is unlikely that people who fall into the coverage gap will be able to afford ACA coverage, as they are not eligible for premium subsidies: in 2019, the national average unsubsidized premium for a 40-year-old non-smoking individual purchasing coverage through the Marketplace was $478 per month for the lowest-cost silver plan and $340 per month for a bronze plan, which equates to nearly eighty percent of income for those at the lower income range of people in the gap and more than a third of income for those at the higher income range of people in the gap.

If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences. Many are in fair or poor health or are in the age range when health problems start to arise but lack of coverage may lead them to postpone needed care due to the cost. While the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be an important source of care for the remaining uninsured under the ACA, this system has been stretched in recent years due to increasing demand and limited resources.

Most people in the coverage gap live in the South, leading state decisions about Medicaid expansion to exacerbate geographic disparities in health coverage. In addition, because several states that have not expanded Medicaid have large populations of people of color, state decisions not to expand their programs disproportionately affect people of color, particularly Black Americans. As a result, state decisions about whether to expand Medicaid have implications for efforts to address disparities in health coverage, access, and outcomes among people of color.

[….]

From former State Representative Chris Kelly (D):

Chris Kelly @repckelly
And virtually all of them are working.
Props to @Kip_Kendrick for articulating this serious problem.
7:31 AM – 31 Mar 2019

But, the right wingnut republican majority in the Missouri General Assembly can’t believe this problem has adverse affects on rural Missourians? Right.

Successful Medicaid innovation in Missouri may die thanks to AHCA

20 Monday Mar 2017

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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.

What does Governor Greitens have in common with the Liar-in-Chief?

04 Saturday Feb 2017

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Did the title give it away? Do you think the commonality shared by Jefferson City’s GOP Boy Wonder and the Orange Buffoon might have something to do with a willingness to exploit the reptilian brain of the base by presenting made-up stories to explain unpleasant facts? Stories that shift blame by exploiting carefully nurtured negative, emotionally evocative connotations? Stories like the one Governor Greitens told when he claimed Missouri’s budget shortfall is due to Obamacare?

There’s no rightwing buzzword with greater negative emotive impact for the red meat base than “Obamacare” – or at least that’s been true in the past. Now that it might disappear, however, lots of folks are experiencing a newfound appreciation for the ACA, a.k.a. Obamacare. Which is why GOPers are also desperate to paint the by-and-large successful initiative as a dead-on failure – that, they hope, will make it easer when they do repeal with no meaningful replace, and the masses, including their prone-to-snarl base, lose their insurance and start dropping like the flies they might as well be when it comes to the consideration they can expect from members of the Great Orange Pumpkin party.

These facts likely explain why our novice Governor tried to blame Missouri’s budget shortfall and the very nasty cuts he’s made on Obamacare. But they don’t make his lie right. Either Baby Big Chief hopes to pull the wool over our eyes, or he isn’t quite as smart as he’s cracked up to be. Despite the bushwa he’s trying to sell, Obamacare had nothing to do with the two cost factors he, or at least his spokespeople, cite:

1. Increases in Medcaid caseload: It’s likely that publicity for Obamacare resulted in more Medicaid applications, but it seems to me that the guilty party here is really the Missouri Republican party, not Obamacare:

  • The Missouri GOP legislature refused the federal (Obamacare) Medicaid expansion.
  • Medicaid expansion would have saved the state $100 million a year.
  • Medicaid expansion would have accommodated even more growth than the increase – mostly needy children – that the state is now struggling to cover

2. Soaring pharmaceutical prices: Here we have two villains only peripherally related to Obamacare –greedy Big Pharma and the Republicans who enabled them by throwing hissy fits about not including pharmaceutical cost controls back when Obamacare was being formulated and there was still some foolish hope that a few GOPers would come on board:

  • Obamacare at its inception failed to build in regulation of prescription drug prices, and proposals to use Medicare’s clout to bargain down drug prices were mooted thanks to persisitent aforesaid GOP vapors over “big gubment” intrusion.
  • Unregulated Big Pharma decided to milk the market for all its worth.
  • Many new drugs have come onto the market with sky-high and higher prices
  •  P.S. It’s a problem that could be fixed were saner minds ever to prevail.

And guess what? Both of these problems will continue to get worse if Obamacare goes away. Greitens just doesn’t seem to understand or refuses to acknowledge the real problem behind his budget troubles:

These budget cuts are a big deal. Tax cuts have been a disaster – one that Greitens threatens to make worse. State spending had been pared down to the bone before we ever heard of Eric Greitens. If he goes ahead and returns value for dollars to all those dark-money and upfront donors who funded his campaign and cuts taxes even more, it’s gonna be hello to that raggedy-ass Kansas state of being. If you think today’s cuts are bad, just wait. Greiten’s wealthy donors will make out big and the rest of us will bear the costs. And worst of all for Governor Baby Boy, he may not have a fanciful Obamacare crutch to lean on .

Organizing at the grassroots level for Medicaid expansion in Missouri

20 Friday Feb 2015

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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)

HJR 40: let’s give voters an opportunity to put it in the Constitution

19 Thursday Feb 2015

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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)

Sen. Ed Emery (r): be careful what you ask for

05 Monday Jan 2015

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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.

Oh, and Obamacare is evil, too

02 Tuesday Dec 2014

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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)

A sign of our current time

16 Friday May 2014

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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.

Medicaid expansion and death from preventable causes: On their heads be it

07 Friday Feb 2014

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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.