Issue link: http://accesshealth.uberflip.com/i/1022933
withinsurancethroughhigherpremiums." HembreesaidintheKansasCityareaalone,the pricetagforcost-shiftingis$325million.For thestateasawhole,thepriceskyrocketsto$1 billion."Ifwecancreatemorewaystogetthe uninsuredcovered,itwillstabilizethehealth insurancemarket,"shesaid. There ' ssomethingelsetoalsoconside r . Hospitalsandclinicsaregettingsmaller reimbursementsforMedicareandMedicaid patients.Medicaidexpansionwasdesignedto o f fsetthesecuts.Projectionsdon ' tlookgood. Forthe24statesthathavenotexpanded Medicaid,6.7millionresidentsareprojectedto remainuninsuredin2016asaresult,according totheRobert W oodJohnsonFoundation ( R WJF). Thesestatesareforfeiting$423.6 billioninfederalMedicaidfundsfrom2013 through2022.Economistssaythiswillthwart economicactivityandjobgrowth.Hospitalsin thesestatesarealsoprojectedtolosea$167.8 billion(or31percent)boostinMedicaid fundingthatwasoriginallyintendedtoo f fset majorcutstoMedicaidandMedicare reimbursement.BecauseMedicaidwasnot expandedinMissouri,thesehospitalsare takingthesecutsonthechin. Asforrural hospitals,Pierlesaidtheyaregettingpunched hard. AftertwoyearsofadvocatingforMedicaid expansioninMissouri,wheredoMissouri votersandlegislatorsstandontheissue?Both T rupianoandPierlebelievewe'restillinthe educationphase.Onelessonlearned,that T rupianopointedout,isthatpoliticiansrespond totheirconstituents.Sheu r gesvoterstostay vocalabouttheimportanceofMedicaid expansionandhowitimpactstheirlivesand thelivesoftheirlovedones." W eneedto Accordingtoexpansionadvocates,amongmany things,liveshanginthebalance. " W e'velosta lot,"saidMichelle T rupiano,directorofMissouri MedicaidCoalition."Severalstudiessaythatasa resultofnotpassingMedicaidexpansionin Missouri,700liveshavebeenlosteveryyea r .I believewehavelostlives,wehavelostquality oflifeformanypeoplewhodon ' thaveaccessto healthcareandmaybedon ' thaveaccessto medicationandotherservices. Asaresult,they areleadinglessfulllinglivesbecausetheyare toosick." JoePierle,chiefexecutiveo f ceroftheMissouri PrimaryCare Association,saidnotpassing expansiona f fectsMissouri ' seconom y ."The bottomlineisthathealthcareisaneconomic engineinalmosteverycommunityinMissouri. OurfailuretomoveforwardwithaMedicaid solutionisgoingtoputruralandurbanhealth systemsataneconomicdisadvantagetostates aroundus.I'mnotaneconomist,butit ' svery simple—stateslikeIowa, Arkansasand Kentuck y ,wheretheyshowedgreatleadership andfoundasolution—healthsystemsinthese statesaregoingtoberiche r ." Butthat ' snotall.PierletoldaccessHealththat Missourimayhaveanotherissue:"Iwouldn ' tbe surprisediftheytrytostart[poaching]our providers.MostofMissourialreadyfacescritical providershortages." JessicaHembree,programo f cerattheHealth CareFoundationofGreaterKansasCit y ,saidthe "hiddenhealthcaretax,"orcost-shifting,is anotheroutcomeofnotexpandingMedicaid. "Peoplewhoareuninsuredarestillgettinghealth carebuttheyarejustgettingitinine f fectiveand ine f cientways,likeineme r gencyrooms,"she said."A lotofthosecostsarepassedontopeople M e d i c a i d e x p a n s io n a dvoc a tes ho pe that 2 0 1 5 is t h e ye a r t h e M is s o u ri l e g isla t u re w i l l h e a r t h e v oi ces o f t h e 3 0 0 , 00 0 M is s o u ri a n s w h o f al l i n to t h e cov e ra g e g ap . T h e s e pe o p l e m a k e t oo m u ch to qu a l i fy f o r M e d i c a i d a n d too l i t t l e to qu a l i fy f o r cos t - s a v i ng s u b s i d i es t h r o u g h t h e fe d e r a l H e a l th In s u r a n ce M a r k et p l a c e . T h e M is s o u ri l e g i s lat u re h a d two o p p o rt u n i t i es t o p ass M e d i c a i d e x p a n s io n a n d f a i l ed to g et i t d on e tw i c e . L E F T B E H I N D 3 0 0 , 00 0