Issue link: http://accesshealth.uberflip.com/i/307308
9/ TheBucknerClarion.com May 8, 2014 Expand Medicaid Republican Looks to Party for Compassion the Medicaid gap work jobs that pay "roughly between $8 and $12 per hour. Working people will finally have a chance to have the thing most of us take for granted; a health insurance card in our wallet." Currently, Missouri's Medicaid benefit, known as MoHealthNet, only covers adults who earn no more than 19 percent of the federal poverty level, which equates to $4,500 per year for a family of four. For the last two years, Gov. Jay Nixon, a Democrat, has been ral- lying to expand Medicaid up to 138 percent of the poverty level (roughly $27,310 for a family of four), which matches the level required by the federal govern- ment to qualify for federal subsi- dies. If Missouri passed Medicaid expansion, the federal govern- ment would foot the bill for ex- pansion costs for the first three years. After that, Missouri would be on the hook for 10 percent of the costs, with incremental in- creases over subsequent years. Several republican lawmakers ar- gue that Missouri can't afford to pay for expansion costs and vow to block any measure that adds people to the Medicaid rolls. Nevertheless, a few Republicans have pursued a different angle to Jamie is 29 years old, with five children. The Potosi, Missouri native works as a home health care attendant, has a post at the local auction and works at a Super 8 Motel. She suffers from back injuries resulting from an abusive relationship and has migraines so intense that it makes her nose bleed. She needs back surgery and needs to see a neurologist. But, she can't. Jamie has no insurance and is not eligible for Medicaid because she works every day. "I am right in the middle of the gap," she says. "I don't have insurance and I don't make a lot of money. I make less than $1,100 a month." Jamie doesn't know what the next three or four years will bring— without medical help, she may be stuck in a wheelchair. The doctors she has visited tell her to get on disability. But Jamie doesn't want to. "I am 29 years old, I don't want to get on disability. I want to be able to go to every one of my kids' games and be in the crowd like everyone else. I want help….I want to be normal," she said. Jamie's story isn't an anomaly. According to a recent study by health care advocacy group, Families USA, more than 200,000 of the 350,000 Missourians who would gain coverage if Missouri expands Medicaid are the work- ing poor. These individuals in- clude waitresses, cashiers, child care workers, some barbers and beauticians, among others. Andrea Routh, executive director of the Missouri Health Advocacy Alliance, told the St. Louis Post- Dispatch, that there is a big misconception about who needs the help. "These are working people, sometimes working two to three jobs, trying to put food on the table, trying to pay the rent, trying to take care of their children," she said. Rep. Chris Molendorp, a Belton Republican, agrees. "Those who will benefit, very simply, are peo- ple who work! They may be full time at a businesses that does not offer a health insurance ben- efit. They may be self-employed like a contractor. They may be working two part time jobs," he said. Molendorp, who is the Missouri House Insurance Committee Chairman, added that for the most part, the people wedged in By Tonia Wright "transform" Medicaid so that it includes individuals, like Jamie, who make up the working poor. Rep. Noel Torpey, an Independence Republican, crafted House Bill 1901 that would also include federal funds to purchase private insurance through a health care exchange for individuals whose wages account for 100 to 138 percent of the federal poverty level. However, the proposal has several mandates that require individuals to be employed, restrictions on utilizing emergency rooms as a means for primary care, as well as health-based incentives to contain medical costs, among others. "If we don't do this, we will be facing two realities: a large, growing group of underserved, sick and unwell Missourians," Molendorp said. "This group will continue to flood Missouri's ERs, but access to the emergency room will be threatened. With DSH payments going away and reduction in Medicare reimburse- ments staring our hospitals in the eye, it becomes the perfect storm of increased need with shrinking provider resources." Disproportionate Share Hospital or DSH payments are federal funds given to hospitals that treat indigent patients. The 2014 legislative session will soon come to an end. Deep-rooted Senate opposition makes the likelihood of a vote hopeful but dim. As for HB 1901, Molendorp said it's stuck in the Government Oversight and Accountability Committee and is not scheduled for a vote. On top of that, a few Senators who are vehemently opposed to anything that resembles Obamacare have vowed to filibuster any bill with Medicaid expansion language. However, Molendorp and four Democrats on his committee recently collaborated on a bill that would expand Medicaid to approximately 300,000 low income adults. The vote passed 5-2, with five Republicans absent. The bill attempts to pacify GOP expansion opposition by inserting new requirements such as photo IDs for food stamp recipients, among other things. "So it's symbolic and I understand that, but someone has got to lead on this issue," he said. "I know it's not going anywhere. This is a squabble amongst Republicans. Republican voters who support reform and expansion need to call, write and email Republican legislators. This is about Republi- cans—it's a family fight. GOP vot- ers who agree need to let GOP legislators know how important this is to our state." Last year's (April 2013) Medicaid Expansion rally at the State Capitol in Jefferson City, MO.