Issue link: http://accesshealth.uberflip.com/i/411404
5/ TheBucknerClarion.com November 6, 2014 300,000 Left Behind Momentum Builds to Pass Medicaid Expansion Most of Missouri already faces critical provider shortages." Jessica Hembree, program officer at the Health Care Foundation of Greater Kansas City, said the "hidden health care tax," or cost- shifting, is another outcome of not expanding Medicaid. "People who are uninsured are still getting health care but they are just getting it in ineffective and inefficient ways, like in emergency rooms," she said. "A lot of those costs are passed on to people with insurance through higher premiums." Hembree said in the Kansas City area alone, the price tag for cost shifting is $325 million. For the state as a whole, the price skyrockets to $1 billion. "If we can create more ways to get the uninsured covered, it will stabilize the health insurance market," she said. There's something else to also consider. Hospitals and clinics are getting smaller reimbursements for Medicare and Medicaid patients. Medicaid expansion was designed to offset these cuts. Projections don't look good. For the 24 states that have not expanded Medicaid, 6.7 million residents are projected to remain uninsured in 2016 as a result, according to analysis from the Robert Wood Johnson Foundation (RWJF). These states are forfeiting $423.6 billion in federal Medicaid funds from 2013 through 2022. Economists say this will directly thwart economic activity and job growth. Hospitals in these states are also projected to lose a $167.8 billion (or 31 percent) boost in Medicaid funding that was originally intended to offset major cuts to Medicaid and Medicare reimbursement. Because Missouri opted against expansion, these hospitals are taking these cuts on the chin. As for rural hospitals, Pierle said they are getting punched hard. After two years of advocacy, where does Missouri stand on the issue? Both Trupiano and Pierle believe we're still in the education phase. One lesson learned, that Trupiano pointed out, is that politicians respond to their constituents. She urges voters to stay vocal about the importance of Medicaid expansion and how it impacts their lives and the lives of their loved ones. "We need to continue to bring everyday, ordinary people to the Capitol to talk to their legislators," she said. Pierle added that the last legislative session included "Republican champions who put political ideology aside and stepped forward. We intend to work off the momentum we had in the last session to continue to make the case about why this is so important." Pierle also urges voters to talk to their representatives and senators about why this is imperative to local communities. "I think it's time we move past whether you are for Obamacare or against Obamacare to what impact it will have on the local community," he said. "Somehow, we need to take politics out of this and better understand that decisions have consequences. And these decisions, whatever they are, are going to impact real people." Arousing Republican voters will be one strategy advocates will rely on in the coming months. Trupiano said it's clear that many Republicans see how expanding Medicaid makes for good health care policy and good economic policy. "It just makes good sense all the way around. The devil is in the details for a lot of our Republican legislators to make sure that this is a reform bill that works well for all Missourians," she said. Trupiano added it's also important to get in touch with Republican voters to make sure their voices are heard and empower them to speak out about their support for Medicaid expansion that includes reform. "Last year, we came very close and I think it is unfortunate that two to three senators can hold up all of the progress that has been made. So we are continuing to work on those legislators who stand in opposition and have real dialogues about what they need in order to move forward." When asked if cost was a viable argument for not expanding Medicaid, Hembree said expansion can happen without breaking the bank. Medicaid expansion was designed to use federal dollars to pay for the lion's share of health care costs for newly eligible enrollees. How that breaks down is that the federal dollars would pay 100 percent of the costs from 2014 through 2016. In 2017, the federal government pays for 95 percent of costs and states will be on the hook for the remaining five percent. In 2018, states would pay six percent of costs and in 2019, seven percent and from 2020 on, states' responsibility would cap at 10 percent. Hembree said that the added costs for Missouri would level out as some of the safety net programs it currently pays for, like mental health for instance, would now be covered through the expansion. Additional tax revenue would come to the state through income taxes generated by a more robust health care force. The numbers alone paint a clear picture. A recent article in the Kansas City Business Journal talks about how for-profit hospitals are faring in states that expanded Medicaid. In short, hospitals saw a decrease in uninsured patients and an increase in Medicaid patients. A PricewaterhouseCoopers report revealed that HCA "revised its earnings outlook to account for better-than-expected revenue from health reform." However, the health care system did not disclose actual numbers. Tenet, a Dallas-based health care system that operates in five states with expanded Medicaid, saw a $78 million reduction in unpaid care in the second quarter alone, according the report. However, according to the RWJF report, hospitals in non- expansion states are set to lose $167.8 billion in Medicaid revenue By Tonia Wright (Continued from page 1) between 2013 and 2022. That includes $2.6 billion in Kansas and $6.8 billion in Missouri. "I anticipate that if we continue to pay politics with this issue longer, at the end, everybody is going to hurt—not just people who could have benefited from Medicaid expansion, but everybody in a community who counts on their local hospital, clinic, physician or nurse is going to feel the impact. There are empty medical offices throughout rural Missouri today…I anticipate that that's only going to increase the longer we drag our feet," Pierle said.