By Johnny Kampis | Missouri Watchdog
ST. LOUIS — The U.S. Supreme Court ruling Thursday on the Patient Protection and Affordable Care Act removed one of the more onerous provisions for states-rights advocates – that states could lose funding for not participating in Medicaid expansion.
States are now free to decide if they want to expand coverage to adults earning as much as 133 percent of the federal poverty level, without penalty.
Will Missouri participate? If recent and post-SCOTUS decision chatter is any indication, the answer is probably no.
Several Missouri Republicans, who control both the House and Senate by a wide margin, spoke out against the expansion after the Supreme Court’s ruling.
Lt. Gov Peter Kinder called it a “break-the-bank provision for the state of Missouri.”
Sen. Luann Ridgeway, R-Smithville, told Missouri Watchdog on Friday she is adamantly against it.
“If I have anything to do about it, it will not happen,” said Ridgeway, who chairs the senate’s Health, Mental Health, Seniors and Families Committee.
The Missouri General Assembly slashed its Medicaid program during a state budget crisis in 2005,. To deal with a more than $2 billion budget shortfall, legislators reduced eligibility for families making up to 75 percent of the federal poverty level to 17 to 22 percent of the poverty level. This pared about 100,000 people from the state Medicaid rolls.
Expanding Medicaid in Missouri under the health-care act would initially be funded completely by federal dollars, but the state would have to kick in $100 million annually beginning in 2017. That number would increase to about $150 million in 2019, said Missouri House Budget Committee Chairman Ryan Silvey. The expansion would cover an estimated 255,000 additional adults.
“I don’t think there’s any way in which Missouri will participate in the expansion,” said Silvey, R-Kansas City.
Ridgeway said that barring a tax increase – which she doubts Missouri residents would support – boosting Medicaid would likely mean cuts to the budget for public education.
“Right now the greatest threat to public education funding is the implementation of Obamacare,” she said.
Many health-care professionals in Missouri support Medicaid expansion. The Kaiser Foundation said the state would receive billions in federal benefits in return for its contributions to the program.
The Missouri Health Advocacy Alliance, a coalition of health-care providers and consumer groups, said it would push for increased Medicaid.
“It’s really important that that Medicaid piece be implemented in Missouri,” said Executive Director Andrea Routh. “It’s really designed to give those low-income families coverage in a way that is organized and we can track the spending.”
Missouri Hospital Association Director Herb Kuhn said a “hidden health-care tax” would, if Missouri drops out, affect the health-care community; the law calls for reduced payments to providers without an increase in coverage.
“It is fair to also ask whether the economic activity generated from the Medicaid spending would create enough new state revenue to meet the state’s future general revenue obligation when the federal funding drops from 100 percent to 90 percent,” Kuhn said.