Nixon moves forward with expansion of health-care program

Tuesday, March 10, 2009
Governor Jay Nixon explains an initiative to expand health care to more than 34,000 adults in the state Monday afternoon, March 9, 2009, at Cross Trails Medical Center in Cape Girardeau.

During his campaign for governor in 2008, Jay Nixon argued that Missouri should restore Medicaid eligibility for thousands of adults who lost coverage in 2005. On Monday in Cape Girardeau, Nixon announced that hospitals will help fund a down payment on that promise.

During a visit to Cross Trails Medical Center, a clinic that serves the uninsured as part of its not-for-profit mission, Nixon said his proposal will provide health-care coverage to 34,500 low-income adults. The expansion will not cost state taxpayers any money, Nixon said, because hospitals are willing to tax themselves at a higher rate.

Rising health-care costs are a major obstacle to economic recovery, Nixon said. Caring for the uninsured adds to costs for businesses and individuals. He cited a Missouri Foundation for Health study that found cost-shifting by providers to recoup the money the uninsured are unable to pay for services adds $225 to $609 to the insurance premiums for Missouri families.

"We cannot get this economy moving unless we get the costs of health care under control," Nixon sad.

Paying for the plan

Governor Jay Nixon explains an initiative to expand health care to more than 34,000 adults in the state Monday afternoon at Cross Trails Medical Center in Cape Girardeau.

Nixon was accompanied by Marc Smith, president of the Missouri Hospital Association, as he detailed how hospitals would provide the mechanism to draw $93 million in new federal funding to pay for the expansion. Hospitals support the Medicaid program, known in Missouri as MO HealthNet, through a provider tax.

Almost all of Missouri's hospitals never actually send any money to the state because the tax payments are credited against Medicaid-covered services. The federal government recognizes the tax as state spending and provides matching funds that are used to support the general Medicaid system.

The program generated $825 million in 2007, drawing $1.26 billion in federal funds. Hospitals are willing to increase their tax rate from 3.25 percent to 4 percent to make sure that more people entering emergency rooms have a means to pay for their care, Smith said. The change will recognize an additional $52.5 million that hospitals are dedicating to caring for those in need.

Getting coverage

People without coverage put off care, making their services more costly, Smith said.

"Delaying their care or the care of a family member makes costs far higher than they need to be or should be," Smith said.

Under Nixon's plan, the income limits for adults seeking Medicaid coverage would increase to 50 percent of the federal poverty level from the current limit of about 20 percent.

That would mean adult members of a family of four with an income of $11,025 or less would now be eligible. Eligibility rules for children have much higher income limits. Missouri lawmakers would have to approve the eligibility change.

The change will help cut into the more than 700,000 Missourians who have no health coverage, Nixon said. It will also help relieve pressure put on health insurance premiums when hospitals and other providers treat patients who are unable to pay for their health services.

"It isn't just the right thing to do for our neighbors, it is the smart thing to do," Nixon said.

Restoring cuts

Eligibility for Missouri's Medicaid program was cut from 100 percent of the poverty guideline to 75 percent under Gov. Bob Holden and cut again to current levels by Gov. Matt Blunt. The last major expansion of eligibility took place in the 1990s.

Denny Garner, chief executive officer of Cross Trails, said 28 percent of the clinic's patients pay for services based on a sliding scale tied to income. Of the clinic's entire caseload, he said, 30 percent have no insurance.

If more patients become eligible for Medicaid, Garner said, they will be more likely to seek care before a condition becomes an expensive problem to cure.

Hospitals support the measure because it will mean fewer patients with no means to pay. "This is a step," he said. "We are doing the best match we can do with the dollars available. It is an important first step."


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