Should Missouri Expand the Medicaid Program?

*My office has been flooded with calls and emails regarding the expansion of the state's Medicaid program. Let me respond up front with the following statement: I have an intense desire to help those with a genuine and serious economic need. However, I also understand that any state or nation that continues to expand entitlement programs --adding more persons into a dependent existence- also are responsible for the fiscal impact; after all a bankrupted entity cannot provide for any citizen, particularly one in great need. The country of Greece is a perfect example. They expanded their social programs until they could no longer support anyone!

Another reason for non-expansion is less identifiable but nonetheless extant; that being, dependency reduces self-reliance and therefore produces lower self-esteem. When a people become more dependent on their government to provide for their needs that person will not look within for a solution for self-improvement of any type for any reason.

But enough philosophizing, let's take a look at some hard facts that affect the Medicaid fiscal-proficiency level:

1) According to the Department of Insurance, Financial Institutions, and Professional Registration there are 19,628 Missouri Doctors of Medicine (MDs) and 3,145 Doctors of Osteopathic Medicine (DOs). According to numbers obtained from the Department of Social Services only 88% of Missouri MDs accept Medicaid. Amongst DOs, however, the contrast is even worse. Of all DOs in Missouri, only 33.19% are even registered to accept Medicaid. Side note: DOs routinely perform certain forms of treatment that are not reimbursed by Medicaid -- it is the nature of their methods. This means that simply having Medicaid card doesn't ensure access to needed care.

2) Most MDs practice in larger hospital systems and in more urban areas. There will be DOs at these hospitals, but you will find a much larger percentage of DOs practicing in our rural areas -- perhaps with their own small practice -- than in urban regions. Our urban areas are also home to much larger populations of individuals and families covered by strong, private insurance policies. These policies, along with the size of the larger hospital systems, allow the more urban facilities to leverage the profits they realize from private insurance carriers against the heavy losses they see when they care for individuals on Medicaid. In many cases, our rural areas do not have this luxury -- doctors in small, private practice shops literally cannot afford to accept Medicaid patients.

3) A significant truth that lies within the Medicaid program is that it compensates providers at alarmingly low rates. Often, this rate is barely above 50% of what the same provider would receive in payment from Medicare -- the federal health insurance program for our nation's senior citizens (and even that rate often cannot match private insurance). Steven Lipstein, CEO of BJC HealthCare, alluded to the ramifications of Medicaid's low reimbursement rate and its negative impact on healthcare costs in an article appearing on STLToday.com on January 15, 2013. I would encourage you to read it.

For these reasons and several more, simple Medicaid expansion, as President Obama and Governor Nixon have proposed, will only further deteriorate an already broken system. Even worse, it costs hard-working taxpayers billions in borrowed money with no end to the unprecedented national deficit spending in sight. Yet that is the only solution currently being offered which has brokered attention on either a state or a national level. Your state leaders should be proposing innovative solutions to the healthcare crisis in our state.

*The next issue for which I'm receiving significant constituent feedback is with regard to our Second Amendment right to bear arms. No one here at the Missouri Capitol questions the personal and socially devastating impact of crimes committed by armed perpetrators, but neither do we question the constitutional right to gun ownership. It is in everyone's best interest to come to a viable solution to address the violence in our communities and at the same time recognizing and retaining our constitutional right to bear arms --both on a state and federal level.

I support --and will continue to support - every House bill that is a worthy solution to a most difficult issue, but I will in no way violate the oath I took to uphold both the Missouri and US Constitutions.