Mo. medical groups pushing for Medicaid expansion

JEFFERSON CITY, Mo. -- Missouri medical groups launched a campaign Wednesday to expand Medicaid coverage to thousands of working adults, citing a study estimating that the expansion largely funded by federal money could lead to 24,000 new jobs across the state.

The push to expand Missouri's Medicaid program could also get a boost from Gov. Jay Nixon, who before his re-election this month had been noncommittal about whether the state should embrace the enlarged Medicaid program called for under President Barack Obama's health care law.

Nixon is planning news conferences Thursday at Truman Medical Center in Kansas City, Barnes Jewish Center in St. Louis and Jordan Valley Community Health Center in Springfield "to make a major announcement regarding health care in Missouri." Officials representing the Missouri Hospital Association and the Missouri Primary Care Association both said Wednesday that they plan to join Nixon at the events.

The hospital and primary care associations are part of the new Coalition for Healthy Economic Growth, which announced a campaign Wednesday to try to persuade state officials to expand Medicaid eligibility by highlighting the economic benefits. A report released by the hospital group and the Missouri Foundation for Health estimated that an additional 161,000 people would enroll in Medicaid if eligibility is expanded to adults earning up to 138 percent of the federal poverty level.

The study said the increased Medicaid spending could lead to 24,000 jobs by 2014 in nursing homes, hospitals, home-health care services, doctor's and dentist's offices and nonmedical industries such as retail stores and real estate developments.

Under a Supreme Court ruling earlier this year, each state can decide whether to enact the Medicaid expansion called for under Obama's health care law. The federal government would pay the full cost of the expansion starting in 2014, but states would begin paying a 5 percent share in 2017 that would gradually increase to 10 percent by 2020.

Nixon, a Democrat, has said only that he was reviewing Missouri's options on the Medicaid expansion called for by the new federal law, though he had campaigned in 2008 on expanding Medicaid.

Republican state legislative leaders have expressed opposition to the Medicaid expansion, citing concerns about whether the state could afford to pay its share of the future costs. Shortly after the Nov. 6 election, newly nominated Senate President Pro Tem Tom Dempsey said a Medicaid expansion was highly unlikely.

"The basic conclusion is the state cannot afford it," House Speaker Tim Jones said earlier this month.

A report released earlier this week by the Kaiser Family Foundation and Urban Institute estimated that an additional 383,000 people would join Missouri's Medicaid rolls by 2022 if eligibility is expanded to the levels called for in the federal health care law. It projected the expansion would bring an additional $17.8 billion of federal Medicaid money to Missouri from 2013 to 2022 while costing the state an additional $1.6 billion.

But Herb Kuhn, president and CEO of the Missouri Hospital Association, said Wednesday that those figures likely were too high. The hospital group's report -- prepared by the University of Missouri and the Vienna, Va.-based health care consulting firm of Dobson DaVanzo and Associates -- estimates that a Missouri Medicaid expansion would cost the federal government $8.2 billion and the state $333 million between 2014 and 2020.

But the report suggests Missouri actually could make money from the Medicaid expansion, concluding that the infusion of health care spending would generate $856 million in additional state and local taxes during that period due to the increased jobs and economic activity.

"This effort has the potential to have the greatest statewide economic impact in terms of job creation, income growth and revenue growth of any initiative ever considered by our elected officials in the past decade," said Joseph Pierle, CEO of the Missouri Primary Care Association and chairman of the Coalition for Healthy Economic Growth.

If Missouri does not expand Medicaid eligibility, hospitals could take a financial hit. The federal health care law reduces payments to hospitals for treating the uninsured on the assumption that more people will have coverage either through private insurance or Medicaid. If hospitals have more uncovered costs, they may seek to recoup money by charging more for services that are likely to be covered by private insurers, the report said.

U.S. Sen. Claire McCaskill, who supports the federal health care law, said Wednesday that state lawmakers should expand the Medicaid program. Otherwise, federal taxes paid by Missourians would end up supporting Medicaid programs in other states, she said.

"I just think it's dumb to turn down this kind of resource that Missourians are paying for," McCaskill said.