Medicaid expansion is a cost shift to the middle class

By Eric. G. Morton

I must say that I was concerned, as well as amused, while reading Mr. Bjelich's recent column regarding the impact of Medicaid expansion. While expanding the Medicaid program would indeed increase the number of insured patients throughout the state of Missouri, there is still a significant amount of disagreement about how this expansion would help, if not indirectly hurt, the people of Missouri.

As stated in the column, the federal government has committed to funding 100 percent of the costs associated with expanding Medicaid through 2016. However, it is a rather large assumption that the federal government will actually fulfill this commitment due to our nation's dwindling reserves and increasing deficit.

The federal government can change its mind and policies at any time by either presidential directive or congressional intervention. If, in two years, they decide that the program is too costly, the federal government could cut funding at any time without approval from the states.

If the states have already committed to the Medicaid expansion, they will still be obligated to provide health-care coverage. However, in this case, the costs would be shifted from the federal government to the states. Our state budget, like so many others, has been quite tight for a number of years. Where would this additional money come from?

Mr. Bjelich also states that the hospital has been providing unreimbursed care for a number of years. This is true, but as he states in his column, the hospitals do receive federal assistance through a Disproportionate Share Hospital program to provide care for the uninsured.

While he states that Missouri hospitals had $1.1 billion in uncompensated care in 2011, what he does not state is that the physicians in Missouri also provide this care at an unfunded rate (especially in this area).

We, as the medical staff of both hospitals, provide care on a rotating basis through a medical staff bylaw for patients who have no local physician. This care is unfunded and non-reimbursed for those patients who are self-pay, which is quite a large number. This service is provided by the physicians of Southeast Missouri and has been for years. Therefore, the concept of universal health care has been present in this area for as long as I have been here.

It was also stated in the column that 24,000 jobs would be generated in 2014 in the Southeast Missouri Workforce Investment Area as a result of Medicaid expansion. I would be interested in seeing how this number was calculated.

The majority of the patients who will be receiving new coverage as a result of Medicaid expansion are already receiving health-care services in this area. The only difference is that the care will now be reimbursed, whereas before it was not.

There is no guarantee that just because patients now have health insurance that they would use health-care services at a higher or lower rate. The projected number of jobs that would be generated is based upon assumptions, and I am not sure that all of those assumptions are 100 percent correct.

Also, very damaging to Missouri residents is the "potential cost shift savings of $1 billion to private insurance through 2020 because of fewer uninsured patients." How exactly will additional patients insured by Medicaid result in a savings to private insurance? By reducing hospital costs? Who will ultimately be responsible for funding the Medicaid expansion? Middle class Americans.

This is truly not a savings, but is just a cost shifting to the middle class Americans who are already financially strapped. Who stands to gain the most from Medicaid expansion? The hospital systems.

Charity begins at home, and all of the health-care providers, including the hospitals of Southeast Missouri, must bear the burden and responsibility of taking care of the people whom they are, by oath, serving.

There is no proof that increasing reimbursement is going to increase the quality of health care. What it will do is increase the bottom line for those who are going to benefit directly from the increased reimbursements: the hospital systems in the state of Missouri.

Dr. Eric. G. Morton is a physician in Cape Girardeau.