As of Tuesday, October 1, 2013, uninsured Missourians have a new way to buy health insurance: the Health Insurance Marketplace.  The Marketplace is designed to help you find health insurance that fits your budget, with less hassle.

Make one application, one time, and you or your family can explore every qualified health insurance plan in your area of the state.  You may even be eligible for a zero dollar premium plan or a new kind of tax credit that lowers your monthly premium immediately. For consumer information, visit www.HealthCare.gov.  You can sign up for email and texts at www.HealthCare.gov/subscribe.  You may also call the Health Insurance Marketplace Call Center at 1-800-318-2596.  TTY users should call 1-855-889-4325.

Private companies will run plans in the new Marketplace, and every health insurance plan will cover a core set of benefits called essential health benefits. You’ll be able to compare your options based on price, benefits, quality and other important features.  New and expanded programs will be directly linked in, and more people than ever before will get a break on costs.  Make one Marketplace application, one time, and you’ll see all the programs you qualify for.

Your life and family are unique. Find health insurance that fits the way you live at the Health Insurance Marketplace, AND learn whether you can get a break on costs.  You can see what your premium, deductibles, and out-of-pocket costs will be before you decide to enroll.  You can make apples-to-apples comparisons of costs and coverage between health insurance plans.

When you shop at the Health Insurance Marketplace, everything you need is laid out for you.  Information about prices and benefits is written in practical terms you can understand, so you don’t have to guess about your costs. You get a clear picture of what you’re paying and what you’re getting before you make a choice.

Visit www.HealthCare.gov or call 1-800-318-2596.

Attorney General Warns of Fraud, Scams With Insurance Marketplace Launch 

Attorney General Chris Koster and the Missouri Hospital Association (MHA) are teaming up to educate Missourians about possible scams surrounding the new federal Health Insurance Exchange plans that begin enrollment on October 1st. As part of the Affordable Care Act, an insurance marketplace, commonly referred to as an exchange, will provide individuals with options for private health insurance coverage to comply with the law’s minimum essential coverage requirement.

“As with any new system, scam artists may prey upon consumers who are attempting to comply with the law,” said Koster. “My concern is that scammers will use the insurance coverage enrollment period opening on October 1 as an opportunity to commit fraud.”

Consumers seeking insurance coverage through the exchange will need to provide personal information in order to determine which plans are available to them and to sign up for health insurance coverage. Missouri Hospital Association President and CEO Herb Kuhn warns that scammers may attempt to con people into thinking that they are enrolling in a marketplace insurance plan when they are not.

“Scammers may trick consumers using phony websites, mailings, calls, or visits to the home,” said Kuhn. “We want Missourians to be on the lookout for fraudsters asking consumers to provide personal information or to take steps that are not actually required.”

Scammers could use personal information to commit financial identity theft, medical identity theft, or insurance identity theft. Financial identity theft is when a scam artist steals your information to access your accounts or to open a line of credit in your name. Medical identity theft happens when the scam artist gets medical treatment by using your information. Insurance identity theft is when someone uses your information to sign up for coverage.

In an attempt to prevent Missourians from becoming a victim of these types of identity theft, Koster and the MHA offer the following tips:

• Beware of people asking for money to enroll you in the Marketplace, “Exchange,” or “Obamacare” insurance. Legitimate enrollment assisters will NOT ask for money. Especially be wary of anyone offering to sell Obamacare insurance cards. Scammers could try to sell you an insurance card without enrolling you in an insurance plan.
• Check Credentials. Ask anyone who wants to help you enroll to verify their affiliation. In addition to your licensed insurance agent, there are two new types of licensed assistants who can also help you take the steps necessary to sign up: Certified Application Counselors and Insurance Navigators.  Certified Application Counselors are part of organizations, such as hospitals, that have been certified by the Center for Medicare & Medicaid Services.  Insurance Navigators are licensed with the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP). For a list of navigators licensed by DIFP in Missouri visithttp://insurance.mo.gov/otherlicensees/navigators.php.  To learn whether the person assisting you is legitimate, call 1-800-318-2596, the number for the CMS Marketplace assistance.  It is available 24 hours a day, seven days a week. There are two Missouri websites that provide legitimate information only – enrollmissouri.org operated by the Missouri Hospital Association and covermissouri.org operated by the Missouri Foundation for Health.
• Don’t be swayed by high-pressure visits, mail solicitations, e-mails, and phone calls from people pretending to work for the government. No one should threaten you with legal action if you do not sign up for a plan.
• Always ask for identification if someone comes to your door.
• Provide personal information only if you initiate the contact.  People who contact you seeking personal information may be trying to steal your identity. No one from the government will call or email you to sell you an insurance plan or ask for personal information. Be careful when giving out personal information, such as credit card, banking, or Social Security numbers.
• Communicate directly with the Official Marketplace.  Unless you are using a licensed insurance agent or assistant, the only way to ensure that your personal data is not going to a scammer is to sign up using the official website at HealthCare.gov or by calling 1-800-318-2596. Avoid sham websites and look for official government seals, logos or website addresses. Look for internet sites with a .gov on the end of the website address.
• Watch for “fake” products.  Some scammers will try to sell you a prescription card.  These can be phony.  Some appear to be real but are only discount cards and not really insurance.
• Suspected fraud should be reported to the Federal Trade Commission through the Marketplace Call Center at 1-800-318-2596 or on FTC.gov/complaint. All suspected fraud should also be reported to the Attorney General’s Office online or 1-800-392-8222.

Koster said Missouri consumers should not hesitate to report anything suspicious because scams can only be stopped if law enforcement learns of them.

Washington Post, August 30, 2013

Obamacare is upon us, and already fraudsters are out to cheat people.

With a lot of confusion about the health insurance marketplaces, consumers are receiving phone calls from people claiming to provide insurance cards needed under the Affordable Care Act. Keep your guard up, says Edward Johnson, president and chief executive of the Better Business Bureau of Metro Washington and Eastern Pennsylvania.

One of the more controversial and confusing provisions of the law, and one that con artists might try to exploit, is the provision that requires most Americans to maintain “minimum essential” health insurance coverage. A just-released Kaiser Family Foundation poll found that about half of respondents do not understand how the law will affect their own families.

Kaiser found that just over a third of the public, including the uninsured, say they have tried to get more information, most often through a general Internet search.

That should please the con artists. Fraudsters are pretty clever about creating Web sites that spoof legitimate Internet sites.

Johnson said health insurance schemes will only get worse over the next four to six months as the Affordable Care Act is implemented.

“Scammers take advantage of the latest policy or new program to hook potential victims with something new in the news that they don’t yet know much about,” Johnson said.

The Federal Trade Commission is hosting a roundtable Sept. 19 to discuss health care-related scams. The agency is bringing together federal and state consumer-protection officials, legal-service providers, community organizations and consumer advocates to discuss how best to help consumers avoid potential scams. The roundtable will be broadcast on the Web.

“We have lots of eyes on the marketplace already,” said Lois Greisman, associate director of the FTC’s division of marketing practices.

So how might one of the scams work?

You might receive a call from someone claiming to be from the federal government, Johnson said. The caller informs you that you’ve been selected as part of the initial group of Americans to receive insurance cards through the new Affordable Care Act. That’s the hook — and a lie. Before he or she can mail your card, you are told, you need to provide some personal information. That’s the heart of the scam.

The goal is to get you to provide personal information, such as your bank account or Social Security number. Scammers can use this information to open credit cards in your name or steal from your bank account.

There are no special insurance cards being issued as part of the enrollment for the Affordable Care Act. Further, open enrollment doesn’t start until Oct. 1. So anyone claiming they can sign you up now is deceiving you.

Here are some tips from the BBB to protect yourself:

● Government agencies normally communicate through the mail, so immediately put up your guard if you get an unsolicited call, text message or e-mail from someone claiming that he or she will help you sign up for health insurance. The way the exchanges work, you must take the initiative to sign up.

● If you get an unsolicited call regarding health care insurance, hang up. Don’t engage the person. If you need any information, go to www.healthcare.gov, the official insurance marketplace Web site. You can also dial a toll-free number — (800) 318-2596 — 24 hours a day, seven days a week. Hearing-impaired callers using TTY/TDD technology can dial (855) 889-4325 for assistance. Kaiser found that few people were turning to health insurance companies, nonprofit or community organizations or government Web sites to become informed. Be sure you are searching legitimate sites.

● Don’t trust your caller-ID screen. Scammers have access to technology to manipulate the screen to display any number or organization name.

● Never give out personal information such as credit card numbers, bank account or Social Security numbers or your date of birth to unfamiliar callers.

If you suspect a scammer has contacted you or if you’ve been conned, file a complaint atwww.ftc.gov. To file a complaint in English or Spanish, click on the link on the home page that says “Consumer Complaint?” You can also call the FTC at (877) 382-4357. Tell the BBB by going to www.bbb.org/scam.

“We have lots of eyes on the marketplace already,” Greisman said. “Consumer complaints are critical in helping us identify and stop these scams. We want to hear from consumers.”

Readers may write to Michelle Singletary at The Washington Post, 1150 15th St. NW, Washington, D.C. 20071 or singletarym@washpost.com. Personal responses may not be possible, and comments or questions may be used in a future column, with the writer’s name, unless otherwise requested. To read previous Color of Money columns, go to postbusiness.com.

The Beacon, August 19, 2013

A few years ago, Missouri had a surplus of funds for assisting visually impaired people in the state but had difficulty reaching these clients. The state sought the help of the Missouri Association of Area Agencies on Aging, based in Jefferson City.

“The state couldn’t spend all of the money because it couldn’t find the population needing the services,” explains Catherine Edwards, executive director of the association. “They came to us and guess what? We used our outreach network to get out there, and we found many new clients for the rehabilitation services.”

Edwards mentions this incident as a reason federal officials might have selected the association as one of two Missouri groups to find and help tens of thousands of Missouri residents sign up for the insurance exchange program, which begins Oct. 1. The Department of Health and Human Services awarded the association $750,000 for exchange work. Slightly more than $1 million was awarded to Primaris Healthcare Business Solutions.

The two groups will use the money for what’s known as navigators, people trained to help consumers buy health coverage through an insurance exchange, which is still being developed. Navigators will educate people about coverage options and how to choose insurance plans based on their family’s needs and the subsidies they might be eligible for. The federal agency awarded $67 million for navigators nationwide.

“We’ll help people see how the insurance exchange will work and show them options so that they can make informed decisions.” Edwards says. “But we cannot enroll them or point them to a particular insurance plan. We will show them what this plan has and what the other has, but the individual will have to make the decision.”

She says the association will partner with a range of community organizations and use public meetings, radio announcements and other means “to get the word out that there is help and assistance for people who want to sign up for insurance.”

She says the association is a logical recipient because it runs several programs, including meals on wheels, that keep them in touch with hard-to-reach populations. Some members also have experience in helping seniors sign up yearly for supplemental insurance under Medicare.

“We have at least seven years of experience in helping people enroll in the Medicare” supplemental insurance program. “That’s similar but in this case (of the insurance exchange), the program will be for people of all ages under 65 and will be for private insurance rather than Medicare.”

Jennifer Bersdale, executive director of Missouri Health Care for All, says the announcement of federal navigator grants will spur more activity to prepare the uninsured for the health reform law.

Rather than helping to enroll clients, her group’s focus will be on getting out the word to encourage people to enroll.

“We will be trying to reach some of the underserved populations,” she says. “Our role is to spread the word, give people information and help them get to the navigator organizations” and others that will help educate consumers about the enrollment process.

“One exciting thing about the announcement is that we now have more information about the first question of where to go for help,” she says,. But she notes that answers to questions about actual health plans for Missouri and the benefits are still being developed. She is grateful that Missouri will get more money than anticipated – nearly $1.8 million rather than the $1.3 million previously mentioned by federal officials.

Other major groups gearing up for the insurance enrollment program on Oct. 1 are the Missouri Foundation for Health and its Cover Missouri project. The group is hosting a summit in Columbia on Aug. 27, titled Cover Missouri Summit: Ready, Set, Enroll!

The mission, says Ryan Barker, the MFH’s director of health policy, is targeted at nonprofits, civic, academic and health-care organizations. They will be provided with “information, skills and strategies” to educate and enroll the uninsured in the exchange. The MFH also has said it would donate up to $8 million in grants for activities related to exchange enrollment in Missouri.

Consumers Council of Missouri advocated for the expansion of Medicaid to give more Missourians access to affordable health care — one of CCM’s primary issues — in testimony before the Missouri House Interim Committee on Citizens and Legislators Working Group on Medicaid Eligibility and Reform.   Joan Bray, Interim Director of CCM, spoke before the committee on Wednesday, August 14, at Forest Park Community College.

Bray’s two main points were for the state of Missouri to fulfill its obligations to provide healthcare and maximize cost-effectiveness by operating Medicaid as a large business would by self-insuring and to provide each healthcare consumer with a medical home for consistency and continuity.  The full text of Bray’s comments follow:

Testimony

Thank you, Mister Chairman and members of the committee.  I appreciate the opportunity to appear before you today.  My name is Joan Bray.  I am the interim director of the Consumers Council of Missouri.  Consumers Council is a non-for-profit advocacy organization that represents the interests of individual consumers collectively.  We spend most of our efforts in three areas:  utility law and regulation; healthcare access; and personal finance.

Today I want to speak to you about our interest in the transformation of Medicaid in Missouri by expanding it and making it more consumer friendly.

We have two recommendations.  Missouri should operate Medicaid in the same way most large businesses provide healthcare to their employees.  And every consumer of healthcare should have a medical home.

The state of Missouri should look at itself as a large business providing healthcare.  A very large business.  In the Medicaid program alone, more than 1 million people could be eligible.

Rather than pass along the risk to an insurance company, Missouri should self-insure Medicaid as a group health plan.  A self-funded plan, as it is also called, is one in which the employer assumes the financial risk for providing health care benefits to its employees.  In practical terms, self-insured employers pay for each out-of-pocket claim as it is incurred instead of paying a fixed premium to an insurance carrier.  Typically, a self-insured employer sets up a special trust fund to earmark money (both employer and employee contributions) to pay incurred claims.

Reasons most large businesses self-insure would also apply to the state:

1.  The employer can customize the plan to meet the specific health care needs of its workforce, as opposed to purchasing a one-size-fits-all insurance policy.
2.  The employer maintains control over the health plan trust fund, enabling maximization of interest income.
3.  The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
4.  The employer is free to contract with the providers or provider network best suited to meet the healthcare needs of its employees.

By self-insuring the state enjoys the likelihood of spending less on administering healthcare and more on ensuring better health for its Medicaid population.

But the state should explore putting all its obligations for healthcare –Medicaid, all the state employee pools – including all the departments and universities – and the prison system into the same risk pool and delivery system to come up with the most efficient and effective use of tax dollars for healthcare.

Consumers Council’s second point is to provide each Missourian under its care with a patient-centered medical home.  This is a team-based model of care led by a medical professional who personally provides continuous and coordinated care throughout a patient’s life to maximize health outcomes.  The consumer learns to know and to trust the team.

Costs for such a model can be based on monthly care coordination payments, fee for service based on visits, and performance or outcomes.  The model enables not only the highest and best use of public money but also the appropriate deployment of a variety of medical professionals.  The most satisfying result is high consumer satisfaction.

In fact, Missouri has invested in the medical home model in pilot programs in small pockets of the state and through federally qualified health centers.  It should expand this practice for access to all in its care.

Again, thank you for the opportunity to speak to you.

By Timothy McBride in the St. Louis Beacon, June 11, 2013 

The Missouri legislature closed its 2013 legislative session without resolving what was likely the most important question facing it: whether to adopt the proposal put forward by Gov. Jay Nixon, a Democrat, to expand the Medicaid program to a projected 260,000 uninsured people in Missouri.  While a bipartisan solution did not pass, the legislature appointed a committee to consider this question further. Recent signals suggest that a compromise solution could be found in the 2014 session.

It is imperative that the legislature and governor find a bipartisan solution to the problem of the uninsured. In Missouri, in 2011, the uninsured reached a record number of 877,000 people, according to the Census Bureau. Also this researcher has found that Missouri has experienced the second largest increase in the uninsured rate in the country over the last 12 years, rising from 6.6 percent in 1999 to 14.9 percent in 2011. This suggests that expanding Medicaid for the neediest should be a moral imperative.

Nixon proposed a sensible and straightforward expansion of Medicaid that would meet the guidelines laid out by the Affordable Care Act in January; it would have made Medicaid available for all people below 138 percent of the federal poverty line. The federal government would cover the entire costs of this expansion in the first three years (2014-16) and up to 90 percent of the expansion during the years 2017-19.

In response, Republicans in the state House proposed a logical counter-proposal (HB700) authored by state Rep. Jay Barnes, R-Jefferson City.  Unfortunately, even though the governor suggested that this proposal could be a vehicle for compromise, Republicans in the state Senate told Nixon that there was no possibility of passing Medicaid expansion this session.  What were the reasons for blocking the legislation and can this stalemate be broken?

Some legislators rejected Medicaid expansion because they say the state cannot afford it. One problem with this claim is that reasonable fiscal projections show that the costs of expansion would be more than offset by cost savings as some individuals in the new expanded program — financed almost entirely by the federal government — would have cost the state more if they had enrolled otherwise. In addition, the state will collect additional state taxes on the new federal dollars flowing into the state. The governor’s budget office estimates that the savings would in fact exceed the costs to the state by about $46 million in the first fiscal year alone.

Finally, the legislature passed a quite large $800 income million tax cut, which the governor vetoed. The legislature’s action, though, suggests that the idea that the state cannot afford to expand Medicaid is a weak argument.

A further benefit of Medicaid expansion is the economic activity created by the nearly $2 billion of new federal dollars, which has been estimated to create at least 24,000 new jobs in Missouri.

In arguing that no political consensus exists to expand Medicaid in Missouri, legislative leaders such as House Speaker Tim Jones, R-Eureka, argue that we “know where Missourians are on Medicaid expansion – they’re opposed to it. They’re opposed to Obamacare” because, these leaders argue, the voters twice voted “against Obamacare” in ballot initiatives in 2010 and 2012.

The fallacy is that both ballot initiatives were cast on very narrow parts of “Obamacare”: in 2010 on the “individual mandate” and in 2012 on the “health-care exchanges.” Neither initiative was on Medicaid expansion. Further, the 2010 initiative was voted on in a primary election with a very narrow turnout (less than 25 percent of voters, in contrast to the 66 percent turnout in the 2012 general election). In contrast, a statewide poll commissioned by the Missouri Foundation for Health found that a majority (52 percent) supports a Medicaid expansion.

If the argument against Medicaid expansion is weak, as this suggests, is there a compromise path? Barnes’ HB 700 would expand Medicaid to a lesser extent than envisioned by “Obamacare” (generally up to the poverty level, not 138 percent of the poverty level) and ask the federal government for a “waiver” to accept this, while also cutting children’s health coverage. Every analyst who has followed health reform knows that this waiver would be rejected by the Obama administration, and the additional cuts in eligibility would also not be accepted.  However, if a compromise is reached to raise the eligibility level to 138 percent of the poverty line, then a compromise is much more likely.

In addition, the proposed House legislation comes from a view that it would be irresponsible to expand Medicaid without “reforming” or “transforming” the program first or simultaneously.  Barnes’ bill includes a set of initiatives to achieve cost savings and improve care. It is in this area where common ground can certainly be found. Every reasonable analyst can agree that further reforms of Medicaid are possible, even though many analysts would disagree with the characterization of Medicaid as a totally “flawed” or “broken” program.

I am the chair of the MOHealthNET Oversight Committee, an 18-member committee, with most public members recommended by the governor and approved by the legislature. This committee, created during Gov. Matt Blunt’s administration, regularly reviews every aspect of the state’s Medicaid program.  In contrast to the view that the state’s Medicaid program is flawed or inefficient, delivering low quality care, the members sitting on the committee know that Missouri has a Medicaid program that delivers medical care on par with the rest of the health-care system (when it is understood that Medicaid is designed as a safety net to serve the neediest).

In addition, in recent years, Missouri’s Medicaid program has put in place many very good initiatives, which are improving quality for the recipients and saving the taxpayers’ money. If the legislature wishes to achieve efficiency and improvements in the Medicaid program, it should simply hold up a mirror to its own Medicaid program to find some very good ideas that can be expanded in many cases to broader populations. In addition, the program can look to other states for models of reform.

This is the common ground that Republicans and Democrats can reach either in a special session or early in 2014 to expand Medicaid so that the neediest Missourians are not forgotten. Nearly everyone who has looked at Medicaid can agree that some reforms would be acceptable. But they must be wrapped in a package that includes expansion of eligibility up to 138 percent of income for all people, as envisioned in “Obamacare,” bringing in significant federal dollars to Missouri and increasing economic activity.

Timothy D. McBride, a professor in the Brown School at Washington University in St. Louis, serves as chair of the MO HealthNET Oversight Committee, a public body that serves in an advisory role over Missouri’s Medicaid program.

Capitol Watch: Failure and Inertia in Jefferson City

Kansas City Star, May 17, 2013 

Missouri Medicaid Expansion Too Important to Die

St. Louis Post-Dispatch, April 22, 2013

Columbia Tribune, April 28, 2013

In a number of states, Republican lawmakers are making a stubborn stand against the expansion of Medicare coverage contained in the federal Affordable Care Act.

They laud themselves for having denied a tenet of Obamacare, sticking it to the president whose name is attached.

Trouble is, their main effect is to make life harder for constituents in their own states, not to mention throwing sand in the progress of health care reform.

Republicans in the Missouri General Assembly proudly tell us they will not expand Medicare this year in an effort to gain leverage over the federal government for vague and unlikely concessions next year. This is a fool’s game. Even states whose leaders don’t like the new law are signing up for Medicaid expansion because the consequences of doing otherwise are negative.

Those consequences are well known to Missourians: a loss of millions in federal health care assistance with associated damage to our state economy, and denial of health care help for hundreds of thousands of Missouri residents. Health care providers and economic development groups universally urge expansion. That General Assembly Republicans deny these traditional support groups is amazing. Either the partisans have imbibed the Kool-Aid by the gallon, or they believe hospitals, doctors and the Missouri Chamber of Commerce will have nowhere else to go with their political allegiance.

Opponents gripe about the requirement that Medicaid coverage must be extended to those at or below 138 percent of the federal poverty level without mentioning that cutoff is about $15,860 for an individual. Apparently they think this is plenty of income to allow people to buy their own insurance. More to the point, they don’t buy the very idea of expanded affordable care, preferring to see hundreds of thousands without.

Obamacare is complicated because it represents a difficult change from a broken system, and to even get started it had to survive total unrelenting opposition from Republicans who fought over every detail of the new law, resulting in a number of compromises that make implementation hard. The ultimate goal is worth the struggle, but as long as the Republican Party is determined to be as obstructionist as possible, we will be in for destructive moves like our own legislative denial of Medicaid expansion.

I think most Americans support a national health care system that will provide affordable basic care for everyone. We can see proof of this thesis everywhere else in the developed world, where health care outcomes are better and costs are lower. Because this requires comprehensive federal oversight, opponents will parrot criticism of government per se, but they forget government is us and their knee-jerk opposition does nothing to improve health care. They should join in an all-out effort to develop the best system rather than try to stymie progress. But, alas, they have staked out such intransigent territory even the slightest relent will be unnecessarily hard.

The current Medicaid flap is possible because the U.S. Supreme Court allowed states to opt out of federal requirements for expansion. If the Affordable Care Act is a valid exercise of federal government prerogative, it’s hard to figure why this particular carve-out was specified, but it helps show what a proper law will look like.

When the system is well developed, no unique Medicaid program will exist. Everyone will receive basic coverage under Medicaid regardless of income, poverty or age status. Coverage and contribution levels will be means-tested, as now is done partially. Basic coverage limits in the universal national health insurance policy will be determined by Congress and available through public or, at the option of providers, through private insurance. Individuals will be able to buy additional coverage with their own money.

Once this legal basic framework of coverage is established, we will continue with an eternal discussion about coverage limits and implications for funding. One salutary result will be the disappearance of employer group insurance, a perverse arrangement that enables coverage based on health characteristics of small particular groups rather than the large national population. The persistence of employer groups complicates reform progress and does nothing to improve potential individual coverage.

Meanwhile, Missouri Republicans deserve sharp rebuke for the harm they are doing. They are imposing pain on local employers and needy citizens and denying the state many millions in federal assistance that will go to other states. It’s a GOP trifecta the party should not be proud of.

Add this to the litany of stances casting the GOP ever more firmly in a political corner, leaving a growing spectrum of the political landscape to others. Being against health care reform is a denial of the future.

HJW III

St. Louis Post-Dispatch, April 22, 2013

A brutal form of cynicism lies behind the latest excuse offered by Missouri Senate Republicans for refusing to even discuss an expansion of the state Medicaid program. The proposal would extend health insurance to poor people and bring thousands of jobs to the state by leveraging billions of dollars in federal investment.

Sen. John Lamping, R-Ladue, was one of several senators to use the word “dead” to describe House Bill 700, sponsored by Rep. Jay Barnes, R-Jefferson City. The bill would both revamp the state’s Medicaid program and seek to take advantage of the promised federal money to pay for it.

If it’s dead, why did it die?

In his 2014 budget filed earlier this month, President Barack Obama proposed delaying $500 million in spending cuts called “disproportionate share” payments. These are the federal payments to hospitals that pay for at least some of the health care costs of the millions of Americans who are uninsured, but end up in hospital emergency rooms for care.

It’s a horribly inefficient system that is being phased out under Mr. Obama’s Affordable Care Act. Because millions more Americans will have insurance, the payments will be unnecessary. The spending on the front end saves us all money on the back end.

Mr. Obama is seeking to delay the cuts specifically because of the intransigence of some state lawmakers, like the Republicans in Missouri, who have ignored both the moral and economic imperatives to find a way to provide insurance to more Americans. If states are slow to implement the ACA, then cutting the disproportionate share payments will be devastating to hospitals, specifically those in rural areas, that will still have to spend millions of dollars on uncompensated care. Those proposed cuts have put pressure on reticent rural lawmakers afraid that major employers in their regions could lose jobs.
It’s key to understanding the moral bankruptcy of the Missouri Republican Party that this is the only motivation that might have persuaded them to keep the Medicaid expansion proposal alive.

Senate Republicans weren’t moved by empirical evidence that uninsured people are more likely to die than those with insurance. In 2009, a Harvard Medical School study found that 45,000 Americans die premature deaths every year in part because they lack health insurance. They weren’t moved by several studies showing that the infusion of $2 billion a year in federal funds each of the next three years will create thousands of health care jobs as hospitals and other health-care professionals increase staffing and investment to help serve more than 260,000 newly insured Missourians. They weren’t moved by the fact that if those 260,000 Missourians remain uninsured, an average insured family of four will pay about $1,688 more a year for health care to cover those costs.

They weren’t even moved by an opportunity to reform Missouri’s Medicaid system and leverage the federal money to move more poor people into the private insurance system.

No, what “killed” the Medicaid expansion bill was Mr. Obama’s proposed budget, a budget that Congressional Republicans called dead on arrival. The circular logic is stupendous in its deception.

First Republicans blame Mr. Obama for the ACA, even after he models it after many of their ideas. Then they spend two years doing their best Walter Mondale impersonation, repeating over and over again, “Where’s the budget?” When the budget is released, of course, they declare it dead. But in Missouri, those same Republicans seize one line of the budget and say, “See? Medicaid expansion is unnecessary!”

Meanwhile, they’re spending their time making sure more Missourians will be in poverty. Not only will poor folks continue entering the health-care system through the expensive door of the emergency room, they also face GOP tax-cut legislation that will further shift the costs of nearly everything toward poor people.
Perhaps we enjoy tilting at windmills, but we refuse to believe that the Missouri Legislature is so bereft of people with a moral commitment to their fellow man that this sort of nihilism can continue ad infinitum.

Why, we recall being impressed when Mr. Lamping told us, back when he was running for office in 2010, that he is guided by the principle set down by St. Ignatius Loyola, the founder of the Jesuit order, that those entrusted with power should make “no decision without considering the impact on the least in society.”

The Medicaid expansion effort is too important to allow it to be blocked, particularly for the Senate’s specious reasons. Gov. Jay Nixon, a Democrat, has done his level best traveling the state, hand in hand with business leaders, most of whom have traditionally supported Republicans, to rally support for this important legislation. But it hasn’t been enough.

It’s time for those business leaders to take a stand. Write some big checks for Democrats and see who comes running. Let Republicans like Mr. Lamping know that their careers are over if they don’t get serious. Let Mr. Nixon know you’ll help him round up the votes to beat back overrides if he starts vetoing every bill that comes to his desk.

Medicaid expansion isn’t about Mr. Obama and it’s not about some consultant-driven debate about future electoral success.

The more people in Missouri who have health insurance, the fewer of them will die. This is literally a life-and-death issue.

Associate Press, April 16, 2013

Rallying with one of the largest crowds of the year at the Missouri Capitol, Gov. Jay Nixon urged activists on Tuesday to implore reluctant Republican lawmakers to expand Medicaid coverage to hundreds of thousands of lower-income adults.

The Democratic governor headlined a nearly hour-long pep rally that his administration says drew more than 1,000 people to the Capitol – a crowd so large that some state employees were asked to park their vehicles elsewhere Tuesday to make way for the busloads of rally participants. The event featured business leaders, doctors, pastors and police officers, all lending their support to the Medicaid expansion called for under President Barack Obama’s health care law.

Nixon, who has been public office for 26 years, praised the proposed Medicaid expansion as the greatest opportunity to do good for the greatest number of people in his political career.

“Let’s make sure that the words we’ve said here are turned into action up there,” said Nixon, pointing upward to the third floor of the Capitol, where the House and Senate chambers are located.

Yet Tuesday’s rally may have done little to change Republican legislative leaders, who repeatedly have rejected a traditional Medicaid expansion while citing concerns about its potential long-term costs.

“In my opinion, a supermajority of Missourians, who I consider my constituents, do not want us to implement any form of Obamacare in this state,” House Speaker Tim Jones, R-Eureka, told reporters as Nixon participated in the rally.

Obama’s 2010 health care law envisioned a Medicaid expansion as one of the primary means of providing health coverage to those currently without insurance. A Supreme Court ruling last summer made the Medicaid expansion optional for states but left in place a powerful financial incentive. States that expand adult Medicaid coverage to 138 percent of the poverty level – about $15,800 for an individual or $32,500 for a family of four – can receive full federal funding for the first three years, starting in 2014. The federal share will be gradually scaled back to 90 percent by 2020.

Nixon says about 300,000 Missouri residents could eventually gain coverage under the Medicaid expansion – a one-third increase in the size of the current program. He also contends the influx of federal money will spur thousands of new jobs and generate more than enough tax revenue and savings to offset the additional state dollars that eventually would be spent on the program.

A Republican-led House committee has endorsed an alternative Medicaid plan that would add some adults to the rolls, though not as many as Obama’s administration has said is needed to qualify for the enhanced federal funding. The GOP plan also would remake Medicaid to more closely resemble private-sector insurance.

But rally participants said it would be foolish to insist upon overhauling Medicaid while delaying the receipt of the federal money.

“Postponing Medicaid expansion until it is perfectly reformed is like leaving shipwrecked passengers treading water and sinking because somebody thinks that the rescue vessel needs some business-process improvement,” said Dr. Heidi Miller, of the Family Health care Center in St. Louis.

Miller predicted that if Missouri waits even one more year to expand Medicaid, doctors and nurses would leave to take more lucrative jobs in states that are enlarging Medicaid.

Among the arguments that Nixon has been making for a Medicaid expansion is the fact that the federal health care law cuts funding to hospitals for the cost of treating uninsured patients beginning in 2014. Without adding those uninsured patients to the Medicaid rolls, hospitals stand to lose money, Nixon has said.

Yet Obama may have partially undercut that argument last week by proposing to delay the federal funding cut to hospitals by a year. Some Republican Missouri lawmakers have cited that as an additional reason not to act this year on a Medicaid expansion.

Lisa Church, a spokeswoman for Bothwell Regional Health Center in Sedalia, stressed Tuesday that Obama’s funding-cut delay is only a proposal.

“I’m afraid that it gives people a false sense of security, and this really is an urgent issue,” said Church, who was near the front of the audience at the rally.

Participants held red-and-white signs that said such things as “Strengthen Medicaid Now” and wore stickers proclaiming: “Full Medicaid Expansion Now.”

Pastor Ron Webb, of Mount Calvary Powerhouse Church in Poplar Bluff, began the event with a praying that legislators “would do the righteous thing, and that’s to vote for Medicaid expansion. “

Springfield New-Leader, March 2, 2013

Kansas City Star, March 1, 2013

Kansas City Star, March 8, 2013

St. Louis Post-Dispatch, March 1, 2013