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 âdeadâ to describe House Bill 700, sponsored by Rep. Jay Barnes, R-Jefferson City. The bill would both revamp the stateâs Medicaid program and seek to take advantage of the promised federal money to pay for it.
If itâs dead, why did it die?
In his 2014 budget filed earlier this month, President Barack Obama proposed delaying $500 million in spending cuts called âdisproportionate shareâ 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.
Itâs a horribly inefficient system that is being phased out under Mr. Obamaâs 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.
Itâs 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 werenât 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 werenât 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 werenât 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 werenât even moved by an opportunity to reform Missouriâs Medicaid system and leverage the federal money to move more poor people into the private insurance system.
No, what âkilledâ the Medicaid expansion bill was Mr. Obamaâs 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, âWhereâs the budget?â 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, âSee? Medicaid expansion is unnecessary!â
Meanwhile, theyâre 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 âno decision without considering the impact on the least in society.â
The Medicaid expansion effort is too important to allow it to be blocked, particularly for the Senateâs 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 hasnât been enough.
Itâs 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 donât get serious. Let Mr. Nixon know youâll help him round up the votes to beat back overrides if he starts vetoing every bill that comes to his desk.
Medicaid expansion isnât about Mr. Obama and itâs 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.