As the COVID-19 pandemic continues and the August 4 election is just weeks away, the statewide push to expand eligibility for Medicaid in Missouri comes as millions have lost jobs and health insurance in the state as a result of the pandemic.
If voters approve Amendment 2 to expand Medicaid, advocates say, nearly a quarter-million additional people will get to enroll in MO HealthNet (as Medicaid is called in this state). Missouri currently has one of the lowest income-eligibility thresholds in the nation. A family of four can make no more than $5,550 a year to be eligible. Mo HealthNet provides health insurance for low-income children and parents, seniors, pregnant women, and people with disabilities. Adults who are not parents, seniors, disabled or pregnant are not eligible, regardless of income.
Approving Medicaid expansion would raise that income threshold to approximately $18,000 per year for an individual. This would give many Missourians, including childless adults, the option of having health insurance for the first time and it would significantly narrow the health coverage gap.
With a half-million Missourians filing for unemployment in the last few months since COVID-19 spread into the state, the temporary Medicaid assistance will allow Missourians to seek health care when they are sick, buy medications, and maintain their health, so they can go to work, and take care of their families.
If wider health coverage for those who may have lost income due to the pandemic doesn’t affirm the need to expand MO HealthNet Medicaid services, its positive effect on economic growth Missouri economy will. The Regional Economic Models Inc. (REMI) report (https://bit.ly/2BPuH7G) commissioned by the Missouri Foundation for Health provides a comprehensive analysis of how federal funding of expansion of MO HealthNet Medicaid services will affect the state’s economy. The report, released in early June, includes a close analysis of inter-industry relationships, estimates of the long-run stability of the economy, and measures effects of the geographic concentration of labor and industry. The REMI report finds that Medicaid expansion would have several positive outcomes in Missouri’s economy.
Between the years 2022 and 2026, the REMI found that Medicaid expansion would result in an annual job growth of 16,330 new jobs each year across the state, with 9 out of 10 of those new jobs paying at least $15/hour for full time workers; with most new jobs located outside of the Kansas City and St. Louis metropolitan areas; large-scale annual economic growth, with an average $2.5 billion increase in economic output, $1.6 billion in gross domestic product, and $1.1 billion in personal income. Job growth is projected to expand well beyond health care, with 79% of new jobs created in other industries including retail and construction.
“This report makes a very strong economic argument for Medicaid expansion,” Barker said, “to say nothing of the moral imperative to get more people covered under health insurance, especially during a pandemic.”
By law, the cost to expand Medicaid expansion comes from the federal government. Feds cover 90% of the cost for the expansion population of Missouri’s Medicaid program. That means expanding Medicaid would also return federal tax dollars to state, saving an estimated $39 million in state funding in the first year, keeping rural hospitals open, and creating over 16,000 new jobs on average per year.
Additionally, Barker said other health programs within Medicaid where the state currently pays 100 percent of the cost – the uninsured women’s health program for example, Medicaid expansion would also cover most of the costs instead of the state.
“If you expand Medicaid, then, that program fully gets wrapped up into the Medicaid expansion, and instead of the state spending 100% of the cost, all of the sudden, the feds are covering 90% of the cost and the state cost is down to 10%,” Barker said. “There are several of those programs where the state would just see this 90% savings to what they are currently paying.”
“The reduction of state government spending would effectively expand Missouri’s operating budget to reallocate funding for other priorities,” the REMI analysis states, adding that the impact “would be spread throughout the state.”
Disparities in insurance coverage, essential worker jobs that don’t offer livable wages or health insurance, and exposure to COVID-19 are having a disproportionate impact on African Americans. Barker said Medicaid expansion will help reduce the disparity.
“Expanding Medicaid will help eliminate that coverage gap,” he said. Before the pandemic, Barker said Missouri had about a 5% disparity, with an uninsured rate for whites at 10%, compared to 15% uninsured for African Americans. With the pandemic, unemployment hit communities of color harder than white communities. Barker said it is expected that disparities in insurance coverage has probably gotten wider with the pandemic.
“What we’ve seen in other states is that disparity lessens significantly with Medicaid expansion. It really does provide a safety net for folks when they do become unemployed,” he said.
Thirty-six states and the District of Columbia have already expanded Medicaid for their residents, including neighboring states of Iowa, Illinois, Kentucky and Arkansas. Barker said that other states have shown the positive results of that expansion and that includes covering the new category of childless adults.
“When a consumer chooses to apply under one of the expansion populations, they are once again getting that 90 percent match,” Barker said. While the state cannot automatically switch Medicaid clients into the new expanded categories to get higher federal reimbursements, Barker said new consumers would need to apply for the new categories and that would lessen the state’s share of the cost.
Another area where Barker said states are seeing a lot of savings through Medicaid expansion is in prison health.
“Other state departments that are spending money on health care, those costs can be shifted to Medicaid and receive this federal match. The biggest example is Department of Corrections,” Barker said.
“If a prisoner needs health care, the Department of Corrections has a contract to provide that health care to prisoners. Right now, we’re paying the full cost for those prisoners’ health care. If there is Medicaid expansion and a prisoner would need hospital care, and they would actually leave the prison to receive health care, they would be eligible for Medicaid coverage while they are in the hospital.”
As soon as they become Medicaid-eligible, Missouri will receive 90% of that cost.
“There really is significant savings generated from Medicaid expansion,” Barker said. “Medicaid expansion makes a lot of sense for Missouri.”
Vote Yes on Amendment 2 on the August ballot to approve Medicaid expansion in Missouri.
To read the Missouri Foundation for Health report, visit https://tinyurl.com/MFH-Medicaid.
