We hope the Republican leadership in the Missouri Legislature pays close heed to letters sent to them last week by Joe Reagan, president and CEO of the St. Louis Regional Chamber and Growth Association (RCGA). “We have come to the conclusion,” Reagan writes, “that the prudent course is to request your support for expansion of Medicaid in Missouri under the federal Affordable Care Act” (ACA).
If the Legislature decides to maximize Medicaid coverage, Reagan points out, that would result in the leveraging of an estimated $8.2 billion in federal funds between 2014 and 2020. Whatever ideological qualms Missouri Republicans might have about the federal debt burden, he notes, the return of such a large amount of federal funding to Missouri is important, because Missouri employers and workers have contributed a substantial amount of that funding with their own taxes. The federal government is going to spend these Missouri tax dollars somewhere; it is up to the Legislature to make sure they are spent in Missouri.
As a business advocacy organization, the RCGA also is concerned that “failure to expand Missouri’s Medicaid program could result in potential liability on the part of Missouri employers for increased taxes imposed by the ACA, as well as further cost shifting of health care premiums paid by Missouri employers to cover the cost of providing health care to the uninsured.” Any federal tax dollars that Missouri Republicans refuse, in other words, will be paid in part by Missouri employers.
The proposed Medicaid expansion that would cover an additional 220,000 low-income Missourians would also produce significant economic development benefits, including the creation of some 24,000 jobs, according to a recent study by the Missouri Hospital Association and the Missouri Foundation for Health. “The program expansion is also estimated to increase labor income in the state by nearly $7 billion and generate $856 million in additional state and local taxes from 2014 to 2020,” Reagan notes.
The RCGA makes a compelling business case. However, this group that represents business interests is addressing the ideological right wing of the Republican Party, which now controls the state Legislature. These doctrinaire ideologues have spent so much political capital bashing President Obama and his landmark health care reform that it is now difficult for them to walk back from their tough talk and swallow the basic common sense that the state should benefit from $8.2 billion in federal funds that was paid into the federal government by Missouri taxpayers.
Conservative Arizona Gov. Jan Brewer has said that she plans to push for expansion of the state’s Medicaid program under the ACA and that she will fund it by raising taxes in hospitals despite the philosophical and economic concerns from members of her own party. She has found support in Arizona from hospital executives and the Chamber of Commerce, a perennial opponent of raising taxes. We suspect that increasingly large numbers of Hispanic voters, whom Republicans have estranged with their stern immigration policies, put fear in the heart of the Arizona governor. Unfortunately, the Missouri Democratic Party has not developed the political muscle to bend Republicans, even though voters tend to elect more Democrats statewide than Republicans and thus – presumably – favor Democratic policy stands. Importantly, Gov. Jay Nixon has announced his support of Medicaid expansion and intention to work hard for it in Missouri.
The RCGA gets it, and we hope that Missouri Republicans begin to follow suit. We can’t run this state with ideological inflexibility. Republicans can not continue to foster elective politics that reward ideological rigidity at the expense of the public good. With the RCGA, we urge Missouri Republicans “to support leveraging the available federal funds to expand Missouri’s Medicaid program to help reduce the uninsured population, prevent further cost-shifting, create jobs and improve the health of our workforce.” The economic benefits go beyond providing better health care for more Missourians – and they trump ideology.
