With more than 1 million COVID-related deaths [in the U.S.] one would think the pandemic would serve as a great equalizer in this country. It has impacted everyone – Black, white, rich, poor, urban, suburban, and more.
“Medicaid expansion will greatly improve the health of our communities, especially those underserved low-income communities…”– Lachelle Livingston, director of population health at CareSTL clinics.
Of course, it has not been that. Minorities were infected and died at disproportionate rates. Poor countries struggled to get vaccines. Many wealthy people became richer, regardless of one of the greatest recessions since the 1930s.
And, in Missouri, Republican legislators are still working tirelessly to stall healthcare coverage for hundreds of thousands of Missourians.
Under the Obama administration, the “Patient Protection and Affordable Care Act” (commonly referred to as the Affordable Care Act or ACA), was expanded to increase access to primary care. Before expansion, enrollment was limited to mostly children, pregnant women, and people with disabilities.
Although these groups still make up the vast majority of those enrolled in the state’s Medicaid program, Medicaid expansion is open to nearly all adults with incomes up to 138% of the Federal Poverty Level.
To date, 38 states and Washington, D.C. have adopted Medicaid expansion and 12 states have not. Through a 2020 ballot measure, Missouri voters approved expanded eligibility for Medicaid to people ages 19 to 64.
That has not stopped numerous Republican attempts to derail or defund what voters passed by a wide margin.
“Sometimes voters are smarter than the people they elect,” said State Sen. Karla May regarding the state GOP’s efforts to stop voter-approved Medicaid expansion.
Drawn-out court battles and the pandemic have plagued expansion efforts in the state. For years, the Republican majority in the legislature fought to prevent expansion by refusing to put the necessary funds in the budget. This move was supposedly halted last year when the Missouri Supreme Court ruled the expansion amendment constitutional.
But, as the St. Louis Post-Dispatch noted in its February 11, 2022, editorial, “Missouri’s Republican-run legislature has been so determined to sabotage Obamacare that it has steadfastly refused to go along with the program’s call for Medicaid expansion.”
Recently, state Sen. Lauren Arthur (D-Kansas City) derided the GOP’s efforts.
“I think any attempt to undo what the voters approved is disrespectful. There are a lot of people, working people, who hope to have access to health care through Medicaid, and any sort of attempt to undo the will of the voters after the Supreme Court has weighed in on this issue … people are going to be less healthy.”
Arthur made a point about “working people.” According to the Commonwealth Foundation, by June 2020, as many as 7.7 million workers lost their jobs. This meant that, because of the pandemic, many also lost employer-sponsored insurance.
The pandemic proved that Medicaid expansion is a much-needed resource. Between February 2020 and June 2021, enrollment in Medicaid rose by about 18%, with 12.5 million people gaining coverage after the government relaxed enrollment regulations.
A growing body of research has concluded that Medicaid expansion pays for itself, by increasing employment and the tax base and reducing health-care expenses. New research indicates that increased access to health insurance has crime reducing benefits. Considering that Medicaid expansion is funded by the federal government, it’s hard to comprehend why GOP legislators fight so hard to not receive hundreds of millions in federal dollars or why they’re willing to leave some 275,000 Missourians without coverage.
Much of the Republican’s efforts to halt Medicaid expansion is based on the stereotypical belief that it is designed to only support poor people or those unwilling to work. In fact, the latest effort through a proposed constitutional amendment sponsored by Rep. Cody Smith (R-Carthage), requires Medicaid recipients to work or be in job training at least 80 hours a month or perform 80 hours of community service.
Tim McBride, a professor at the Brown School at Washington University and local expert on the effects of health reform at the state and national levels, challenges the GOP’s popular but misguided perception.
“Politicians like to say ‘we need to make them work’ but the truth is many are working. Something like 80% of the people who are uninsured, have someone in their household who’s working,” McBride explained.
“These people are working but they’re working at jobs that don’t provide insurance. It’s part time or it’s temporary work.
“Medicaid expansion, in part, was created to deal with that population. It has a very simple rule: If you’re below 150% of the poverty rate, you’re eligible regardless of anything else.”
In a recent interview with The Examiner, McBride said, “We are clearly behind where we said we would be at this point in terms of enrollment.”
The article contrasted Missouri with other states that have enrolled half of their newly eligible residents within the first month. Yet, in nearly five months “Missouri has enrolled less than 25% of the estimated 275,000 eligible” as of January 2022.
“It’s unacceptable!” said Dr. Kendra Holmes, president, and CEO of Affinia Healthcare.
“The State has done little to nothing to encourage enrollment. There are over 70,000 pending applications statewide. Processing time for a Medicaid application is 99 days. Without access to health insurance, many in the black community will simply go without treatment.”
Holmes worries about addressing the healthcare needs of the disenfranchised now and after the virus is contained. Once the public health emergency ends, will the government still finance COVID-19 immunizations? What about those suffering from underlying conditions that make them more susceptible to death during a pandemic?
Holmes is concerned because “a significant number of preventive screenings” have been delayed because of COVID. Therefore, she fears an increase in colorectal, prostate, and breast cancers in black communities because of these delayed screenings. Additionally, those suffering from behavioral health issues resulting from COVID or “Long COVID” will be left without safety nets, Holmes stressed.
While Republicans continue to play politics with Medicaid expansion, some nonprofits are working diligently to enroll and educate people about expanded coverage. In January, Lachelle Livingston, director of population health at CareSTL clinics, told St. Louis Public Radio that it’s imperative to increase Medicaid enrollment numbers.
“Medicaid expansion will greatly improve the health of our communities, especially those underserved low-income communities that have not been able to seek out services.”
Sylvester Brown Jr. is The St. Louis American’s inaugural Deaconess Fellow.
