Letter to the Editor

Medicaid expansion needs to be considered

Wednesday, October 21, 2015

Dear Editor:

Two small town hospitals in our region have recently closed their doors. The Sac Osage Hospital in Osceola, Mo., closed last fall and this month Mercy Hospital in Independence, Kan., closed. Both Osceola and Independence were hospitals in states where the Legislatures declined to enact Medicaid expansion.

As part of the Affordable Care Act and later Supreme Court ruling, states were given the option to expand Medicaid coverage to low income adults. If Medicaid expansion was enacted by the individual state - the federal government would pick up 100 percent of the tab for the first three years, then shift to a 90 percent federal and 10 percent state obligation thereafter.

In Missouri, Republican politicians argue that the federal government can't be trusted to hold up its end of the bargain, even though they are footing 90 percent of the bill.

And while it is up to debate whether Medicaid expansion would have saved these two hospitals, it is hard to ignore the financial impact the decision has made. When the Missouri Legislature decided not to expand Medicaid (and not even hold a public hearing to consider the issue) the money that could have gone to Nevada and other small Missouri communities went to other states.

The money goes to hospitals in 31 of the other states -- states like Kentucky. In Kentucky, as Dr. John Cox from Joplin wrote recently in the Joplin Globe, the "estimate is that it (Medicaid expansion) created 12,000 new jobs and added $1.6 billion to the economy there, an estimated $900 million net improvement to the state after expenses."

Part of the reason Medicaid expansion is so important to rural areas like Vernon County is that we have a higher number of uninsured patients.

Hospitals like NRMC can't just turn people away without insurance. They end up writing off a significant portion of the losses treating the uninsured. Medicaid expansion, if enacted, would cover patients with income up to 138 percent of the federal poverty level and help cover these losses.

A conservative estimate is that is that Medicaid expansion would net an additional $300,000 to $400,000 at Nevada's hospital and put money into the local community.

The main reason the public has not gotten behind this is probably because expansion has been painted as another "handout" to people not willing to work.

In reality, Medicaid expansion would go towards helping the working poor who can't afford insurance coverage. Folks without insurance get sick too and they often wait to go to the emergency room and the hospital ends up writing off their expense.

I hope we can start a conversation with our representatives Sen. Emery and Rep. Pike in Jeff City and not continue to ignore the problem. Medicaid expansion probably is not a "cure all" for saving all small town hospitals but it at least needs to at least be part of the discussion.

Mike McCaffree