Missouri Lawmakers Seek Medicaid Reform Help

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JEFFERSON CITY - The Medicaid Reform and Transformation Committee met Wednesday morning to hear from other states which have expanded Medicaid in hopes of reforming the current Medicaid system.

The chairman of the Medicaid Reform and Transformation Committee heard from Iowa, Louisiana, Kansas and Florida.

"Florida in 2006 started a reform program before it was mandatory and had some good experiences and we want to glean through some things that worked for them," said Sen. Gary Romine, R-Farmington. "It's not a one-size-fits-all project."

Romine said Missouri needs to reform the flaws in the Medicaid system before looking to expand it. He said one problem is the misuse of emergency rooms.

Dr. Randall Haight sees a few Medicaid patients each day at the Capitol Region Medical Center in Jefferson City.

"Uninsured patients will come to the emergency room for a cough or sore throat," he said. "They may have tried to see another office but couldn't get in anywhere because they didn't have insurance. You have multiple people coming in for these non-emergent situations that leads the emergency room to prioritize who they're seeing."  

The director of the Missouri Health Advocacy Alliance said many hospitals are already suffering from the lack of expansion.

"The Affordable Care Act reduces payments to hospitals over time for the care that they used to give to uninsured people, because the idea now is they're going to have insurance," Andrea Routh said.

She said if payments continue to decrease with Medicaid expansion, hospitals will not make it.

"Some of them will have to cut essential services like psychiatric beds. One hospital group said they may have to cut labor and delivery. A Kansas City hospital, Truman, may have to cut their level one trauma center," she said.

Spokesman for the Missouri Hospital Association, Dave Dillon, said one in seven Missourians is uninsured. He said without Medicaid expansion, taxpayers may pay more money to maintain hospital services.

"Almost immediately we saw some hospitals say, 'Well, we can't continue to run an ambulance service, so we're going to give that responsibility back to the county,'" Dillon said. "The county taxpayers are then on the hook for it. It doesn't go away. The cost doesn't go away; it's just shifted elsewhere."

But if Missouri lawmakers have their way, as well as governors and legislatures in nearly a dozen other states, low-income Americans may not have expanded access to federal funds needed for vital procedures. The majority of Missouri lawmakers feel the expansion is an unnecessary government overreach at a time when spending should be limited, not expanded.

Romine said there is too much uncertainty in the Affordable Care Act (ACA).

"We've seen a lot of different issues that have come up over the past year or so that indicates the ACA has some pitfalls," he said. "We want to make sure that before we embrace ACA and Medicaid expansion, we don't fall into those problems."

If Missouri were to expand Medicaid, 351,000 people would be newly eligible for qualifying.

Open enrollment begins October 1 and the Affordable Care Act goes into effect in January.