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Missouri Chamber tries different angle as it lobbies legislators to expand Medicaid

This article first appeared in the St. Louis Beacon, March 13,2013: In an apparent attempt to nudge Missouri’s Republican legislative leaders, the Missouri Chamber of Commerce and Industry has told employers around the state that if the state doesn’t expand Medicaid, they’ll be left holding the financial bag.

The chamber's state president, Dan Mehan, emphasized at a news conference today at the organization’s Jefferson City office that it continues to oppose the federal Affordable Care Act — but, given the fact the act is going to be implemented anyway, failure to expand Medicaid hurts business.

Joining the chamber was the Missouri Hospital Association, which presented a study "that outlines the significant burden on employers that could result from health-care cost shifting if Missouri fails to expand Medicaid."

The shifting amounts to $3.5 billion, the study says, because hospitals will have to charge more to make up for $4.2 billion in federal payments for treating the uninsured that will disappear over the next six years as the Medicaid expansion kicks in — whether or not Missouri participates.

The Medicaid expansion is a key, but optional, provision of the ACA.

Beginning in 2014, the federal government will cover all of the expansion costs for three years, plus at least 90 percent thereafter.  State officials have estimated that up to 300,000 Missourians could be added to the rolls. The added coverage is expected to make up for the loss in the federal hospital payments for the uninsured.

The Republican-controlled General Assembly has, so far, shown no interest in approving the expansion and has removed Gov. Jay Nixon’s related financial provisions from the proposed budget for the coming fiscal year. 

On Wednesday, the House Budget Committee rejected an amendment to restore $54 million in related Medicaid-expansion money, from the federal government, to the proposed budget. The 19-10 vote was along party lines.

Republican leaders, including House Speaker Tim Jones, say they oppose expanding entitlement programs in general and also believe that the federal government doesn’t have the money to continue its share of the funding.

Nixon, a Democrat, continues to travel the state to promote the Medicaid expansion, highlighting the hospital association’s estimate that 24,000 jobs wpuld be added, mainly in health-related fields. Today, the governor is holding Medicaid-related events in St. Francois County and Chillicothe, Mo.

But the governor also found the time to issue a statement in support of the Hospital Association's study:

"This new report presents a stark choice: we can bring our tax dollars back to Missouri to strengthen Medicaid and reduce costs for employers and families, or we can send these dollars to other states and see these costs skyrocket,"  the governor said. "That’s why a large and growing coalition of business groups, including the Missouri Chamber of Commerce and local chambers across the state, supports our plan to move forward — because otherwise we fall far behind."

The chamber's pitch to businesses appears to be directed at resistant GOP legislative leaders as well.

At the chamber’s news conference, Mehan said, "Our hands have been tied by Obamacare. We don’t like it, we don’t agree with many of the tenets of it, but Obamacare is law and whether we like it or not, we have to abide by it. The only choice we have is to decide if it is going to cost the employer community a lot or a whole lot more. That’s where we are."

According to the association’s study, Missouri hospitals have seen a 90 percent growth in uncompensated care since 2002. The state cut its Medicaid rolls in 2005 as part of a cost-cutting move.

"The potential cost of uncompensated care as a result of Obamacare would be staggering for Missouri employers and individuals," said Mehan. "This poor policy has Missouri employers over a barrel. We have no choice but to expand Medicaid or face millions in a hidden health-care tax."

Jo Mannies is a freelance journalist and former political reporter at St. Louis Public Radio.