Politics & Issues
3:33 pm
Tue December 31, 2013

Without Medicaid Expansion, 193,000 Missourians Left In Coverage Gap

Key provisions of the Affordable Care Act go into effect at midnight and health-care coverage will begin for millions of Americans.
 
Yet because some states declined to expand Medicaid, there is a coverage gap for 5 million others, including more than 193,000 in Missouri.
 
As part of the federal Affordable Care Act, those with incomes between 100 and 400 percent of federal poverty levels will be eligible for financial assistance, or subsidies, as they purchase health insurance through the new marketplace.
 
But there was no provision for those under 100 percent of the level who were supposed to be covered under the Medicaid expansion recommended by the Affordable Care Act. The federal government is paying all the additional cost of the expansion for the first three years and at least 90 percent thereafter. Even so, 25 states, including Missouri, opted out.
 
Republican state legislative leaders have opposed the expansion on financial and philosophical grounds.
 
Ryan Barker, vice president of health policy at the Missouri Foundation for Health, says that means an adult making less than $11,500 annually will have to pay full price for insurance on the exchange. They would have qualified for free coverage under Medicaid if Missouri had chosen to expand the program.
 
“For people making less than $12,000, that’s pretty unreasonable to expect that they could afford the full price of health insurance,” Barker said.
 
He says he expects Medicaid expansion to be a “hot topic” in the upcoming legislative session.
 
Gov. Jay Nixon renewed his call for an expansion on Tuesday. He pointed to states surrounding Missouri that have expanded the program, including Arkansas and Iowa.
 
“They’re using market forces to modernize what had been outdated and inefficient health-care systems, and improve outcomes and reduce costs for everyone,” Nixon said. “Unless we change course, they’re going to do all this with our tax dollars, while Missouri gets left behind.”
 
But Missouri House Speaker Tim Jones, R-Eureka, said in an interview that Republican legislative leaders first want to revamp the existing Medicaid program before considering any expansion.

He reaffirmed his opposition to expansion and to other provisions of the Affordable Care Act. "The more Obamacare fails, the less you'll see that happen,'' Jones said.

Jo Mannies contributed information for this article.

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