Medicaid expansion | St. Louis Public Radio

Medicaid expansion

One of the first signs drivers see on the way into Unionville, Missouri, is this billboard advertising cardiology at Putnam County Memorial Hospital, a hospital in northern Missouri.
Bram Sable-Smith | Side Effects Public Media

Rural hospitals are more likely to close in states such as Missouri that have not expanded Medicaid.

A recent report from the pro-Affordable Care Act organization Protect Our Care analyzed 84 rural hospital closures since 2010. It found 90 percent of those hospital closures were in states that had not expanded Medicaid coverage. Missouri remains one of the 14 states that hasn’t amended its program to cover people who earn up to 138 percent above the poverty line.

Missouri and Kansas have joined 18 other states in seeking to have the Affordable Care Act declared unconstitutional following Congress’ repeal last year of the tax penalty associated with the individual mandate.

In a lawsuit filed late Monday in federal court in Texas, the coalition of 20 mostly red states claimed that the elimination of the tax penalty for those who don’t buy health insurance renders the entire healthcare law unconstitutional.

Lacy Seward, social services coordinator for the Monroe City Manor. Medicaid cuts proposed by Senate Republicans could hit hard in this small town, that helped vote them into office.
Durrie Bouscaren | St. Louis Public Radio.

MONROE CITY, MO. — The closest emergency room is 20 miles east on the highway. That’s why it isn’t unusual for people experiencing heart attacks, blood clots and strokes to show up at Dr. Rodney Yager’s clinic on Main Street in Monroe City.

Yager, who grew up in the area, can handle the fast pace of a small-town clinic. What worries him more is how federal health care policies being shaped in Washington, D.C., could affect his patients.

David Mueller, 31, picks up his three-year-old daughter Marjorie from daycare on May 4, 2017. She has a rare form of cystic fibrosis, and Mueller worries the Republican health plan will affect the family's ability to pay for her care.
Durrie Bouscaren | St. Louis Public Radio.

A Republican proposal to gut the Affordable Care Act narrowly passed the U.S. House of Representatives and now the U.S. Senate is crafting its own bill to reshape the nation’s health care system. Elected officials have held few town halls to hear from constituents in the St. Louis area about what they want in a health care bill, sparking demonstrations outside representatives’ offices.

Drive down a dirt road in Dallas County, under a thick canopy of walnut trees and over three cattle guards, and you’ll come to Rachel Harrison’s home in Windyville, Missouri.  

A few years ago, Harrison was using her Bachelor’s degree in biology in a hospital laboratory.

“I was a generalist, which means I was in charge of urinalysis, chemistry, special chemistry, hematology, blood banking, coagulation, I think I got it all—phlebotomy, all that kind of stuff,” Harrison said.

But at age 25, she began to hear what sounded like people talking.

Six years ago, 53-year-old Corla Morgan noticed blisters forming on her neck and back.

“I couldn’t sleep because when I took my shirt off, if my shirt touched my skin, the skin just peeled off,” Morgan says. “I was in really horrible pain.”

The St. Louis Children's Hospital's logo, which replaces the 'n' in 'Children's' with an image of the Gateway Arch, is printed all over the hospital campus, including the entrance off Kingshighway Boulevard. Spokeswoman Abby Wuellner said the logo represe
File photo|Nassim Benchaabane | St. Louis Public Radio

Missouri hospitals are providing less charity care than they did before the Affordable Care Act, according to a report by the Missouri Hospital Association.

But that's not necessarily a sign that hospitals are being stingy. According to the report's authors, that means more people can pay their medical bills.

It’s indicative of more people having insurance,” said Dave Dillon, spokesperson for the MHA. “The numbers for 2015 show very good progress.”

Protesters disrupt the Missouri Senate on May 6, 2016.
Courtesy, Missouri Senate

It's a split decision in the trial of the so-called "Medicaid 23," a group of religious leaders who staged a protest in the Missouri Senate more than two years ago over lawmakers' refusal to expand Medicaid.

Twenty-two members of the group were found guilty of trespassing for not leaving the Senate gallery when ordered to do so by Capitol police. But they were found not guilty of obstructing the operations of the Senate. The case of one other member will be decided later.

Keith Carter, 53, waits to pick up a prescription for diabetes at Affinia Healthcare in St. Louis. Though he falls in the income gap, he's able to get his preventive care covered through Gateway to Better Health.
Durrie Bouscaren | St. Louis Public Radio

At any given time, a half dozen people sit in the waiting room at Affinia Healthcare in south St. Louis. Two parents coo over a new baby, while a group of older patients chat along the back wall.

53-year-old Keith Carter sits alone. An embroidered polo shirt and badge show he’s just come from work.

“I seem fit. Inside, it’s just breaking down like sawdust. I just keep it in motion,” he said, as he waited to pick up a prescription to manage his diabetes.

Gov. Jay Nixon made expanding Medicaid a top priority when he first ran for governor. While he made some small steps, he was largely unsuccessful in achieving that goal.
File photo by Carolina Hidalgo I St. Louis Public Radio

After Gov. Jay Nixon placed his signature on legislation that could expand Medicaid for Missourians who are disabled or elderly, I couldn’t help but think back to when the Democratic official visited Bob Pund’s apartment.

Nixon was a mere attorney general when he ventured into Pund’s residence back in 2007. Pund is paralyzed from the shoulders down and had been critical of major cuts made to Medicaid in 2005. As Nixon sat in Pund’s living room, the aspiring governor vowed to make reversing those reductions a priority of his eventual administration – even if he was faced with a Republican-controlled legislature.

The program is credited with helping St. Louis land the SEC Men's Basketball Tournament next March at Scottrade Center.
.bobby | Flickr

In our weekly "Behind the Headlines" segment, “St. Louis on the Air” host Don Marsh discussed several of the top news stories that caught St. Louisans’ attention this week, with the people that produced them and influenced them. 

Here’s what we talked about, including:

Chief Medical Officer, Dr. Johnetta Craig, walks to a meeting at the Carondalet location of Family Care Health Centers in St. Louis.
Durrie Bouscaren | St. Louis Public Radio

Despite the efforts of healthcare advocates, hospitals and notable former legislators, the Missouri legislature did not pass Medicaid expansion this year, or even bring it to the debate floor. That means an estimated 147,000 Missourians will have another year without health coverage, and the community health clinics that care for the uninsured will continue trying to bridge the gap.   

U.S. Sen. Claire McCaskill at a hearing at Washington University with more than a dozen experts in medicine and geriatrics 3/31/15
Jo Mannies | St. Louis Public Radio

As U.S. Sen. Claire McCaskill sees it, the Missouri General Assembly will be sharing more of the blame as the state’s medical professionals find it more difficult to provide the services and funding needed to care for Missouri’s growing elderly population.

Marshall Griffin/St. Louis Public Radio

Missouri lawmakers are heading home as their annual spring break has arrived, but they took time before leaving to tout their mid-term accomplishments.

jay nixon 81814
Bill Greenblatt | UPI

After two years of failing to convince Republican lawmakers to expand Medicaid in Missouri, Gov. Jay Nixon is pitching an alternative he hopes will sway enough of them to come aboard. But key Republicans remain cool to the idea.

Nixon, a Democrat, unveiled his new proposal Wednesday at appearances in Springfield and Kansas City.

Adrian Clark | Flickr

Administrators for Missouri’s Medicaid program told members of their oversight committee that they are getting closer to fixing their processing delays for new applicants. But the wait can still take months.  

“We are now under 13,000 pending applications. I think we will get into that normal, historical range within the next week,” said Family Support Division Director Alyson Campbell at an oversight committee meeting of MO HealthNet, the social services division that administers Medicaid in Missouri.   

Richard von Glahn explains the plan to canvass in House Speaker John Diehl's district as Judith Parker and Andrew Westbrook look on.
Camille Phillips | St.Louis Public Radio

Advocates continue to push for the expansion of Medicaid to include Missourians who fall in the so-called “coverage gap.”

Because Missouri has so far opted out of Medicaid expansion under the Affordable Care Act, thousands of Missourians fall into a gap -- they make too much money to qualify for Medicaid, but not enough to qualify for federal aid on the healthcare exchange.

State legislators have made it clear that expansion is unlikely to happen this year either.

But Medicaid advocate Richard von Glahn remains optimistic.

State Sen. Ryan Silvey, R-Kansas City, proposes to expand Medicaid to military vets currently ineligible for coverage.
Marshall Griffin | St. Louis Public Radio

A Republican member of the Missouri Senate is proposing expanding Medicaid to military veterans who are currently ineligible.

Adrian Clark | Flickr

The state agency that provides Medicaid coverage to more than 840,000 Missourians does not have proper oversight over contractors in charge of certain aspects of payment processing, according to an audit released Monday of MO HealthNet.  

The report by the office of Tom Schweich, the Missouri state auditor, identified four areas of concern:

Flickr/rosemary

To date, Missouri has failed to expand its Medicaid program as part of the Affordable Care Act, aka "Obamacare." As a result, federal dollars that would normally flow to underserved areas are being transferred to states that have expanded their programs. This loss of funding has major implications for health care in our state especially for those in areas of poverty and who are underserved. One particularly susceptible area is rural Missouri.

Sac-Osage Hospital in Osceola is a telling example.

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