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HHS secretary urges Missouri to take Medicaid expansion money

This article first appeared in the St. Louis Beacon, Sept. 20, 2013 - Missouri could lose $8 billion in federal funding during the first six years of health reform if state lawmakers continue to refuse to expand Medicaid to insure more of the needy, according to Health and Human Services Secretary Kathleen Sebelius. She spoke during a stop in St. Louis for a meeting with St. Louis Mayor Francis Slay, County Executive Charlie Dooley, health leaders and others working to help prepare consumers for the reform law’s insurance exchange marketplace, which opens for business on Oct. 1.

Sebelius said that under the federal health law states get 100 percent of funding to expand Medicaid to cover individuals and families with incomes below 100 percent of poverty – or roughly $19,530 for a family of three.

She  said repeatedly that the federal government would pick up all the cost during the first three years of Medicaid expansion and at least 90 percent in future years.

“As a recovering governor of a nearby state, I would have loved to have had that deal on the table in a heartbeat,” said Sebelius, who is a former governor of Kansas.

While warning that billions of dollars in federal assistance will be left "on the side of the road” if Medicaid isn’t expanded, Sebelius also struck a conciliatory tone toward all 27 states that have yet to expand their programs.

“There is no deadline for Missouri to expand Medicaid. We are going to continue that discussion in Missouri and in other states, hoping that the business community and provider community are able to convince legislators” about drawbacks of “turning down that money to pay for uninsured Missourians.” She said accepting the expansion plan would mean “that tax dollars could be diverted to education and economic areas that would benefit the state overall.”

Sebelius was asked about mostly Republican opposition to embrace the health reform law.

She said, “I think this debate has been unfortunately partisan from the very beginning,”  following President Barack Obama's campaign on a promise of providing a health reform law, and continuing through its enactment and after most of its key provisions were upheld by the Supreme Court.

“This has been very contentious,” she says. “For some people, it’s because it’s connected to the president. There are members of Congress who said their whole goal in life is to make sure the president did not have a second term.”

She concedes others voiced principled opposition by arguing that the health law was unconstitutional.

“Unfortunately, the debate has gone on. There is lots of misinformation. The Wall Street Journal poll has confirmed that about 70 percent of people still don’t understand what the law means to them and their families and what kinds of benefit they are entitled to. That’s what this local effort is all about.”

The Missouri Foundation for Health has made information available at Cover Missouri.

She says the dialogue to change minds isn’t going to come from Washington but from local groups like those in St. Louis. She encouraged “faith leaders, community leaders, neighborhood friends, Facebook friends, Twitter followers to get information to people in a way that they understand it (and) get folks on the ground who can answer questions and let people make good decisions for themselves.”

Sebelius arrived in Missouri after discussing health reform issues during a visit to Florida. She left St. Louis for a similar discussion in Kansas City, where she will later meet up with President Barack Obama, visiting the western part of the state to discuss the economy.

The St. Louis region has a special interest in the debate on the  Affordable Care Act because it usually receives $25 million a year through a federal waiver to underwrite primary health care in area clinics. The special funding was to come to an end after Missouri expanded its Medicaid program. Because that didn’t happen, the region is asking the federal government for a waiver to continue receiving the $25 million subsidy.

At the press conference, Pamela Walker, head of the St. Louis Health Department, thanked federal officials for considering an extension of the waiver.

Officials under Sebelius are “working with us when they don’t have to in order to keep our safety net in place until our legislature does the right thing and the smart thing and expands Medicaid,” Walker said.

“We are going to work with them as much as we can, hopefully to get a one-year extension. It is a Band-Aid to keep that safety net in place because if it falls apart, there won’t be rebuilding.”

In addition, Walker said failure to expand Medicaid “is costing 2,000 jobs in this region and the poorest of the poor are not getting the medical care that they have a right to under the law.”

Slay said about 40,000 city residents would get help through the insurance exchange system. “We have a law in place and a lot of opportunity for people who are not now covered by insurance. There are options available. That’s what we are here to talk about. The insurance network will be available through the exchange and is easily available online. This could help strengthen families to do a better job of staying healthy, which helps all of us.”

Some local officials have been straddling the fence on whether to help educate the public about the coming insurance exchange program citing Proposition E, which forbids the governor or state agencies to get involved in helping set up an exchange system. But not officials in St. Louis County.

“In St. Louis County our health centers, our libraries will be assisting people, navigating them through the process,” Dooley said. “There are too many people in our community who are uninsured or underinsured. That needs to stop. That is not acceptable. We are going to navigate people through the process at no cost. It’s an opportunity for us to move forward.”

Dr. Dolores Gunn, the St. Louis County Health Commissioner, estimated that 120,000 county residents would be eligible to enroll in the insurance exchange system. She urged these residents to become familiar with healthcare.gov, the website where consumers will be able to sort through insurance options and find out if they are eligible for subsidies, effective Oct. 1.

She added that another 60,000 residents of St. Louis County would have been eligible for health insurance through Medicaid if state lawmakers had expanded the program.

“But there is no Medicaid expansion, so they are left out.”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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