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What gridlock? Delegation wants continued funding for unique health program

This article first appeared in the St. Louis Beacon: In an unusual display of political bipartisanship, some members of the Missouri delegation in Congress have joined forces to urge the federal government to continue funding a health program that was begun as a placeholder for expanding Medicaid.

The program is Gateway to Better Health, which provides basic medical insurance to 25,000 area residents, including 21,000 who eventually had been expected to be enrolled in an expanded Medicaid program in Missouri. Coordinated by the Regional Health Commission, the Gateway program was supposed to end on Dec. 31, when Medicaid expansion took effect.

But state lawmakers refused to expand Medicaid, citing finances and philosophical opposition to the program. They chose instead to continue limiting its benefits to pregnant women, children and people who are blind, disabled or aged. By contrast, the Gateway program is open to all uninsured adults with incomes at no more than 133 percent of poverty level, just as Medicaid benefits would be made available in states choosing to expand the program under the Affordable Care Act.

Gateway is providing the region $30 million a year to underwrite primary and specialty care to the 25,000 indigent patients, many of whom suffer from chronic conditions, including diabetes or hypertension.

The four federal lawmakers signing the letter in support of continued funding for Gateway were U.S. Sens. Claire McCaskill, a Democrat, and Roy Blunt, a Republican; and the area’s two U.S. House members, William Lacy Clay, a Democrat, and Ann Wagner, a Republican.

The letter said the program should continue until Missouri “finalizes long-term (health care) solutions for this (low income) population.” Legislative hearings will be held across the state to help lawmakers figure out what to do in the next session to address Medicaid in Missouri. The hearing in St. Louis takes place at 9 a.m., Wed., Aug. 14 in room 210 in the B Tower at St. Louis Community College at Forest Park, 5600 Oakland Ave.

Among those elated by Gateway’s support from the federal lawmakers is Robert Fruend, CEO of the Regional Health Commission. RHC seeks to boost access to care for the uninsured, reduce health disparities and improve health outcomes for the needy in St. Louis and St. Louis County.

He says, “We’ve always been thankful that our work has been one where people check their partisanship and organization affiliation and talk about how we can make health care better for the region.” During a year of services, he says Gateway has financed:

• Nearly 47,000 primary care and dental visits for needy patients.

• More than 150,000 medications to help poor patients manage chronic conditions and diseases.

• More than 28,000 specialty and diagnostic care visits.

The practical impact of Gateway, he says, is that fewer than 5 percent of Gateway patients now use the emergency rooms for non-emergencies, meaning savings to the health system,. In addition, thousands of otherwise uninsured individuals are now getting health-care coverage.

Such outcomes would vanish come Jan. 1 unless Gateway is extended, Fruend says. That’s also the date when expanded Medicaid takes effect in other parts of the country.

“Gateway was supposed to be a bridge to Medicaid expansion,” Fruend says. “But we didn’t expand it, so this population becomes uninsured on Jan. 1. Providers can’t provide coverage, can’t provide access, if they don’t have funds.”

Backers of extending Gateway are hoping the federal decision will come well before Oct. 1, the day insurance exchanges are supposed to be up and running. It’s also the deadline for Missouri to inform Gateway’s 25,000 enrollees whether their benefits will end on Dec. 31.

Fruend and others don’t want to face the prospects of having to tell the enrollees prematurely on Oct.1 that benefits will end only to learn later that the feds have decided to extend Gateway. An early announcement that turns out to be incorrect would create a lot of stress for the needy worried about the future of their health insurance, he says.

Gateway is the successor to a highly regarded health-care model that the region put in place about a dozen years ago. With the closing of Regional Medical Center, Fruend and others appealed to federal officials to allow them to take the $30 million a year set aside annually for hospital care for the needy and use it instead to fund improved care in health clinics in St. Louis and St. Louis County.

With the ongoing waiver granted and renewed, the Regional Health Commission has been awarding block grants to health clinics to underwrite medical services. But under the Gateway model, clinics are reimbursed on the basis of services rather than given a block grant.

Each patient in the Gateway program gets a card and the clinic gets a payment whenever the enrollee uses the card to access medical care.

Fruend says St. Louis region’s effort to extend health care to its needy during the past 12 years has become a national model.

“We are providing care in the right place, at the right time, in the neighborhoods, and avoiding costly visits to emergency rooms when people get sick,” he says. “It just makes good medical sense and good economic sense, and we’ve been grateful that people can support it across political spectrums and across organizations as well.”

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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