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Getting Up To Speed On Medicaid Expansion Ahead Of Next Week’s Vote

Missouri’s Aug. 4 primary has sneaked up fast against a backdrop of the U.S. presidential election and a global pandemic. But plenty of key local races will be decided in the heavily Democratic St. Louis region — and voters throughout the state will determine whether Missouri expands Medicaid coverage, joining the 37 other states that have opted to do so in conjunction with the Affordable Care Act.

If passed, Amendment 2 (the Medicaid Expansion Initiative) would effectively expand Medicaid eligibility to include adults between the ages of 19 and 65 whose income is at or below 138 percent of the federal poverty level. As of 2020, that amounts to $17,608 for an individual and $36,156 for a household of four.

Show-Me Institute, Missouri Foundation for Health & Siteman Cancer Center
Patrick Ishmael (at left), Ryan Barker (center) and Dr. Tim Eberlein joined Friday’s broadcast.

On Friday’s St. Louis on the Air, host Sarah Fenske was joined by several guests with varying perspectives on the ballot issue.

Dr. Tim Eberlein, director of the Alvin J. Siteman Cancer Center and chair of the Department of Surgery at Washington University School of Medicine, explained why he’s a proponent of Medicaid expansion.

“I’ve had the opportunity to personally care for patients who are hardworking Missourians and who face a stark contrast of either feeding their family or getting health care,” he said.

Eberlein noted that the state has some of the highest rates of cancer incidence and mortality in the entire country.

“In all 50 states [there] are approximately 3,000 counties, and if you were to rank those counties by mortality due to cancer, four of the top six counties in the entire United States of America are here in Missouri,” he said, pointing to lack of access to screening and prevention modalities among lower-income citizens.

He added that because Barnes-Jewish Hospital and the Siteman Cancer Center are “safety net” organizations, he and his colleagues “tend to care for a lot of patients who are underinsured or have no insurance,” providing almost $50 million in care to such cancer patients in 2019.

Patrick Ishmael, director of government accountability for the Show-Me Institute, indicated that in his view, the economics don’t add up. If 250,000 Missourians are added to Medicaid rolls, Ishmael said, “that puts pressure on every other priority” in the state budget.

“It actually is going to cost the state about $200 million a year, and because the state has to balance its budget, there are basically two considerations that we have to keep in mind here,” he said. “One, the Medicaid population for those who are in a traditional position — folks who are poor, folks who are vulnerable — if we are spending money on this new population, it has to come from someplace. It could come from them. Or it could come from someplace else in the budget including our public schools. It could come from infrastructure.”

Ryan Barker, vice president of strategic initiatives for the Missouri Foundation for Health, argued otherwise. Bigger picture, he sees Medicaid expansion as an economic boon for the state.

“We’ve lost 10 rural hospitals in Missouri in the last 10 years, and most of them have said part of the reason was because we did not expand Medicaid,” Barker said. “Hospitals just cannot afford the number of uninsured folks who are coming through their doors, and with Medicaid expansion those hospitals are getting reimbursed at Medicaid rates. It really helps those hospitals, especially in rural Missouri, stay in business.”

St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill and Lara Hamdan. The audio engineer is Aaron Doerr.

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Evie is a producer for "St. Louis on the Air" at St. Louis Public Radio.

Send questions and comments about this story to feedback@stlpublicradio.org.