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Nixon Visits Rural Hospital Facing Layoffs, Challenges Constituents to Push Lawmakers on Medicaid

This map shows the status of the Medicaid Expansion decision in various states, as of early 2014. (Image credit: Kaiser Family
This map shows the status of the Medicaid Expansion decision in various states, as of early 2014. (Image credit: Kaiser Family

Governor Jay Nixon on Wednesday said the state of Missouri has reached a benchmark in lost money because state lawmakers have not accepted federal dollars to expand Medicaid, the health care program for the lower-income and disabled.

$500 million:  that’s how much Nixon says Missouri taxpayers have paid in federal dollars that are being used to expand Medicaid in other states. The federal government, as part of the new Affordable Care Act, is offering hundreds of millions of dollars to states to expand Medicaid.  If state lawmakers take it, people making up to 138% of the federal poverty level will suddenly have government-funded health care.

Nixon spoke from Ozarks Medical Center, a rural hospital in south-central Missouri that recently saw 32 layoffs

Read more from KSMU about those layoffs here.

Since Missouri’s state lawmakers have, so far, voted not to expand Medicaid, rural hospitals like this one are hurting more than usual, because their federal reimbursements have been cut.  Those cuts were made with the expectation that Medicaid would be expanded…but it hasn’t been.  At least, not in Missouri.

Tom Keller is the new CEO at the hospital. When he mentioned the hospitals “bad debt” to a packed auditorium, it was like the breath was sucked out of the room.

“Because of OMC’s high percentage of Medicaid and ‘charity care’ patients, the organization is greatly impacted by decisions regarding Medicaid reform, and eligibility expansion.   In 2013, OMC provided a total of $6.5 million in charity care to patients without insurance. In addition, OMC had more than $20 million in ‘bad debt’ in 2013 from patients who were either  unable, or unwilling to pay,” Keller said.

OMC is the region’s largest employer, and the only hospital in the area. Employees are nervous here. One nurse asked the governor from the standing-room only how much time the hospital has left.

And OMC is not alone.  CoxHealth and Mercy Hospital Springfield also see a hefty percentage of patients who cannot pay.  And that’s where Medicaid Expansion comes in.

Read more from KSMU about other local hospitals and how the Medicaid Expansion issue is affecting them.

Supporters of expanding Medicaid say if the state were to accept those federal dollars—like Illinois, Arkansas and some other states have—those patients who are causing such a strain on rural hospitals would have a way of paying their tabs.

Click here for a comparison of Illinois, which has expanded its Medicaid program, with Missouri, which has not.

But so far, most Republican lawmakers in Jeff City have said, “No thanks” to the federal dollars.  Nixon holds the legislature responsible.

When asked if he could have worked more closely and nurtured more relationships with Republican lawmakers on this issue, he said it’s ultimately not the governor who is going to get lawmakers moving.

"Ultimately, I think, though, that we live in a world in which, in a democracy, elected people most likely react to what their constituents feel. I mean, we live in a representative democracy,” Nixon said.

Expanding Medicaid is one arm of the Affordable Care Act, often referred to as Obamacare.

West Plains is in the district of Republican Representative Shawn Rhoads and Republican Senator Mike Cunningham.  Both lawmakers have remained opposed to expanding Medicaid, despite that the hospital board, the Chamber of Commerce, and now grassroots groups in this traditionally very conservative district have all endorsed it.

Cunningham has said he is concerned about the portion of the cost the state will have to payafter two years, and Rhoads has echoed the concerns of other Republicans who say the program needs to be updated and streamlined before it’s expanded.

To read more from KSMU about Republican lawmakers' concerns, and for details on the cost of Medicaid Expansion, click here.

The federal government has agreed to pay for 100% of the cost for the next two years, and up to 90% after that.