Opinion -- The “Big Beautiful Bill’s” Impact on Missouri Healthcare

By the Missouri Budget Project

A new fact sheet from Families USA details how the pending budget bill, set to be voted on by the Senate in the next week or so, will harm Missouri’s health system, including cutting off coverage for at least 210,000 Missourians, making it harder for people to get and maintain coverage, and taking away crucial patient protections for children. The bill also drives up costs for those buying insurance through the Marketplace, skyrocketing premiums and increasing out-of-pocket costs while taking away crucial premium tax credits.

“The cuts to Medicaid and the ACA will have devastating and dramatic impacts on health coverage, care, and costs for American families, and in many ways especially in Missouri. The cuts will not just mean that tens of thousands of Missouri residents lose coverage, but federal cuts will force state budgets into crisis, forcing states to drastically scale back services, leading to closures of rural hospitals and community clinics,” said Anthony Wright, executive director of Families USA. “Senator Hawley must side with patients and health providers and plans to oppose this bill that harms access and affordability of health care for so many Missouri working families.”

“The Senate budget bill as proposed is a direct threat to Missouri's families, communities, and long-term economic future. It fails the test of sound policy and abandons the values of fairness and opportunity that should define our state's priorities,” said Amy Blouin, President & CEO of the Missouri Budget Project. "We urge Senator Hawley to reject this harmful bill and instead champion a budget that reflects the real needs of Missourians — one that invests in our health care. Missouri deserves better.”

The proposed cuts are in opposition with the voters when 82% of adults nationwide — including 67% of Republicans want Congress to maintain or increase Medicaid spending.

The Medicaid program, MO HealthNet, covers 1,268,000 children and adults, including:

—1 in 5 Missouri residents.

—573,000 children — 42% of all children in Missouri.

—237,000 seniors and people with disabilities.

Marketplace coverage, available for individuals and families who do not qualify for MO HealthNet but also do not have employer sponsored coverage, serves:

—417,000 Missouri residents.

—28,000 small business owners in Missouri and over 47,000 self-employed Missouri residents.

—About 95% of enrollees in the state who received an advanced premium tax credit to help them pay their premium.

Families USA, the longtime health consumer advocate, is organizing with Missouri Budget Project and other groups in Missouri and across the nation to protect against cuts care cuts that would force Americans to face increased costs and the loss of health coverage. The Families USA website has a plethora of materials on how its partners are working to defend Medicaid, and has facts sheets on the overall importance of Medicaid to people, the economy and the health care system, how work reporting requirements would undermine access to Medicaid, and how cuts harm families and communities.

Families USA, a leading national voice for health care consumers, is dedicated to the achievement of high quality, affordable health care and improved health for all.

The Missouri Budget Project is a nonprofit public policy analysis organization that analyzes state budget, tax, and economic issues.

 

Medicaid Expansion Vote Moved to August 4th

On Tuesday, May 26th, Governor Mike Parson ordered the Missouri Medicaid Expansion Vote to be held on August 4th. Normally, such measures are placed on the November ballot. However, Parson says that if it were to pass, the state would need more time to prepare financially given the depleted revenue from the Coronavirus. The governor has the authority under state law to move ballot measures to the August election; if he does not do so, it will automatically appear in November.

The proposal would expand Medicaid eligibility to adults earning up to 138% of the poverty level. 36 states have expanded Medicaid, but Missouri has not.

Blue Cross & Blue Shield of Kansas City to Drop ACA Health Insurance Plans for 2018

Blue Cross and Blue Shield of Kansas City (Blue KC) today announced the company’s decision to not offer or renew individual Affordable Care Act (ACA) plans in the company’s 32-county service area in Kansas and Missouri for 2018. This decision will affect Blue KC members with both on- and off- exchange individual plans but does not affect individual plans that were purchased on or prior to October 1, 2013.

“Since 2014, we’ve expended significant resources to offer individual ACA plans to increase access to quality healthcare coverage for the Kansas City community,” said Danette Wilson, President and CEO of Blue KC. “Like many other health insurers across the country, we have been faced with challenges in this market. Through 2016, we have lost more than $100 million. This is unsustainable for our company. We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation.”

Blue KC has more than 1 million members, and this will affect approximately 67,000. This decision will not affect 2017 coverage. It also does not affect Blue KC members who are covered under one of its “grandfathered” or “grandmothered” plans. These plans were purchased on or prior to October 1, 2013. Additionally, members who receive coverage through their employers, as well as those who purchased a Medicare Advantage, Medicare Supplement, short-term or student health plan from Blue KC, are not affected.

“This decision is necessary at this time, but we’ll continue to work with federal and state legislators to identify solutions that will stabilize the individual market and bring costs down for our members, the community and Blue KC,” said Wilson.

For more information, call 1-888-737-7086. Affected Blue KC members will be notified via mail by Blue KC by July 1, 2017.

15% of Worth County Residents Without Health Insurance

Around 15% of Worth County residents are without health insurance, an analysis by Upshot, a blog contained in the New York Times found. That is up 1% from last year. Nodaway County is at 13%. Andrew County is at 11%. Gentry and Harrison Counties are at 16%. Ringgold County is at 7%, while Taylor County is at 8%; both numbers were lower than in years past.

States which have not expanded Medicaid under the Affordable Care Act have higher numbers of uninsured people than states which have. Iowa has expanded Medicaid, while Missouri has not. All figures could go higher after this year because of the sharply higher increases in rates being offered this year. The Supreme Court, while upholding the Affordable Care Act, has ruled that states are not required to pass the Medicaid Expansion portion of the bill.

All Americans who meet certain income thresholds are required to purchase health insurance or face tax penalties by the IRS. Last year's penalty was $95. The annual fee for not having insurance in 2015 when income thresholds are met is $325 per adult and $162.50 per child (up to $975 for a family), or it's 2% of your household income above the tax return filing threshold for your filing status – whichever is greater.

Growth in Healthcare Spending Slowest on Record

Figures show that real per enrollee growth in health spending has shown the slowest growth on record according to figures from the Center for Medicare and Medicaid Services and the Bureau of Economic Analysis. The Center for Medicare and Medicaid Services administers those programs at the federal level while the Bureau of Economic Analysis provides economic data for the government.

For 2000-2007, the increase for private health insurance was 5%, as was Medicare. The increase for Medicaid was nearly zero. These numbers started going down before Obamacare was passed, meaning that these decreases are not entirely attributable to Obamacare For 2007-2010, the increases were 4% for private insurance and 2% for Medicare and 0% for Medicaid. Following the passage of Obamacare, these trends continued downward. For the period 2010-2013, private insurance increased by 1.5%, Medicare did not increase at all, while Medicaid showed a slight decrease. While the problems with the healthcare.gov website have been in the news, the real success of Obamacare will hinge on whether these trends accelerate or continue given that its stated purpose is to make healthcare more affordable.

Figures from the Presidents’ Council of Economic Advisors showed that the rate of increase for total national health expenditures was declining during the 2000-2007 time frame. From 1965 to 2010, total national health expenditures went up 4.5% annually. For the period from 2000 to 2007, that figure was 3.9%. For 2007 to 2010, the figure was 1.8% while for 2010-2013, that figure was 1.3%.

In a recent 25-page report about healthcare costs, the Presidents’ Council of Economic Advisors stated, “The evidence is clear that recent trends in healthcare spending and price growth reflect, at least in part, ongoing structural changes in the healthcare sector. The showdown may be raising employment today and, if continued, will substantially raise living standards in the years ahead.” Since the rate of healthcare increases is slowing or stopping, that will free up money for employers to hire more workers. Given the recent protests at Wal-Marts across the country, this could create even more pressure for Wal-Mart to raise wages.

But the slowing rate of increase is not being felt across the board. The City of Grant City paid 10% more this year for its health insurance plan for its employees, and alternatives were substantially higher or would have come with less benefits. A similar plan for the County of Worth would have cost tens of thousands of dollars annually. And some users who got into the healthcare.gov website have been offered more expensive policies than the ones they already have.

Committee rejects bill to expand Medicaid eligibility

By Meghan Boggess and Emily Donaldson

(MDN News) -- A Missouri House committee defeated a Democratic-backed measure to expand the state's Medicaid program Monday, Feb. 25, despite an overwhelming number of witnesses voicing their support at the hearing.

The bill, sponsored by Rep. Jacob Hummel, D-St. Louis, would have provided up to 300,000 more Missourians access to Medicaid. The committee defeated the measure in a 5-2 vote split along party lines.

Hummel said that if the state did not expand Medicaid, it would miss out on the federal funding allocated under the federal health care law.

"These are our dollars that we're sending to Washington that we need to bring back to the states," Hummel said.

Critics, however, argued giving more funding to the program would worsen the program's efficiency.

"Medicaid is a system that right now doesn't work...why are we going to take an additional 300,000 Missourians, and put them into a system that nobody believes works very efficiently to begin?" said Rep. Todd Richardson, R-Poplar Bluff.

But the Medicaid issue may not be dead in the House.

House Government Oversight Committee chairman Rep. Jay Barnes, R-Jefferson City, unveiled his own plan, which he called "market-based Medicaid."

The Associated Press reported that Barnes' legislation would expand the income eligibility for adults, possibly adding 180,000 people to the state's Medicaid rolls, but it would not cover all adults earning up to 138 percent of the federal poverty level, which is called for under the federal health care law.

The AP also reported that the bill cut eligibility for children by putting them on the same level as their parents, which would remove about 44,000 children from the rolls.

McCaskill Stresses Need for Greater Transparency in Medical Pricing

In a hearing of the Senate Commerce Committee this week, U.S. Senator Claire McCaskill praised recent progress in health insurance pricing transparency, but stressed that work remains to ensure that consumers are getting good information on the cost of surgery, treatment, and medical services.

“I’m a big believer that in the health care sector we need to unleash the American consumer,” McCaskill said. “We’ve got to figure out a way to make the consumer feel like they’re entitled to get better information about health care costs.”

Today’s hearing included witnesses from leading consumer and health policy groups, including Margaret O’Kane, President of the National Committee for Quality Assurance.

“It’s a mess,” said O’Kane, describing the difficultly of ascertaining the price of medical procedures.

The hearing examined how the Affordable Care Act’s Summary of Benefits and Coverage (SBC), Coverage Examples, and Uniform Glossary provisions have increased transparency in the health insurance market by standardizing and simplifying information used to purchase health insurance.  The SBC is helping consumers make “apples to apples” comparisons of health insurance plans.

“The health care law improved things a great deal, but we’ve got a lot more ground to cover to get consumers the information they need,” McCaskill said.

McCaskill was recently named Chairman of the Senate subcommittee with jurisdiction over consumer protection and product safety, and has served on the Senate Commerce Committee since joining the Senate in 2007.

Health care law allows consumers to easily find and compare options starting in 2014

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a final rule that will make purchasing health coverage easier for consumers.  The policies outlined today will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act. 

“The Affordable Care Act helps people get the health insurance they need,” said Secretary Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”

Today’s rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule released today also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.

A new report by HHS, also released today, details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans.

In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services.  The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways:

(1)   By including mental health and substance use disorder benefits as Essential Health Benefits
(2)   By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets
(3)   By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services

To give states the flexibility to define essential health benefits in a way that would best meet the needs of their residents, this rule also finalizes a benchmark-based approach. This approach allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan.  Twenty-six states selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest.

The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage.  Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.”  These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors.  In addition, the health care law limits the annual amount of cost sharing that individuals will pay across all health plans – preventing insured Americans from facing catastrophic costs associated with an illness or injury.
Policies in today’s rule also provide more information on accreditation standards for qualified health plans (QHPs) that will be offered through the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices.
Together, these provisions will help consumers compare and select health plans in the individual and small group markets based on what is important to them and their families. People can make these choices knowing these health plans will cover a core set of critical benefits and can more easily compare the level of coverage based on a uniform standard.  Further, these provisions help expand choices and competition on the Marketplaces.

Community leaders plan to deliver letters calling for Medicaid expansion

An organization of religious leaders and community activists -- the Missouri Medicaid Coalition -- presented lawmakers with more than 1,500 letters from concerned citizens.

The letters were delivered to the office of Rep. Sue Allen, R-Town & Country, on Thursday, Jan. 31. Allen serves as the chairwoman of the House Appropriations Committee on Health, Mental Health and Social Services.

Members of the coalition are calling for state lawmakers to expand Missouri's Medicaid rolls to provide coverage for 260,000 Missourians without health insurance, especially single parents and childless adults.

Retired Jefferson City Rev. John Bennett said that Medicaid expansion is a moral obligation for Missouri legislators. Bennett said his main concern lies with Missouri's uninsured children.

"There is overwhelming moral evidence that Medicaid expansion is necessary for Missouri," Bennett said.

At his State of the State address on Monday, Jan. 28, Gov. Jay Nixon touted the expansion as the right thing to do for the state. The Democratic governor also included funds for expanding Medicaid in his recent budget proposals. The Department of Social Services is looking at one of the largest percentages of budget increases with this new proposal.

"Providing health care for an estimated 300,000 more Missourians -- men, women and children -- who currently have no health insurance is the smart thing to do, and it's the right thing to do," Nixon said in a statement.

McCaskill Aims to Repeal Problematic Provision of Health Reform Law

U.S. Senator Claire McCaskill today made good on a pledge to make reasonable improvements to the Affordable Care Act, joining Republican Senator Tom Coburn (R-Okla.) to introduce bipartisan legislation to strike a problematic provision of the law.

McCaskill’s legislation would repeal a provision of the law that is causing states, including Missouri, to subsidize high wages at hospitals through Medicare reimbursements.

“This provision unfairly benefits some states to the disadvantage of others, like Missouri—it’s inefficient, and I’m happy to work in a bipartisan way to improve the health care reform law by repealing the provision,” McCaskill said. “I’ve consistently said that, whether you supported or opposed the Affordable Care Act, we can work together to keep improving and strengthening it as it’s implemented.”

As reported in the Boston Globe, Medicare rules stipulate that a state’s urban hospitals must be reimbursed for wages paid to doctors and staff at least as much as rural hospitals. A provision in the health reform law required that Medicare reimbursements for hospital wages come from a national pool of money, instead of from each state’s allocation. As a result, any increase for one particular state means a decrease for other states. This new provision has proved problematic.

Massachusetts has only one rural hospital—Nantucket Cottage—which therefore sets the floor for wage reimbursements in the state. While rural hospitals typically have lower wages than urban ones, wages at Nantucket Cottage are high because of the hospital’s remote location and high cost of living. Therefore, the rural wage floor established on Nantucket has become a boon for hospitals in the rest of Massachusetts. Nantucket Cottage’s rural designation has allowed the state’s 81 other hospitals to collectively reap hundreds of millions of dollars in Medicare reimbursements—at the expense of other states, like Missouri. Missouri alone stands to lose $15 million this year.

Only nine states come out ahead under the current system, while the remaining 41 states—including Missouri—are losing out on Medicare reimbursement funds.

The McCaskill-Coburn legislation will eliminate that provision in the Affordable Care Act, meaning states like Massachusetts will be responsible for bearing the burden of their own increased rural wage floor costs, instead of draining reimbursements meant for other states.

As a strong supporter of the Affordable Care Act, McCaskill has consistently supported efforts to improve and strengthen the legislation. In 2011, McCaskill successfully helped pass legislation to repeal a burdensome tax reporting requirement included in the health care law.

Letter to the Editor -- Business as Usual with Jay Nixon

To the Editor:
Late last month Governor Jay Nixon announced he would support an expansion of Missouri’s Medicaid program under ObamaCare. “[Expanding Medicaid is] the smart thing to do, and it’s the right thing to do,” he said.
Although one could describe Gov. Nixon’s announcement in many ways, “smart” and “right” would not appear in the parade of appropriate adjectives. Gov. Nixon doesn’t appear to have any plan to pay for the expansion, and he will be on his way out of Jefferson City when the new Medicaid costs begin to hit in earnest in 2017.
It fits a pattern. For decades, American politicians have feasted on the dangerous public misconception that Federal spending through the states is essentially free money. It’s not. Missouri taxpayers are also Federal taxpayers, liable for the debts that the Federal government incurs in their names. There’s no level of government cost splitting that can change the fact that Missourians, their children, and their grandchildren will have to account for this spending.
The move isn’t “smart” or “right.” It is, however, “business as usual,” and Missourians can’t afford that.

Patrick Ishmael
Policy Analyst, The Show-Me Institute
St. Louis

Gov. Nixon voices support for Medicaid expansion

By Matt Evans, Eric Stoyanov and Nick Thompson

(MDN News) -- Gov. Jay Nixon announced his support for expansion of the state's Medicaid program under the new federal health care law.

But his proposal for one of the state's largest Medicaid expansions in history came under immediate attack from top Republican leaders.

At a series of news conferences across the state, Nixon pointed to the federal law that would provide full federal funding for the health care coverage of up to 300,000 recipients for the first three years.

After that, however, the state would have to begin picking up a part of the expense at a cost to the state's budget estimated to exceed $100 million per year.

Republican critics, including the House Speaker and lieutenant governor, argued the state could not afford that cost. Nixon, however cited a University of Missouri study that predicts more than 24,000 jobs can be created in 2014 if the state takes part in the expansion.

While Republicans criticized Nixon's welfare expansion proposal, a slight opening emerged for agreement.

The Republican-leaning Missouri Chamber of Commerce endorsed the expansion, and the Senate's Appropriations Committee chair said he wanted to wait on a decision until he got more information from the administration.

"We support the expansion," chamber spokeswomen Karen Buschmann said. "While we do not support the Affordable Care Act, we are supporting this expansion as part of it. It is the law of the land. We do not feel that we should leave the federal money on the table."  

Under the Affordable Care Act, states must expand the Medicaid program to cover people with incomes below 138 percent of the federal poverty line. In upholding the federal law, The U.S. Supreme Court gave states the option to expand the program or not.

Under the expansion proposal, the federal government would foot the bill of expanding the program for the first three years. In 2017, the state would pay 5 percent of the costs and by 2020 the state would pay up to 10 percent.

"Congress passed it, the President signed it, the U.S. Supreme Court upheld it. It is the law of the land," Nixon said during his series of news conferences in St. Louis, Kansas City and Springfield.

Nixon's Republican critics charged the governor was expanding the state's largest welfare program, which already costs Missouri $8 billion a year.

"Overwhelming majorities of the legislature are opposed to this and will not go along with a gigantic expansion of welfare," Republican Lt. Gov. Peter Kinder said. "I think those that do support it in the legislature are overwhelmingly outnumbered and that it will not come to a vote in either the House or the Senate."

House Speaker Tim Jones, R-St. Louis County, could not be reached for comment but said in a statement that he is concerned where the funding will come from for the Medicaid expansion.

"Now is not the time to put our state on the end of yet another big-government program that will only increase the burden on future taxpayers," Jones said.

A study commissioned by the Missouri Hospital Association and the Missouri Foundation for Health predicts as many as 220,000 Missourians would be eligible for the expanded program. Other studies, however, project as many as 300,000 people would be eligible in the state.

According to the University of Missouri study, the federal government would pay about $8.2 billion through 2019 while the state would spend about $332.9 million and about $100 million per year after 2019 to cover new enrollees. A report released earlier this week by the Kaiser Family Foundation and Urban Institute projected the federal government's cost at $17.8 billion and with the state's share at $1.6 billion from 2013 to 2022.

Missouri hospitals are also advocating for the expansion, citing losses in federal payments that reimburse hospitals serving large numbers of low-income patients.

A provision of the federal health care law cuts Disproportionate Share Hospital Adjustment Payments (DSH) in half by 2020. Those federal payments go to hospitals that treat large numbers of low-income patients without health coverage. Missouri received the seventh highest DSH funding in the country in 2011.

Dave Dillon, a spokesman for the Missouri Hospital Association, said Missouri hospitals provide $1 billion worth of uncompensated care in any given year.

Dillon said without the expansion, some Missouri hospitals may suffer when the reimbursement payments are cut. The expansion would allow those low-income patients without insurance to enroll in Medicaid, making DSH payments obsolete.

"If they disappear or are substantially reduced and we don't see an increase in Medicaid, or folks enrolling in an exchange, the hospital and health care infrastructure in the state will be significantly hurt by this," Dillon said.   

A Moment with Mike -- Dealing with Obamacare

With the 97^th General Assembly ready to convene in just a little over a month, the topics and issues that will be at the forefront are starting to emerge.   The new Speaker of the House, Tim Jones has indicated that his priorities are economic and job development, energy policy and education reform.  These are topics that are consistently debated and will continue to be relevant.  However, other important issues that could seriously affect our precarious budget situation and the future of our state may rise to the top.

      The Affordable Care Act which we all refer to as Obamacare was upheld by the Supreme Court of our land.  This act will have extreme consequences on some individuals, businesses and, of course, state and federal budgets.  We have already discussed the implications of creating a Health Care Exchange which will soon be required of all states.  Our Governor has already indicated that the state would not create an exchange and the people recently voted to only create one with the approval of the legislature or the people.  This means that the federal government will probably be creating some type of exchange in Missouri and the cost which will come from our taxes is only a guess at this time.

      The Supreme Court ruling did give each state the option to accept federal funds to expand Medicaid to those that earn up to 138 percent of the federal poverty level.  The Governor has come out in favor of this expansion and hospitals and primary care associations are leading the charge for this expansion.  Advocates say that this will not only provide health care for an estimated 300,000 people, but it will create jobs and increase the state and local tax revenues to help cover the costs.  The federal government will cover the costs for the first three years and then the state will gradually start paying a small percent and work its way up to ten percent after eight years.   Health care providers have already seen reduced payment for Medicaid patients and are looking to this expansion to help make up these losses when expansion would kick in.  They say that if the state does not enact this expansion that there will be providers that will no longer see Medicaid patients or possibly go out of business.

      There is another side of this, however, that we must consider before jumping into another federal government backed  assistance program, many of which are major contributors to an insurmountable national debt and have encumbered state budgets for years.   Health and welfare programs are already the biggest budget items for the state and far outpace the spending that we provide to educate our kids.  The huge amount of federal money, of course, is paid by your taxes and the amount that the state will eventually pick up is estimated to be well over $300 million, an amount that will expand every year.  This past budget year, with no change in eligibility, Medicaid costs went up $189 million.  How we come up with this kind of money when our state workers are the lowest paid in the nation, our education funding is hundreds of millions of dollars behind, the department of transportation is desperate for funds and we are very slowly crawling out of a recession raises a big question. 

      At this point our new Senate President Pro Tem and our Speaker of the House indicate that they will not support this expansion but will continue to look at the options that we have to deal with the numerous requirements and expenses of the Health Care Act.  We must act to do what is best for the people of our state but we must also live within our means, a concept that our federal government has not considered.

          If you have questions, you may reach me at my Capitol number 573-751-9465, at the local district number, 660-582-4014, by email at mike.thomson@house.mo.gov or by mail at Room 401B State Capitol Building, Jefferson City, MO 65101.

Missouri running out of time to decide on expanding Medicaid

Linda Spence is a 63-year-old full-time student at University of Missouri-Kansas City. After losing her job as a Program Director on the campus of UMKC, she has no health insurance because she does not qualify for Medicaid.
After the US Supreme Court ruled it unconstitutional for the federal government to force states into expanding their Medicaid coverage, Missouri now has a choice of whether or not to expand Medicaid for people like Linda Spence.
The Federal government will pay 100 percent of the financial burden imposed by Medicaid expansion for the first three years, but starting after the initial grace period, Missouri would start to become responsible for some of the cost. Starting in 2017, Missouri would be responsible for five percent of the cost in 2017 and 10 percent starting in 2022, according to state officials and advocacy groups.
Spence said she takes advantage of a discount at Truman Hospital for people with lower incomes. She said not many people know about this discount, and people who want it must apply for it. Spence also said without this discount, she would have no way of obtaining any kind of regular health care. She also said that not having insurance can affect the quality of health care she is able to receive.
"If I were able to qualify for something like Medicaid, granted I would have to qualify for it, but at least I would know it was something a little bit more guaranteed. I might have access to other physicians other than going through Truman. Maybe I would be able to choose my own doctor, for example. Go to specialists of my choosing, instead of just specialist that are available," said Spence.
A major concern legislators have with expansion is that it could take away a lot of funding from other areas of the budget, namely education.
"When you're looking at increases of potentially 100 or 200 million dollars that you have to find because of expansion, there is only one place where there is a pot of money big enough to take that, and that is public education," said Senate Appropriations Chair Kurt Schaefer, R-Columbia.
Schaefer said that there is no way around public education funding taking a hit with the Medicaid expansion, and if the true cost, is too detrimental to education then he would not be in favor of expansion.
Sen. Rob Schaaf, R-St. Joseph, thinks Missouri would have to pull funds from a diverse group of areas to fund expansion.
"I know from my experience as a legislator, that anytime one program absorbs up a bunch of resources, they try to spread the pain around everywhere else. So it isn't just education, every other program would suffer," Schaaf said.
Schaaf said Missouri does not have an obligation to use tax dollars to give able-bodied adults health care.
"We already take care of kids, and we take care of the disabled, and we take care of the elderly. These people are able-bodied, and it would be wrong for us to give them free health care and put them on Medicaid, and expect other working adults to pay for them," Schaaf, a licensed physician,  said.
For a single parent with one child to receive Medicaid under the current coverage in Missouri, their annual income would need to be less than $2,809.00, according to the Missouri Foundation for Health. The new program, should it be implemented in Missouri, would allow anyone at 133 percent of the federal poverty line to receive Medicaid. That covers a higher percentage of the poverty line than is currently afforded to people

Health care law delivers higher payments to primary care physicians

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the final rule implementing the part of the health care law that delivers higher payments to primary care physicians serving Medicaid beneficiaries.  The new rule raises rates to ensure doctors are paid the same for treating Medicare and Medicaid patients and does not raise costs for states.
“The health care law will help physicians serve millions of Americans across the country,” Secretary Sebelius said.  “By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones.”
The final rule implements the Affordable Care Act’s requirement that Medicaid pay physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels in Calendar Years 2013 and 2014.
This payment increase goes into effect in January of 2013.
In addition to payment improvements, the health care law includes numerous initiatives designed to bolster primary care and strengthen the primary care workforce, including an expansion of medical residency positions for primary care physicians, new investments in physician assistant and nurse practitioner training, and an unprecedented expansion of the National Health Service Corps, which provides scholarships and loan repayments to primary care providers who practice in underserved areas.

For more information about today’s final rule visit:http://www.cms.gov/apps/media/fact_sheets.asp
To view a copy of today’s final rule visit: www.ofr.gov/inspection.aspx

Rep. Casey Guernsey -- Heartland Hospitals in St. Joseph to Lose $300,000 Annually to Obamacare

On June 28^th, the United States Supreme Court upheld key provisions of Obamacare. As a result of a portion of the ruling, Missouri must decide how to implement a healthcare exchange. We've already seen the impact of Obamacare on Medicare with the major loss of dollars to our local hospitals as it came to light over the last month. For example, Heartland Hospital in St. Joe which provides healthcare for all of Northwest Missouri is slated to lose over $300,000 a year because of cuts to Medicare in Obamacare. That is why we must be deliberate and careful how we create an exchange.

So what does this mean for the future of healthcare in Missouri, and what are we going to do about it? Those questions are what makes 'Prop E' on the ballot in November so very important. This initiative, if passed, ensures that the legislature creates our state healthcare exchange - not the Governor. I believe this is fundamentally important because of the public debate and the deliberate, calculated committee process we use to write laws. It is always better when the public knows what is going on through lawmaking rather than an executive order by a Governor. The legislative process ensures accountability. We saw what Governor Nixon's intentions were this year as it relates to Obamacare when he snuck a $50 million Medicaid expansion line item in his budget. He was trying to begin implementation of Obamacare thru Medicaid expansion as our state healthcare exchange. Fortunately, we in the budget committee caught on to his scheme and tossed out his entire unbalanced budget. Not only did he try to cut higher education by 10%, but he was also trying to implement Obamacare without telling anyone! Now I hear on the radio he takes all kinds of credit for signing the legislature's balanced budget. It must be nice to be able to take credit for other people's hard work. I'm expecting a thank you note from the Governor any day now....

The most significant other aspect of this decision was that the Court ruled the federal government could not punish states which choose not to use Medicaid as the state's healthcare exchange. During the public debate concerning Obamacare, little attention was made to the tremendous cost shift from the U.S. government to Missouri provided in this law. In order to reduce the projected cost of this legislation, President Obama and Congress tried to mandate that Missouri pay a large portion of the additional cost associated with the expansion of Medicaid - the federal and state health insurance program for the poor. Even with this accounting trick, the projected cost of this legislation has sky rocketed since its passage. According to the nonpartisan Office of Management and Budget, the projected cost of Obamacare has tripled since its original adoption. TRIPLED, folks!! This is why Governor Nixon's attempt to use Medicaid as our exchange was so very wrong.

In Missouri, we estimate this law will cost Missouri taxpayers from $300 to $600 million in the first year if we accept it. Missouri has a general revenue budget of almost $7 Billion and can ill-afford this cost. Accepting such additional cost for Missouri would not be possible without drastic cuts in the budget or an increase of taxes. I certainly oppose an increase of taxes, particularly in these difficult economic times. In 2010, 71% of Missouri voters rejected Obamacare in a statewide vote on Proposition C. We need to see a similar percentage on Prop E, and I would strongly encourage everyone to support it. Writing a healthcare exchange will be incredibly important.  We have to get the best possible version and I truly believe this is only possible through the legislature.

It is an honor to serve as your Missouri State Representative, and I do appreciate your input on matters of importance to you, your family and community. Please feel free to contact me at 573-751-4285 or casey.guernsey@house.mo.gov. Thank you for taking an active role by voicing your opinions on our state and national governmental matters.

Proposition E puts health care exchanges on the November ballot

(Missouri Digital News) -- Although the U.S. Supreme Court has already affirmed the constitutionality of the federal health care law, Missouri voters will get to cast ballots in November on another of the law's key components -- insurance exchanges.

Passage of Proposition E on the November ballot would prohibit Gov. Jay Nixon or any state agency from setting up a health insurance exchange without the approval of the legislature or the state's voters.  

A health insurance exchange is a web-based marketplace for consumers to compare insurance plans. The exchanges are a central part of the federal health care law passed in 2009. They are intended to create competition to help individuals and small businesses purchase insurance to comply with another part of the law that mandates most people own health insurance.

Nixon has said that his administration would not move to set up an insurance exchange by decree. But conservatives say they want to make sure the Democratic governor is barred from doing so if he wins a second term, especially after the U.S. Supreme Court upheld the law in a 5-4 decision on June 28.

The Supreme Court's ruling, however, makes it nearly certain that the requirement for health care exchanges will take effect unless congressional Republicans repeal the law.

That has groups who supported the law, such as Missouri Health Care for All, arguing that Missouri should simply prepare its own exchange.

"Prop E is really just an attempt to continue to use health care reform for political gain because there's really going to be no practical effect because health reform, the Affordable Care Act, is the law of the land," said MHCA President Susan Talve, a St. Louis rabbi, in a telephone interview.

HHS -- Medicare Advantage remains strong

Enrollment in the Medicare Advantage (MA) program is projected to increase by 11 percent in the next year and premiums will remain steady, Health and Human Services Secretary Kathleen Sebelius announced today. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent.

"Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries," said Secretary Sebelius. "Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities."
For the third year in a row, the Centers for Medicare & Medicaid Services (CMS) used authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits. Access to supplemental benefits remains steady and beneficiaries’ average out-of-pocket spending remains constant.
The average MA premium in 2013 is projected to increase by only $1.47 from last year, coming to $32.59. However, if beneficiaries choose lower cost plans at the same rate in 2013, as they did in 2012, the average premium is expected to increase by only 57 cents. Access to the Medicare Advantage program will remain strong, with 99.6 percent of beneficiaries having access to a plan. Additionally, the number of plan choices will increase by 7 percent in 2013.
Last month, CMS announced that the average estimated basic Medicare prescription drug plan premium was projected to be $30 in 2013, holding steady from last year. Today's projections show that access to a Medicare prescription drug plan will remain strong in 2013. Everyone with Medicare will have access to a wide range of plan choices.
As a result of the Affordable Care Act, coverage for both brand name and generic drugs in the Part D donut hole coverage gap will continue to increase until 2020, when the donut hole will be closed. This year, people with Medicare received a 50 percent discount on covered brand name drugs and 14 percent coverage of generic drugs in the donut hole. In 2013, Medicare Part D’s coverage of brand name drugs will begin to increase, so people with Medicare will receive approximately 53 percent off the cost of brand name drugs, and coverage for 21 percent of the cost of generic drugs, in the donut hole.
Since the law was enacted, 5.4 million people with Medicare have saved over $4.1 billion on prescription drugs in the donut hole. An estimated 37 million people with Medicare received a preventive benefit free of charge in 2011.

Senate Votes to Override Governor’s Veto of Religious Freedom Act

(Missouri Digital News) -- The Missouri Senate voted 26-6 Wednesday to protect the religious freedom of all Missourians by overriding the governor’s veto of Senate Bill 749.  Sponsor Sen. John Lamping, R-Ladue, said the bill was filed in direct response to President Obama’s mandate under the federal Affordable Health Care Act that forces employers to offer health care services even if those services are against their religious beliefs or moral convictions. 

“This is not an issue about access,” said Lamping.  “All employees still have access to these services.  This is an issue about who pays for them.”

Under current law, employers are not required to offer health care coverage for employees.

A number of employers have announced their intent to discontinue health insurance coverage for their employees as a result of the federal government’s mandate. 

“The stories we are hearing of businesses that are considering dropping their insurance coverage rather than violating their beliefs are alarming,” said Senate Majority Floor Leader Tom Dempsey, R- St. Charles.  “This veto override was extremely important, because it gives employers the option to continue to provide health care benefits without being forced to pay for something that goes against their religious beliefs or moral convictions.”

SB 749 passed the General Assembly during the regular legislative session, only later to be vetoed by the governor.  In order to override the veto in the Senate, 23 votes were needed.  The House also took up and overrode the governor’s veto, so the bill becomes law effective immediately. 

Senate Leader Robert N. Mayer, R-Dexter, added, “Religious freedom is the cornerstone of America.  It is important we protect Missourians from the federal government infringing on our First Amendment rights.  By overriding this veto, we are keeping government out of our businesses and from telling religious organizations they must violate their beliefs to fulfill this mandate.”