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Cost takes centerstage at House hearing on Medicaid expansion


JEFFERSON CITY, Mo. — In a nearly four-hour-long hearing, numbers became the centerfold of the discussion on Medicaid expansion

Increasing the number of Missourians on MO HealthNet rolls, the state’s health insurance program, could blow a hole in the budget or it could save the state millions — depending on who was offering the testimony. 

The House Subcommittee on Health Care Reform got underway Tuesday for its third interim hearing, this time with Medicaid expansion — a question likely to be poised to voters in 2020 — as the topic of discussion. 

“Medicaid expansion throws gas on an already out of control fire,” Greg Fister, with the Florida-based Foundation for Government Accountability, told the committee. “The federal government is setting up a system where the truly needy are the first on the chopping block.” 

He urged lawmakers to “learn from the states before” Missouri. Fister argued the high cost of Medicaid expansion would limit already limited resources, and in order to balance a budget, funding for teachers, police officers, roads, and such will be cut. 

On the other hand, several others testified the fringe benefits would outweigh the costs — such as helping struggling rural hospitals and saving lives.

When it came to hard numbers, economist Abby Barker, from Washington University, offered the most — and least — concrete numbers.

According to a report issued in February 2019, which she authored, the state could save $95 million in a best-case scenario or spend an additional $42 million in a worst-case scenario. A moderate estimate would be revenue-neutral, Barker testified. 

Using information from other states that have expanded Medicaid, the report estimated the cost and growth of MO HealthNet with altered eligibility requirements. An additional 231,000 adults and 40,000 children in Missouri would qualify for state rolls, the report estimated. The increased enrollees would cost an estimated $1.2 billion, of which Missouri’s share would be roughly $118 million. The federal government would cover the other 90 percent of the cost. 

But, the state would find savings elsewhere, the report said. With some members of the population enrolling through expansion, instead of traditional Medicaid, the state would end up shelling out less money in those instances — saving the state $17 million in one instance, $56 million in another, and $31 million in another. 

“Essentially, the punchline is … the offset in savings we can tap into,” Barker said. 

The study only looked at the expansion based on the state’s Medicaid budget. 

“I don’t know if [expansion] is being funded on our children’s back with debt,” Rep. Steve Helms, the subcommittee’s chairman, questioned.

He expressed hesitancy over the idea, noting that it could make the state more reliant on the federal government and that taxpayers are footing the bill whether its state or federal money.

Expansion would open up MO HealthNet to folks 19 to 64 years old with an income level at or below 133 percent of the federal poverty level. The income benchmark would be less than $18,000 a year for an individual or $30,000 for a family of three.