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Opinion: Fix Medicaid now before it sinks Missouri


What comes next? That is the question our state has to ask since voters approved a constitutional amendment to expand Medicaid under ObamaCare in our state.

Expanding Medicaid means that our state will have to invest millions of dollars more that we do not have into the Medicaid program. State programs are going to get cut. Some have estimated that we will see a shortfall of $200 million, which is going to have to come from somewhere, which likely means K-12 education, higher education, and infrastructure will have their money taken to go toward funding Medicaid expansion.

I cannot deny that increased Medicaid spending is helpful to hospitals, even those in our area. I also know that the federal government will reimburse 90 percent of these costs. However, we don’t know that the reimbursement will remain at those levels, and what a lot of politicians and bureaucrats forget is that those are our tax dollars, regardless if they come from the state or federal government. We are taking from productive citizens to pay for this program and it isn’t sustainable.

We also will see individuals who are already insured who will drop that in order to take advantage of a “free” product. This is known as “the woodwork effect” and could cause costs to skyrocket beyond the $200 million.

This kind of budget crisis is exactly the reason why I opposed Medicaid expansion in Missouri. I think that our state will face a wrecked budget without any real improvements in our health care system, and other vital programs will suffer because of it.

It’s the job of the legislature to get Medicaid expansion right — that means keeping costs low, providing the best care we can, and making sure that the market doesn’t suffer. I don’t see any path in trying to repeal or overturn Medicaid expansion, given it’s enshrined in our state’s constitution. Now is the time for the legislature to come together and formulate real solutions to try and make this as painless as possible.

We need to be realistic about Medicaid expansion. Our state’s resources are scarce, which means there needs to be reform as soon as possible. As a state senator, I will be looking for ways to implement some market principles to introduce choice, competition, and stop health care costs from rising. In doing so, we can lessen the impact on our state budget. This may include capping the reimbursements hospitals receive for Medicaid patients; this will also help level the playing field for reimbursements to hospitals in urban versus rural areas. Currently, some hospitals are paid triple the amount of reimbursement in an urban hospital versus a rural one.

Unfortunately, legal challenges to Medicaid expansion will not work. It was passed as an amendment to our constitution. It will just delay the only path forward that I can see: We need to fix Medicaid now before it sinks us.

I know there is a temptation to use the courts as a last resort to block a measure that could be disastrous, but I do not see any grounds for that to be successful. The ballot language and measure were approved by voters, and now Medicaid expansion is in our constitution. There’s no way around it. Missouri is now saddled with the millions of dollars in obligations under expansion.

One way to mitigate the cost of Medicaid is to try and implement pro-market reforms that encourage competition and choice in the health care market. I sincerely believe that where businesses have to compete for the business of consumers, then costs go down and quality of service improves.

I hope to see market reforms to Missouri’s MedEx program that provides the most bang for the taxpayer’s buck. I would also like to see a measure of responsibility for costs incurred assigned to the Medicaid population. Just as other consumers have responsibility for their choices, so should Medicaid recipients learn that everything has a cost. Better choices lead to cost savings.

Regardless of your stance on the Medicaid expansion, it is clear that there needs to be reforms to the current system. The burden is on us, the representatives and senators of the people, to be stewards of Missourians and ensure that the roll-out of Medicaid expansion does not break the bank. I take that role very seriously, which is why we can expect a push for overhauling Medicaid come the new legislative session.