Missouri made the correct decision to pass on Medicaid expansion. Expanding an already broken program would force taxpayers to spend even more money on an unsustainable program and force state leaders to cut spending on other important public services like education, public safety, and transportation. This was true even before the COVID-19 pandemic wreaked havoc on Missouri’s budget.
I was stunned to read recent op-eds from Missouri Republicans asserting Medicaid expansion is both “fiscally” and “morally” needed in Missouri. I wholeheartedly disagree. Missouri voters need to carefully study this issue before voting on a measure that would force increased state spending on a broken health care program, resulting in less money for education and other vital public needs.
Medicaid expansion does not fiscally or morally make sense, as the cost of expanding this program is significant. Even with the federal government covering 90 percent of the costs of newly eligible enrollees in 2020, the cost to the state is still huge. Missouri already spends nearly 40 percent of the state’s operating budget on Medicaid, and this spending would only increase if the state expanded Medicaid. Missouri does not have an unlimited pool of tax dollars, and since the state must balance its budget, cuts would have to be made to education, public safety, and transportation to meet the new state spending requirements. A 2019 report from the Department of Social Services estimates Medicaid costs increasing up to 30 percent of state general revenues, or 44 percent of the total operating budget, by 2023 without Medicaid expansion.
Expansion supporters cite a flawed study in their drive to open up the state’s Medicaid program to able-bodied working adults. It’s important to remember our current Medicaid program is failing to serve its intended recipients. The cited Georgetown study calls attention to Michigan, Montana, Louisiana, Colorado, and Virginia as states that expanded Medicaid and have seen no additional costs to their state. However, reports touting the beneficial impact of Medicaid expansion don’t always tell the whole story. Some states, such as Michigan, Ohio, and Kentucky, expanded Medicaid but actual enrollment far exceeded expectations, leaving these states with huge growth in Medicaid spending. Michigan, along with other states concerned with the growth in Medicaid spending and its programs’ sustainability, implemented work requirements for able-bodied adults.
Pro-expansion supporters continue to lie to Missourians when they claim our state is giving up federal expansion dollars to other states. This argument is false. A state that chooses not to expand does not give up a sum of money that then becomes available to other states. Missourians are also federal taxpayers. States that choose not to expand also choose not to contribute to the almost $25 trillion of the national debt. Medicaid expansion does not aim to take better care of the most vulnerable. The goal of expansion is to open up the program to a new population of able-bodied, working-age, childless recipients. Oregon is proof expansion does not result in improved care. Two years after the original Oregon study results were released, participants still showed no improvement in measurable health outcomes.
Instead of expanding, Missouri should reform the state’s Medicaid program to better serve its current recipients and to protect the interests of Missouri taxpayers. Earlier this year, Missouri’s Show-Me Institute put forth a study with reasonable recommendations to improve our health care system.
State leaders should consider transitioning to a fixed payment structure to ensure our state gets the most value for every dollar spent on Medicaid services. Missouri also needs to implement a value-based approach to provide high-quality care at a lower cost. We can increase access to health care, especially in rural Missouri, by removing regulatory barriers like the Certificate of Need program, which makes it harder for rural providers to expand or purchase new medical equipment needed to care for rural residents.
Missourians need better, more affordable health care, but opening up the program to a new class of childless, able-bodied working adults is not in the best interest of the state.
State Rep. Mike Moon represents the majority of Lawrence County (HD 157) in the Missouri House of Representatives. He was first elected in a special election in April 2013.