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Opinion: Missouri’s Medicaid system is broken, so why expand it?

   

In an article in Forbes written just last month, Adam Millsap notes that Missouri was in the top five states for Medicaid spending as a percentage of state revenues in 2017. Medicaid comprised 25 percent of our general revenues during that year and made us the only non-expansion state in the top five of this category among the likes of New York, Rhode Island, Pennsylvania, and Louisiana. In the current Fiscal Year of 2019-2020, Medicaid costs are still projected to comprise 23 percent of general revenues and total $10,110,992,996 (according to the Budget Fast Facts from the House of Representatives). This means less funding for schools, teachers, roads, bridges, state employees, and correctional officers. 

A rapid response report published in February 2019 by the Department of Social Services (DSS) concluded that Missouri Medicaid spending could exceed 30 percent of state general revenues in an economic downturn and suggested several areas of cost improvement focusing on the state’s outdated payment methodologies. Indeed, the state spends $177,000,000 on payments to non-Missouri residents, $160,000,000 on hospital readmissions, lack of prior authorization for high-cost outpatient procedures, and more. The path to fiscal sustainability and healthy low-income residents is to reform these outdated payment methodologies that DSS uses today. The Show-Me-Institute, a not-for-profit think tank based in St. Louis, concurred, in their October testimony before the House Subcommittee on Health Care Reform, that reforms are needed, stating that “there are numerous ways to improve Missouri’s Medicaid program and health care landscape that don’t include expansion. Missouri’s current program struggles to contain costs and … to improve the health outcomes of its recipients.”

In his State-of-the-State address, Governor Parson called Medicaid Expansion a “massive tax increase” on hard-working Missourians. Indeed, this is what expansion would amount to, as taxpayers will bear the burden of the program’s additional costs. Missouri’s Medicaid system needs to work for its lowest-income residents, and the best way to achieve that is to reform, not expand, the current system. It is up to the General Assembly to pass SJR 60, sponsored by Senator Tony Luetkemeyer, and inform voters of the true costs of Medicaid expansion.