Another reason to expand Medicaid limits in Missouri

Staggering cost of caring for uninsured patients in Missouri

By Barb Shelly / The Kansas City Star.com
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Adding to the case in favor of expanding Medicaid limits, the Missouri Hospital Association announced today that in 2011, for the first time, the cost to hospitals of caring for uninsured patients topped $1 billion.

The $1.1 billion tab was 22 percent higher than what hospitals acquired in 2010. Of the 2011 amount, $622.8 million was charity care provided by the association’s 129 participating hospitals. The remaining amount was bad debt.

Hospitals are currently able to recoup some of that amount from the federal and state governments, which pay “disproportionate share” compensation to hospitals which serve high numbers of poor and uninsured patients. But those payments are expected to be phased out under the Affordable Care Act as more people gain insurance either through new state marketplaces or from expanded Medicaid limits.

The hospital association anticipates that Missouri hospitals will lose $3.3 billion in disproportionate share payments through 2020. They will still have to care for uninsured sick people in their emergency rooms, however. Financially, that’s an impossible scenario.

The answer is for the Missouri legislature to raise Medicaid limits to the level called for in the Affordable Care Act, 133 percent of the federal poverty level.

Missouri currently only covers adults who earn up to 19 percent of the poverty level. That’s a salary of just more than $4,000 a year for a family of four. An expansion to 133 percent would put 200,000 to 300,000 Missourians under the Medicaid umbrella. The federal government would pay 100 percent of the cost the first three years and not less than 90 percent after that.

With the ability to see a doctor regularly, fewer people would end up in hospital emergency rooms. Those that do arrive there would be more likely to have insurance.

Gov. Jay Nixon is pushing for the Medicaid expansion and says he will account for it in next year’s budget. Republicans in the legislature are holding out, with some saying they won’t even consider it. If they stick to their guns, they’d better start considering the prospect of hospitals in Missouri shutting down for lack of money to care for uninsured patients.