Missouri Governor Jay Nixon wants to expand Medicaid coverage in the state. Under the Affordable Care Act, states can voluntarily choose whether or not to expand the public health insurance program for low income individuals.
Regardless of if states expand Medicaid, the Affordable Care Act will cut federal payments to hospitals. The Missouri Hospital Association estimates this could result in up to 4 billion dollars in lost funds for Missouri hospitals.
KRCU’s Jacob McCleland asked Governor Jay Nixon how this plays into his calculus for deciding whether or not to expand Medicaid.
Nixon:
I think it all all plays into a complicated but important issue here which is, are we going to have Missourians pay $1.8 billion a year in taxes that go to Washington? Are we going to get those dollars back to Missouri to use to improve healthcare, healthcare opportunity, healthcare outcomes? Or are we going to leave that money in other states? And so I think that there are a number of complicated, potentially complicated provisions here.
The focused rubric here is that we can cover 300,000 more people with this 100% federal dollars for three years instead of having to spend it in other states. I think there’s a strong business case to be made for that. That’s why we’re working with the Missouri Chamber and associated industries and other local Chambers that have been very, very helpful here to make the strong case that now is the time to accept these federal funds, help improve our healthcare system, and move the state forward.
McCleland:
What would be the impact for rural hospitals in places like southeast Missouri or the Ozarks?
Nixon:
It’s especially important hospitals because, as you said, the way the bill is set up some of what are called disproportionate share dollars are going to begin going away because those are designed to help local hospitals cover the costs of uninsured. And when you move the insured number up then they’ll back off on those dollars. So standing still will actually cost the state hundreds of millions of dollars and hit hardest in those local rural hospitals.
We see that moving forward, and I think business groups around the state are also seeing that moving forward with these federal dollars gives us a better chance to keep that robust healthcare system we have out there with many local hospitals operating to give people access to the needed care that they have.
McCleland:
So the federal government will cover the expansion for the first three years, but then will decrease their contribution after that. How will this work? Will Missouri end up paying the full cost eventually?
Nixon:
No. The bottom line is it phases out into the state share it’s at 90/10. Ninety percent federal and ten percent state at the back end, five years after the first three years.
It’s important to note that right now the Medicaid system that we operate under is 60 percent federal and 40 percent local, 40 percent at the state level. So this is a much more enhanced match for us, and quite frankly, for many of the services, especially in the mental health area that we currently provide either 100 percent or 60/40, to be able to have them paid for by the federal government at this higher mathc will free up general revenue dollars that we can then expend on education, on law enforcement and other important things in the state while holding the line on taxes.
McCleland:
The Missouri Chamber of Commerce and the Missouri Hospital Association are both on your side with this, but who really need on your side is Republicans in the state House and Senate. How do you plan to win them over?
Nixon:
It’s interesting. As we move further away from the, what was a binary choice during the election, you know, are you for it or are you against the whole thing and not a lot of focus on the details, we’re seeing across not only Missouri but across the country, this take on kind of a post-partisan analysis as opposed to a partisan.
Just in the last week, Republican governor John Kasich of Ohio has put this in his budget. Also this week Republican governor Rick Snyder has put it in his budget. Two week ago, Republican governor Jan Brewer put it in her budget. So we’re seeing a clear movement, once the numbers are on the table, once you see that Missourians have to pay taxes and it’s important that we get those dollars back, that we can use them here locally so that we can get the healthcare reforms we want locally rather than sitting around and waiting on Washington, DC, we’re finding movement in other states. I’m certainly finding some good movement here in the state of Missouri, but we’re still on the education process as we work through to answer these questions to make this important choice for the future of Missouri.
McCleland:
We’re talking today with Missouri Governor Jay Nixon. Thank you so much for your time. It’s been a pleasure.
Nixon:
Absolutely.
NOTE: This is a partial interview with Missouri governor Jay Nixon. The rest of this interview will be posted at a later date.
