Under a Supreme Court ruling this year, each state can decide whether to enact the Medicaid expansion authorized under the Affordable Care Act, also known as Obamacare because of President Barack Obama's support of it. The federal government pays the full cost starting in 2014, but states must begin paying a 5 percent share in 2017 that gradually increases to 10 percent by 2020.
The Democratic governor says he will "work tirelessly" to persuade the Republican-led Legislature to approve the Medicaid expansion. Republican leaders are concerned about its future cost to the state, and started criticizing Nixon as soon as he made his announcement.
Republicans say neither Missouri nor the nation can afford it. Lt. Gov. Peter Kinder says the Medicaid expansion would be "ruinous." House Speaker Tim Jones called it a "big-government program" that would "increase the burden on future taxpayers." Senate leader Tom Dempsey says Nixon's plan is "very unlikely" to pass.
Republicans will face pressure from medical organizations and business groups over their opposition.
A study released Wednesday by the Missouri Hospital Association said expansion of Medicaid eligibility would create tens of thousands of jobs for Missouri, in addition to providing hundreds of thousands of Missourians with health care insurance.
In the counties of Christian, Dallas, Greene, Polk, Stone, Taney and Webster in southwest Missouri, the report says, expansion of Medicaid would create 2,043 jobs in 2015, income to employees of nearly $586 million, and generate $206 million in taxes between 2014 and 2020. The report has similar numbers for all other areas of Missouri.
The Missouri Chamber of Commerce and Industry, traditionally a supporter of Republicans, also favors an expansion of Medicaid. The chamber says it would bring $8.4 billion in federal funds to Missouri through 2019.
Cost estimates have varied. The report by the Missouri Hospital Association and the Missouri Foundation for Health estimates a Missouri Medicaid expansion would cost the federal government $8.2 billion and the state $333 million between 2014 and 2020. A report released this week by the Kaiser Family Foundation and Urban Institute projected the federal government’s cost at $17.8 billion and the state’s share at $1.6 billion from 2013 to 2022.
Either way, the federal government will pay most of the bill.
“If we take a pass on billions of health care dollars -- dollars that come out of Missourians’ paychecks -- that money will go to some other state. They’ll get the benefit, and we’ll get the bill,” Nixon said in a conference call with Capitol reporters. “That’s not smart, and that’s not right.”
Nixon highlighted his support for the Medicaid expansion at news conferences at medical centers in Kansas City, St. Louis and Springfield on Thursday.
Nixon said the Medicaid expansion could provide health care coverage to an additional 300,000 state residents. But those estimates have varied.
The hospital association’s report estimated an additional 161,000 people would enroll in Medicaid because of the expansion in eligibility. The Kaiser foundation’s report estimated 383,000 people would join Missouri’s Medicaid rolls because of the expanded eligibility, and an additional 103,000 would gain Medicaid coverage because of other provisions in the federal health care law.
Medicaid is a health care coverage program funded jointly by the federal and state governments. Here's a look at Missouri's current income eligibility thresholds for Medicaid, based on the federal poverty level, and how they would change if the Legislature agrees with Nixon's request to expand eligibility.
- Custodial parents: 19 percent of poverty; $2,875 annually for a single parent and child, or $3,627 annually for a single parent with two children
- Disabled adults and seniors age 65 and older: 85 percent of poverty; $9,495 annually for an individual, or $12,861 annually for a married couple
- Pregnant women: 185 percent of poverty; $20,665 annually for a single women, or $33,317 annually for a mom with two other people already in her household