The Missouri state legislative session ended on May 16, failing for the second consecutive year to expand Medicaid coverage to extremely low and very low income people. Expansion would have added approximately 300,000 people to the Medicaid rolls.
The Missouri Association of Social Welfare (MASW), an NLIHC State Coalition Partner, has asserted that Medicaid expansion under the 2010 Federal Affordable Care Act would save lives and prevent many individuals and families from having to choose between paying a medical bill instead of rent, utilities, food, or other life necessities.
“When illness leads to high medical bills, other basic human needs go unmet,” said Jeanette Mott Oxford, MASW’s executive director and former state representative. “Inability to pay rent and utilities leads to constant transience and some must settle for living in substandard and dangerous housing. Medical debt has also led some to foreclosure or bankruptcy. The stress can push people into depression or other mental illnesses. Some self-medicate with alcohol or drugs to mask their anxieties, and addictions result.”
The Affordable Care Act provides states the opportunity to expand Medicaid eligibility to people with income up to 138% of the federal poverty line. If Medicaid eligibility was expanded, a single person with income up to $16,104 per year and a family of four with income up to $32,913 per year would be eligible. Currently, the state has varied eligibility terms based on household circumstances. For example, a pregnant woman or a child up to one year of age are eligible for Medicaid if household income is at or below 185% of the federal poverty level, while a household that includes adults and children is eligible until household income reaches $4,000 per year. Adults without children are not currently eligible.
For more than a year, MASW engaged its members in advocacy urging the legislature to allow expansion. MASW partnered with the Missouri Medicaid Coalition, comprised of 173 housing, senior, and medical advocates, as well as service providers, civil rights groups, and faith-based organizations. The Coalition educated the public and lawmakers about the need to provide medical coverage to people with the lowest incomes. Advocates won the support of Democrats in both chambers, which helped secure passage of the bill by a vote of 5-2 in the House Committee on Health Insurance.
On May 6, MASW and their allies held a rally, lobby day, and protest at the state Capitol building to pressure House and Senate leadership to bring the legislation to a floor vote. Advocates organized carpools to increase statewide participation. People who were not able to participate in the events were encouraged to contact their elected officials via email or phone. The protest shut down business at the Capitol for an hour, and more than 20 clergy members were arrested.
Eight days later, after no action was taken by the House or Senate, advocates organized a vigil calling on legislators to advance the bill before the end of the session, scheduled for the following day. Supporters placed 700 paper lanterns on the steps of the Capitol building to symbolize the estimated 700 lives that could be saved through Medicaid expansion. At the event, Ms. Oxford spoke about her grandfather who died from a treatable form of cancer because he could not afford treatment.
The House did not take up the bill. However, Senator Ryan Silvey (R) added similar language to a bill modifying the state’s food stamp program. That bill stalled due to a filibuster prompted by Senator Rob Schaff (R), a physician who had concerns about expanding benefits to poor individuals because doctors are reportedly turning away Medicaid patients due to low reimbursements. Another concern included the misconception that expansion’s financial cost to the state would exceed its benefits. Advocates countered that expansion would save the state approximately $94.2 million because the federal government would cover the full cost of the program through 2017 and absorb at least 90% of the cost thereafter. Refusing to act will cause the state to lose $1.7 billion in federal funds, which will be redistributed to other states.
Representative Lynn Morris (R), a pharmacist, recently announced that he will be working with Representative Jeff Messenger (R), owner of a prosthetics and orthotics company, to craft a Medicaid reform bill in coming months, which is evidence that grassroots pressure is having an impact. MASW and the Missouri Medicaid Coalition will continue to build statewide support over the next seven months and make Medicaid expansion an issue in candidate fora this summer and fall. Advocates expect more civil disobedience and arrests at the Capitol when the General Assembly reconvenes in January 2015.
“Thanks to the citizen power of organizing in a diverse coalition, more legislators are speaking up for needed reforms and expansion of the Medicaid program,” said Ms. Oxford. “MASW will continue this fight until every Missourian has affordable and high quality health coverage.”
For more information, contact Jeanette Mott Oxford, Missouri Association for Social Welfare, at firstname.lastname@example.org