Bubbling Up

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Bob_circleAmong President Trump’s first official acts after taking oath of office was signing an executive order regarding the Affordable Care Act, signaling that the fight over the health care law had begun in earnest. As our elected federal officials take on this difficult task, they will propose fundamental changes in the nation’s financing of health care for low-and moderate-income Americans. There remain many unknowns, but there is a real possibility that Medicaid, one of our country’s most important health social safety nets, will change in ways that leave vulnerable citizens in a more precarious position than ever. Even Missouri, a state that has not expanded Medicaid under the ACA, is facing the potential for major health care disruption within our existing Medicaid program. It is up to our citizens, members of the media, and governmental representatives to ensure that we continue to provide health care coverage to those that need it most.

Medicaid expansion was originally an integral part of the plan to achieve near-universal health insurance coverage, but when the Supreme Court found the ACA’s individual mandate constitutional in 2012, they also ruled that state expansion of Medicaid was optional. To date 31 states have opted to expand the program, but Missouri was not one of them. Public attention to Medicaid in Missouri over the past four years has mainly been over the pros and cons of expanding the program to more low-income Missourians.

Less attention has been given to MO Healthnet, the Medicaid program we already have. We need to understand our state’s current program because the potential federal changes go beyond returning to pre-ACA status; they very well might fundamentally alter the program.

Medicaid is financed by state and federal funds and currently provides health insurance for one in seven Missourians: low-income seniors, people with disabilities, children, pregnant women, and very low-income parents. A majority of Medicaid’s dollars pay for long-term care for seniors and care for people with disabilities.

People who are eligible for Medicaid are entitled to the insurance program’s services, just as our elderly and non-elderly disabled citizens are entitled to Medicare. Medicaid is a complicated program, and it certainly has problems, but Medicaid makes people healthier, improves our economy, is less costly than private insurance, and is a crucial payer for mental health care, so it is not surprising that it’s long been supported by the public and opinion polls show that Missourians view Medicaid favorably. The ACA and Medicaid are not the same!

Perhaps more importantly, Medicaid is an embodiment of our collective obligation to provide care for those who otherwise could not afford it. It is an essential component of the social compact we share as part of a just and caring society.

While various Medicaid options – such as block grants – are being discussed nationally, almost all have two key features: future federal funding will be reduced, and broader latitude over Medicaid will default to states to design program eligibility, benefits, and payments. Federally, there is considerable uncertainty about what changes will occur and when. But because changes may come quickly, now is the time to work toward an even more robust, equitable, and effective Missouri Medicaid.

Becoming better educated about our current program is an essential first step. State and local media institutions have a lead responsibility to clearly and fairly communicate the importance of federal developments. Although not an easy job because of its complexity, it can be done! We need widespread, easy, and repeated access to objective information so citizens can express their preferences for our future Medicaid program. This should be augmented by various organizations – businesses, nonprofits, educational institutions – hosting discussions and sharing why MO Healthnet is important to us all.

For a second step, citizens should keep abreast of federal action that will affect Missouri Medicaid. Third, elected state officials should engage the public on the future of Medicaid to ensure that if, as is quite possible, they will be crafting its future, the public’s voices are heard. Medicaid beneficiaries reside in every Missouri county; this issue should be a top priority for all recently elected state officials.

As fundamental changes to Medicaid are considered, it is essential that we as Missourians stand by our values for a more equitable, humane society. It is urgent that all of us come together and remain vigilant to ensure we have a Medicaid program we can continue to be proud of in the future. With the election behind us, we should all be inspired to make things better, instead of eliminating benefits that are vital to the health of our most vulnerable citizens.

As seen in the Friday, February 10, 2017, issue of the Springfield News-Leader and USA Today.