Missouri Medicaid: A state budgeting failure

As a constituent concerned about the state legislature’s decision to expand Medicaid to cover more Missourians, I wrote to my local lawmakers. They were kind enough to respond personally to my concerns, but one response had me even more concerned–concerned about the misinformation readily accepted as fact in the state capital.

Read below the laundry list of rightwing talking points from State Rep. Thomas Flanigan. What’s left unsaid? Everything.

Thank you for your recent email requesting that the General Assembly commit more borrowed federal money to the state’s Medicaid program.  I have consistently opposed this proposal for the following reasons:

1) Our federal government created this crisis by reducing DSH payments to hospitals and I believe the federal government should shoulder the entire responsibility of working to ensure hospitals are not threatened.

DSH or Disproportionate Share Hospital is a program that provides funding to hospitals-such as poor rural and inner city hospitals-that care for a larger number of people who are unable to afford paying for treatment. What Mr. Flanigan did not say is that the ACA’s (Affordable Care Act) Medicaid expansion would have made DSH payments all but irrelevant, because the people unable to pay for hospital care would be covered under the expansion.

SCOTUS’s decision allowing states to opt out of the Medicaid expansion put a wrench in the cogs and Missouri Republicans’ unwillingness to expand Medicaid has hospitals asking for DSH cuts to be reversed. Missouri Hospital Association spokesperson, Dave Dillon, says DSH cuts should not be an argument against expanding Medicaid. That’s right, Missouri hospitals want an expansion of Medicaid.

2) The federal government is severely in debt and shows no signs of alleviating that burden on our kids and grandkids.  Our current spending levels are unsustainable and we cannot keep kicking the can and giving people false promises of entitlements we know will be cut drastically to curb the deficit.

We should be concerned about the debt. Which is why the popular anti-tax sentiment of  the majority party in our state government is alarming in its lack of logic. You cannot sustain government or provide for the general welfare of the people simply by cutting the budget repeatedly. That is as unsustainable as Mr. Flanigan claims social programs are. Increases in the cost of living never end. There must also be revenue increases to protect essential programs–but raising taxes (and cutting the behemoth that is our country’s absurd defense budget) has become taboo and is often taken off the budget table entirely. We’ve witnessed as much time and time again during federal budget talks.

A great example of how extreme budget cuts have a negative impact on people is 2005’s huge Medicaid cut that kicked nearly 100,000 Missourians off of the state’s health insurance rolls. There are entire industries in this state that do not offer employees any health insurance benefits. There’s just not enough living wage jobs with benefits for everyone, no thanks to attacks on living wage job holders, but that is an entirely different discussion. Missouri Medicaid used to cover these working class people who had no other options for health care. Now hundreds of thousands of gainfully employed people are uninsured.

What happens to uninsured working class people who get sick and are unable to receive the care they need because they cannot afford to pay out-of-pocket? They become disabled and/or unable to continue working, then fully dependent on the government or the largesse of those who care; a dependency the rightwing has consistently (and offensively) railed against. Healthy people are productive, contributing members of society and much less likely to be dependent. Providing health coverage is ultimately a money saver. As Ben Franklin said, “An ounce of prevention is worth a pound of cure.”

3) Our state government’s credit rating is in jeopardy because of the level to which it already receives payments from the federal government.   Accepting this “deal” will only worsen that reliance and cost Missouri taxpayers more in the long run.

This point contradicts his first point, where he says “the federal government should shoulder the entire responsibility of working to ensure hospitals are not threatened”. He also inadvertently disproves his own “too much  spending, not enough cutting” argument by bringing up the AFA’s DSH cuts; savings that help pay for a Medicaid expansion.

As he points out later in his list, the federal government will only be making full payments for three years. After that, they will match funding with the state to provide Medicaid coverage to thousands of Missourians. In the end, this vague point leaves me wondering why credit ratings are more important than health care to a party that is so against government borrowing and debt.

4) Medicaid is broken.  I’ve never heard anyone on Medicaid say it was a well-run program.  Instead, I repeatedly hear about how access to care is limited at best and non-existent for many who are on the program.

Medicaid is broken because Missouri state lawmakers broke it. Limited health care is what happens when the program’s budget is cut time and time again. It is non-existent for the 100,000+ people who were kicked off due to budget cuts. This is quite simply a matter of self-fulfilled prophesy. Rightwing lawmakers claim government-run programs are terribly run and inefficient, but they will never utter the reasons why: they are destroying these programs from within by starving them of funding and expounding on the evils of big government. Their no-mercy economic policies create the hardships that make it unnecessarily difficult for working people to become financially independent.

5) Proponents have not signaled where in the budget they would cut once this program expands.  Once our share kicks in, hundreds of millions in revenue will not be available for other purposes.  Right now, education funding is the second largest expenditure in the state (next to social welfare programs) meaning it will likely suffer cuts to make payments for able-bodied adults to receive a Medicaid card.

Note that only budget cuts are supposed here. There’s no mention of revenue increases, which would come from the thousands of jobs created by an expansion of Medicaid. There is no mention of any of the absurd tax legislation being proposed by state Republicans that would take more money away from the “able-bodied” workers of this state while giving huge tax cuts to millionaires; clearly a revenue buster and financially detrimental to large swaths of Missourians. It’s odd that their anti-tax policy does not apply to the working poor or any of the other people (seniors, veterans) who would benefit from a Medicaid expansion.

6) The estimates that were produced that claim this expansion will be a job creator are just patently misleading.  In fact, they assume we will never have to raise taxes to support this vast increase in government spending.  Once those taxes kick in, our economy will react as it always does to new taxes – negatively.

See number 5, specifically this helpful explanation of how expanding Medicaid will create jobs, save us all money, and benefit Missouri businesses. This is why non-partisan groups from all over the place have endorsed the expansion. No explanation or evidence to the contrary was offered by Mr. Flanigan, just the statement that job creation claims are misleading. I asked Mr. Flanigan for data on the correlation between tax increases and a poorer economy. None was provided.

The truth is that Missouri Medicaid has failed countless working and senior Missourians. It is not the failure of a government-run program, however, it is the failure of Missouri’s lawmakers to adequately fund the program. It is the failure of the state legislature that ignores overwhelming support for a Medicaid expansion in favor of political points. State lawmakers need to put aside political shenanigans and get to work creating jobs, a promise as yet unfulfilled. They can start by expanding Medicaid.

Stacy Mergenthal (41 Posts)

Stacy Mergenthal is an activist for progressive causes and voice for the working class. She currently resides in Missouri with her family.


  • I am so sick of the conservative tax hikes = job loss bullscheiss. In the 1950s, we were expanding our economy and our nation’s wealth at an unprecedented rate. We were building interstate highways and dams and other infrastructure. The tax rate in 1955? 91% for the highest bracket ($200K+), 25% in capital gains. (source: http://top-federal-tax-rates.findthedata.org/l/40/1955)
    I wonder how many of the voters who elected these clowns were the very same low-income folks who would have benefited from Medicaid expansion?

  • Ann Mandelstamm

    I was in Jefferson City yesterday (4/16) talking to Representatives and Senators about the Medicaid Expansion. I heard so many distortions and half-truths. One Republican Rep told me that Governor Nixon really OPPOSES Medicaid expansion, although he was the keynote speaker at the Medicaid Expansion Rally. If our elected state legislators can’t get the facts straight in a fairly complicated issue, it is no surprise that many of Missouri’s citizens are easily misled. It is true that the federal deficit is a concern. But we elected our Missouri legislators to look out for the welfare of all Missourians, and those who vote against Medicaid expansion are failing all Missourians, insured and uninsured.