Legislators against Medicaid expansion wait in the wings to say, “I told you so.”

Recently, Ron Pollack, executive director of Families USA, wrote about the “practical effects of the Affordable Care Act. His remarks clarified for me that Missouri legislators are readying themselves for a role as a Greek chorus, where they can affirm, “Yes, we were right, Obamacare is a disaster! It just doesn’t work.”  But what isn’t working effectively is our legislature, which is passing laws that hinder the implementation of the Affordable Care Act. For details on how obstruction of Medicaid expansion promises to affect poverty-level citizens in Missouri, check out the St. Louis Post-Dispatch article, “A Big Medicaid Gap Looms in Obama Healthcare Law.”

Pollack suggests that “states that accept generous federal funding to expand Medicaid coverage for low-income families will show remarkable improvements in reducing uninsured rates.” Our Missouri legislature has chosen to not expand Medicaid.  Up to 300,000 low income Missourians will remain uninsured. When they need care we will bear the expense and our legislators will be in the chorus chanting, “We were right!  Obamacare, government takeover of our health system, didn’t reduce our health care costs!”

Beginning October 1, 2013, more than 500,000 Missourians will begin purchasing health insurance through online exchanges. Pollack says that “states with larger numbers of on-the-ground helpers, sometimes called navigators or assisters, will help their citizens much more effectively secure premium subsidies to obtain coverage that is most responsive to their families’ needs.”  But Missouri has created barriers, imposing unnecessary fees and regulations to make it difficult and even prevent social services agencies from giving assistance to their clients who are eligible to purchase health insurance in the new marketplaces. If SB262 is signed into law, individuals and small businesses purchasing policies will only receive information on coverage from insurance brokers and our legislators will thunder, “We were right!  Health insurance exchanges are too burdensome for our citizens.”

And what of the Missourians who try to purchase insurance under the exchange and learn they are not eligible for insurance subsidies because their income is too low?  They fall into a black hole, not allowed on Medicaid and unable to receive subsidies in the exchanges.  In our play, they fall off the stage into the orchestra pit, where the legislators are drumming to the tune of “It doesn’t work!”

Pollack says that “states that implement active oversights of their insurance marketplaces will do appreciably better in decelerating decades of premium increases.” In Missouri, our insurance commissioner has been given minimal authority to enforce the federal law and protect the consumer. If SB262 is enacted, our legislators will have created the set for a scene where consumers purchase policies that have high deductibles and that do not meet the needs of their families. And, yes, our legislators will be in the wings with an aside, “We were right!  Obamacare does not work.”

Pollack comments that when the states that have not expanded Medicaid see the improvements in care and costs being made in states that have fully implemented the Affordable Care Act, they too will want to the follow the lead of Arizona, New Jersey, New Mexico, Nevada, North Dakota et al and do the right thing for their citizens.

I am not a health policy expert.  I am just a concerned citizen who urges our legislators to read the reviews and acknowledge the critics are giving Missouri a thumbs down.

To our legislators:  Go back, edit the script, and write a play which will have a happy ending with a standing ovation from your grateful constituents for moving us closer to affordable, quality health coverage and care for all Missourians.