It may be late in the Missouri General Assembly's legislative session, but Missouri Gov. Jay Nixon is still pushing a proposal to expand the state's Medicaid system to cover another 300,000 residents who don't have health insurance.

It may be late in the Missouri General Assembly's legislative session, but Missouri Gov. Jay Nixon is still pushing a proposal to expand the state's Medicaid system to cover another 300,000 residents who don't have health insurance.

With only about five weeks left in the session, passing any kind of major legislation, including one with a price tag as steep as this one, is a long-shot but Nixon said he's optimistic.

“I wouldn't be here if I didn't need folks' help but I wouldn't be here if I didn't think we could get this done,” Nixon told a crowd of about 100 community leaders at Mercy McCune-Brooks Hospital in Carthage on Wednesday. “This is a busy job, there's lots of things to do as governor, and I know we're making significant progress and I think a concrete example of that progress is the house voting that bill out of committee, that Rep. (Jay) Barns (R-Jefferson City) and a bipartisan group supported out of committee.”

At issue is a provision of the 2010 federal Affordable Care Act that called for states to extend Medicaid coverage to adults earning up to 138 percent of the poverty level, about $27,000 annually for a family of three. States that do so can get full funding for the first three years, starting in 2014, then an amount that gradually decreases to 90 percent federal funding by 2020. A Supreme Court ruling last year made the expansion optional for states.

Missouri currently has one of the toughest adult eligibility thresholds in the nation — denying coverage, for example, to a single mother of two children who earns more than about $3,700 annually.

Last week, a  Republican-led Missouri House committee approved a plan that would expand adult Medicaid eligibility to the poverty level.

“Last week I met with the Republican House Caucus and the next day, a House committee voted this bill, the Medicaid expansion bill, out of committee 7-2,” Nixon said Wednesday in Carthage. “That's a very positive, concrete step forward. My discussion with members have also been positive. Maybe I've been around the Capitol too much but we're not to halftime in the session yet. It's not the amount of time.”

Under the Affordable Care Act, often referred to as Obamacare, the federal government would fully fund the state's expansion of Medicaid for the first three years, then reduce its share gradually to 90 percent of the cost by the year 2020, leaving the state to cover the other 10 percent.

The bill passed last week only raises eligibility to the poverty level and doesn't meet the standards required by the federal law to raise Medicaid eligibility to 138 percent of the poverty level.

Local lawmakers have said they're not convinced that the federal government will live up to its promise  leaving the state to carry much more of the load than expected.

Nixon said the bill passed last week includes a clause that returns Medicaid to current levels if the federal government doesn't live up to its promises.

He said it's important that the tax dollars that Missourians send to Washington come back to Missouri. Nixon said expanding Medicaid would bring $1.8 billion in federal tax dollars back to Missouri, money that will go to other states if Missouri does not expand Medicaid.

“The answer is clear, the people in Missouri deserve to see their tax dollars come back to their communities,” Nixon said on Wednesday. “That is why we are moving forward on this Medicaid expansion that will provide health care for an additional 300,000  Missourians who currently have no health insurance. It's the smart things to do and it's the right thing to do.”

Nixon also warned of reductions in medical services if the plan is not passed. He pointed to possible cuts in mental health services as an example.

“If we don't move forward on Medicaid, since those are among the least profitable line for hospitals — the study done by the mental health department shows that you'll have a constriction of somewhere between 400 and 700 psychiatric in-patient beds in a system that right now is already stretched thin,” Nixon said. “This is not a system that can take a constriction. If you have a constriction, you're going to have people with serious law enforcement challenges, serious issues with themselves or others, that there will literally be no place for them to be. That is one reason why we've seen a unanimity of support from the law enforcement community also.”

Mercy McCune-Brooks Hospital President Bob Copeland said failure to expand Medicaid would mean less revenue for the local Carthage hospital and a delay in adding new services to the hospital.

Copeland said sequestration, the big cut in federal spending that took affect last month, will likely cost Mercy McCune-Brooks about $2 million in the coming year. He said hospitals agreed to support the Affordable Care Act and a decrease in Medicaid reimbursements to hospitals because it required more people to buy insurance and would expand the number of people on Medicaid.
He said without the Medicaid expansion, people would continue putting off preventative care and seek care at the more expansive emergency room.

“So when you have these cuts in reimbursements, hospitals have to operate as a business, we have an obligation to care for our community,” Copeland said. “We still want to care for the community and we will care for the community, but when things come down to dollars and cents, it could slow construction projects, it could affect business decisions negatively that we want to make and it could impair the growth of the hospital.”

Mary Parrigon Chief Financial Officer at Freeman Health System's Ozark Center, said the impact on mental health beds will be severe without the Medicaid expansion and the increased revenue.
“From the mental health perspective, it does put a lot of the community psychiatric beds at risk of being terminated because that is a lower profitability margin for the hospitals,” Parrigon said. “They'll have to prioritize their services because really, not having expansion of Medicaid really hurts the population and creates a process of having a poorer financial bottom line.”

Ann Carlos, director of the ACHE Dental Clinic, also attended Wednesday's press conference and expressed support for expanding Medicaid. The Area Community Health Emmisaries, or ACHE, have a clinic on Third Street just east of the Carthage Square that Carlos said serves about 1,200 people a month.

“We're in rural areas and we have so much need there and so many people, it's like dental is the last thing people think of,” Carlos said. “Of course they have to take care of their health, but the dental part is a big health issue that they have that they need to take care of and people don't realize the impact it has if they don't take care of their dental needs.

Editor's Note: The Associated Press contributed to this story.