This article first appeared in the St. Louis Beacon, March 15, 2013 - Branson, Mo., gets plenty of good press for being a magnet for millions of visitors who love country music, specialty shops and other amenities in the southwest corner of the state. But the town drew a different sort of attention to itself last month when its Chamber of Commerce endorsed Gov. Jay Nixon’s controversial push to expand Missouri’s Medicaid program.
It is a position that’s strongly opposed at this point by key legislators in the Missouri Legislature, which would have to approve any changes in the program. Though the chamber is only one of many such groups across Missouri trying to prod state lawmakers to embrace expansion, the move in Branson stands out -- as does a similar move by the chamber in Southeast Missouri.
That’s because both communities happen to be among the strongly Republican areas of Missouri where some lawmakers, businesses and residents tend to be fiscally or philosophically opposed to Medicaid.
The state Chamber of Commerce has also come out in support of expanding Medicaid because of the potential financial burden that would fall on employers. (The more urban focused St. Louis Regional Chamber and the Kansas City Chamber of Commerce have also endorsed Medicaid expansion.)
These endorsements may show how chamber groups are reacting to data-driven arguments about the health and economic benefits of Medicaid expansion. It is projected to provide insurance to as many as 300,000 additional residents, create as many as 24,000 additional jobs, boost labor income by nearly $7 billion through 2020 and generate an additional $856 million in state and local tax revenue through 2020.
This economic discussion also shows how supporters have given the expansion debate the equivalent of a face lift, transforming it from a stereotypical discussion image of Medicaid as a program serving mostly the urban poor into a conversation about a system that some say could offer an economic boost for everyone.
In Missouri’s Ozark region, where Branson is situated, expansion is projected to generate an additional 2,043 jobs in 2014 and a total of $585.9 million in income between next year and 2020.
Those projections are persuasive to Ross Summers, president and CEO of the Branson/Lakes Area Chamber of Commerce. He says the group’s focus is a “viable, sustainable economic and environmental climate” in the Branson area.
“We feel we would not be upholding that mission if we did not recommend that the state of Missouri participate in this expansion,” he says. The Branson chamber is one of 19 business and economic development groups, that have endorsed expansion.
The Cape Girardeau Chamber of Commerce announced its support last week. The group’s president and CEO, John Mehner, says expansion would be “economically beneficial to our medical industry, employers, the working poor and bring Missouri tax dollars back to our state.”
In southeast Missouri, expansion is projected to generate 1,723 additional jobs next year and produce a total of $452.7 million in additional income between next year and 2020.
Heading up a long list of business and health groups supporting expansion is Joe Pierle, whose day job involves serving as CEO of the Missouri Primary Care Association. The expansion program of which he is chair is called the Coalition for Healthy Economic Growth. He says he isn’t surprised that business groups in even more conservative parts of Missouri are favoring expansion.
“The economics of this issue are very clear,” he says. “There is positive impact of pulling down these federal dollars, tax dollars that we pay to the federal government. We should use them in our state to help our economy and our health-care system. It would be fiscally irresponsible to send out tax dollars for health care to other states and improve their economies and not our own.”
In addition, he says, business leaders understand that caring for the uninsured the way Missouri now does amounts to a “hidden health-care tax that is passed on to employers and individuals and families that purchase private insurance. So if we can reduce the number of the uninsured, that hidden health-care tax would decrease.”
Finally, Pierle says the health-care system is the economic engine in some rural communities. “There is a real threat to the future of health care (in rural Missouri) unless we work with our legislators to pass and leverage these federal resources” coming to the state from Medicaid expansion.
Legislature still opposed
So far the GOP-controlled legislature has been opposed to expanding Medicaid. Before the state Senate’s Republican leaders left for a one-week recess, they issued a joint statement essentially saying they would not support Medicaid expansion.
“An expansion of such a large program with a partner as unreliable as the federal government would likely mean future tax increases or serious cuts to vital priorities, like K-12 education," their joint statement says.
House Speaker Tim Jones, R-Wildwood, has long been on record as opposing expansion and shows no sign of changing his mind.
Many of the state's lawmakers seem to agree with think tanks, such as the Heritage Foundation. One of its researchers argues that, in the long run, expansion would end up costing Missouri a lot more than it reaps in benefits.
Pierle says that while the coalition's and chambers' support continue to grow, he can offer no bets on changing minds of key legislators. But he says, “When you present a very broad-based coalition, it sends a pretty strong message. We’ve been visiting our legislators since last fall and that will continue till the last days of the session.”
Impact on rural areas
Some scholars argue that Missouri needs to expand its Medicaid program in any case. Pointing to rural communities and small towns like Branson, SLU Law Professor Sidney Watson says the workplace is changing, with more people doing contract employment or part-time or seasonal work with few or no health benefits.
Under the expansion program, she notes, Medicaid would be available to a family or individual earning up to 138 percent of the federal poverty level – or about $26,000 for a family of three and $15,000 for a single person.
“It allows us to build our health-care infrastructure, protect our hospitals, and develop more community clinics. If we don’t expand Medicaid, it will stress our safety net hospitals, stress our rural hospitals. And we will see hospitals closing,” she says.
Watson also notes that under Missouri’s existing rules, Medicaid is off limits to any childless adults who is not disabled, no matter how poor that adult might be.
“Missouri has one of the stingiest Medicaid programs in the country,” she says. “For a single parent, earning $3,500 a year – or $292 a month – is too much income for the family to qualify. That’s a crying shame.”
