Community Building Organizations Should Support Medicaid Expansion in Missouri

Terry Weiss, MD, FACR Member, Provider Services Advisory Board St. Louis Regional Health Commission, Co-founder and Past President, St. Vincent Greenway, Inc.


Every decade since the Theodore Roosevelt administration (1901-1909) the federal government has made an effort to reform the U.S. health care delivery system. The underlying premises have been: 1) health care is a right, not a privilege, and 2) ʻOne can judge a nation by how it treats its most vulnerable citizensʼ (Aristotle).

In 2010 the U.S. Congress passed and President Obama signed into law the Patient Protection and Affordable Care Act, aka the Affordable Care Act (ACA) or “Obamacare.” The goals were to expand coverage, improve quality of care, and lower costs. A principle mechanism for expanding coverage to millions of uninsured Americans is the expansion of Medicaid. Missouri is one of 26 states which has refused to do so. Community organizations should care because of the implications of expanding or not expanding Medicaid.

From the medical standpoint the benefits of expansion include increased access to health care, especially for parents (working and non-working).  Another benefit is preventive care, e.g., vaccinations and disease screening. Medicaid expansion would enhance early detection and treatment, a category in which Missouri ranks thirty-eighth.  What are the implications? Take high blood pressure (hypertension) as an example. Hypertension is an asymptomatic disease. One can have a BP of 150/110 (normal is around 120/80) and feel quite normal. However, untreated hypertension can result in kidney failure, heart attack, or stroke. Which is better and more cost effective? To treat the person with asymptomatic hypertension or wait until the individual has kidney failure and needs dialysis, has a stroke and needs extensive, perhaps life-long care and may be unemployable, or has debilitating heart disease? Finally, there is an emphasis on quality of care through the Agency for Healthcare Research and Quality established by the ACA.

There are many economic benefits of expanding MoHealthNet, Missouri’s Medicaid program. First, as noted above, increased accessibility, prevention, early detection and treatment will lower health care costs. Second, while the state will invest $431 million between 2014 and 2019 it will receive $94 billion federal dollars over 10 years. Most of the funds to pay for the expansion are federal. The federal government will pay 100% of expansion costs through 2016, 95% of costs in 2017-2019 and 90% thereafter in perpetuity. There will be job creation. Had the legislature expanded MoHealthNet in 2013 there would have been 24,000 more jobs in Missouri in 2014, 5,000 of them in the St. Louis area. These are good, well paying jobs, e.g., for construction of health care facilities, laboratory technicians, pharmacists, nurses, nurses aids, etc. These jobs would also generate substantial state tax revenues.

Lastly, expansion is critical to survival of rural hospitals and health systems. Hospitals currently receive extra federal payments for providing care to the uninsured. Providing such care gives those hospitals a disproportionate financial burden and the extra moneys are referred to as ʻDisproportionate Shareʼ funds (DSH, pronounced DISH). One way the federal government plans to pay for Medicaid expansion is by reallocating DSH moneys from states not expanding Medicaid to those that do. This loss of funds to small  Missouri hospitals will be crippling or even fatal to preserving service in rural and poor areas.

Like Medicaid, community development corporations (CDCs), neighborhood associations, and other community building organizations serve the underserved and work toward creating opportunity and a higher quality of life for all. Community building organizations’ constituents include a large number of those who would benefit from MoHealthNet expansion. Collaboration between community building organizations and those seeking to expand Medicaid is a natural. You can help:

• Your CDC, neighborhood association, and the CBN could pass resolutions supporting MoHealthNet expansion;

• You can join the Missouri Medicaid Coalition:;

• You can send your resolutions to your legislators and to the Coalition;

• You can write letters to the editor and to your legislators telling them why you support expansion:

• If you have residents who have stories to tell about their difficulties with lack of insurance you can encourage them write up their stories and submit them to the Coalition.

Join in the struggle, as you do every day in other ways, to improve the quality of life for your constituents. Join in the effort to expand MoHealthN


Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri- St. Louis.