As Missouri's Medicaid awaits reform, health centers continue to serve uninsured

May 22, 2013

This week on KBIA’s talk show Intersection, host Ryan Famuliner sat down with State Sen. Kurt Schaefer (R-Columbia), Rep. Caleb Rowden (R-Columbia) and Rep. Chris Kelly (D-Columbia) to discuss the legislative session that ended on Friday. One of the main things on the show’s agenda was, of course, Medicaid expansion – or lack thereof.

Famuliner asked the panelists why the expansion failed to pass. 

“I think it’s the cost and the uncertainty, keep in mind: We got 900,000 Missourians who are currently on Medicaid,” Sen. Schaefer said. “Of that 900,000 population, we spend just over $3 billion of our discretionary general revenue each year.”

Like other Republicans who reject Medicaid expansion, Schaefer cites high cost and the need to reform the program as reasons for their opposition. Schaefer and other Republicans have expressed the need for Missourians on Medicaid to have more “skin in the game” of their health care cost. They argue that Medicaid needs to have stipulations such as co-pays and deductibles, like regular insurance plans. 

On Intersection, Famuliner asked the panelists what will happen to those who are still uninsured in Missouri without the expansion. Schaefer said: “Anyone who lives in Columbia can get dental to chemotherapy at the FQHC, which is on Worley. The population generally is covered, just the question of who’s paying for it.”

FQHCs are federally qualified health centers.  These are health centers that get federal grants to help cover some of the cost of providing care for people who can't pay for it. The FQHC Schaefer talked about is the Family Health Center on Worley StDr Andrew Quint is the medical director at the center.

He says some of Schaefer's claims about the center is just plain wrong. 

“We can’t take in every single uninsured person that needs to be taken in,” Quint said. “There are limits. We can’t take care of the entire uninsured population.”   

He says the about 20 percent of the facility's patients are uninsured. The federal grant provided to the facility covers the difference between what the patient can afford to pay and the actual cost of their care. Sen. Schaefer said on Intersection the center provides free service, but that's not true: Patients at the center pay on a sliding fee scale. Say a patient comes in for a visit that actually costs $100. After truthfully reporting their income, the patient might only have to pay $30 for the visit. The center then bills the rest of the cost to the federal grant money. 

This grant does not cover, by any means, the full range of services that we try to provide to people,” Quint saidIt's a limited grant that never goes up. It was determined at the time that we became a health center and haven't changed in a significant way.”

Quint said the demand for care far exceeds the center's capacity. If more people became enrolled in Medicaid, more of the grant would be available for others who would still be uninsured, Quint said.

Even if the Affordable Care Act is fully enacted the way Congress and the president intended, there's still going to be large numbers of uninsured people,” Quint said. 

Despite supporting the expansion, Quint would be the first to say that Medicaid is a broken system. He agrees with state Republicans that it needs some reform, but says that reform is an ongoing process that shouldn’t have stopped the expansion.

“This is my seventeenth year at the center,” Quint said. “I’ve gone through many Medicaid fixes. Gov. Blunt fixed Medicaid several years ago. Every few years someone, quote, ‘fixes’ Medicaid. ... I’m not against trying to fix it, but I don’t think there’s a final fix.”

Most Missourians currently enrolled in Medicaid are children. In 2005, Missouri reduced its Medicaid eligibility and removed more than 100,000 people from the program. As it stands right now, without the expansion, Missouri’s Medicaid does not cover able-bodied adults with no children, no matter how small their income.

For now, both the Missouri House and Senate are planning to form interim committees to study Medicaid reforms. Senate president pro tempore Tom Dempsey and House Representative Jay Barnes are in charge of the committees. Neither has come out with an official timeline or a plan for the committees.