JEFFERSON CITY, Mo. -- Here's how much Missouri Republicans oppose Obamacare.
GOP lawmakers are reluctant to spend one dollar in state money for every 19-plus dollars of new federal money if that means expanding Medicaid eligibility in line with the presidents health care overhaul.
The state has no extra money to spare, they say, so any expansion will likely result in cuts somewhere else, like education.
Its a stance thats not playing well with their hometown hospitals, though, who say they badly need more Medicaid dollars as money they get from Washington for caring for low-income patients starts to go away.
And now those hospitals are issuing a stark warning: Failure to act could result in some hospitals closing their doors for good.
Were trying not to be alarmists, but its going to be very fiscally difficult for hospitals if Missouri doesnt get this done, said Dave Dillon, vice president of media relations for the Missouri Hospital Association.
The federal health care law, known as the Affordable Care Act, calls for an expansion of Medicaid to cover millions of low-income residents who cant afford insurance. The federal government would pay the additional cost initially, with states picking up 5 percent beginning in 2017 and 10 percent by 2020.
The expansion in Missouri would cover an additional 255,000 adults earning up to 133 percent of the federal poverty level. The first six years of Medicaid expansion would cost Missouri $431 million, but bring in an additional $8.4 billion in federal money, according to the Kaiser Commission on Medicaid and the Uninsured.
In June, the U.S. Supreme Court ruled that states could refuse to expand their programs, and since then Missouri lawmakers have repeatedly balked at the idea.
The costs down the road are prohibitive, and I dont think anyone believes revenue will improve fast enough to offset the costs, said Ryan Silvey, a Kansas City Republican who has been chairman of the Missouri House Budget Committee for two years. He moves to the state Senate in January.
I dont get the sense there is much support in either the House or Senate for expanding Medicaid, he said.
Others are even more adamant.
The state of Missouri is not going to expand Medicaid in the fashion contemplated by Obamacare, said state Rep. Jay Barnes, a Jefferson City Republican. Thats not happening.
But rejecting federal Medicaid dollars will likely result in a substantial financial hit for hospitals around the state, Dillon said. Thats because of a provision in the health care law that phases out federal payments to hospitals that serve low-income, uninsured patients.
Missouri hospitals expect to receive about $784 million in such payments in fiscal year 2013.
By expanding Medicaid, the number of uninsured people would go down, and thus there would be less need for that funding, Dillon said. So starting in 2014, when the expansion is supposed to kick in, those payments will begin being scaled back whether a state expands its Medicaid eligibility or not.
The Congressional Budget Office projects payments will shrink by roughly 50 percent by 2020. Without that money, and without more patients gaining insurance through Medicaid, Dillon said hospitals that serve vulnerable populations would be put in a precarious situation.