MHAA takes aim at state legislators

Wednesday, March 5, 2014

Sater talks Missouri Medicaid expansion, reform

The Missouri Health Advocacy Alliance, a member of the Missouri Medicaid Coalition, is taking aim at state legislators to support Medicaid expansion, and State Sen. David Sater, R-Cassville, is in the group's crosshairs.

The Alliance has placed advertisements in a number of newspapers, including the Cassville Democrat, listing 43 organizations, along with a website including at least 300 more, that are in favor of Medicaid expansion in Missouri. The advertisement then reads, "Where is Senator Sater? Tell him to support expansion."

Michelle Trupiano, director of the Missouri Medicaid Coalition, said the ad campaign is aiming to convince legislators to reform and expand Medicaid in one fell swoop.

"The legislature has studied this issue for a while and had many hearings over the summer," she said. "There are a couple theories on the best way to do it, but we believe we can reform the system and expand, and we shouldn't wait for the perfect system to come along while people are dying because they have no health insurance."

Sater said Medicaid expansion is a tough subject, and is not likely to see any action because the State Senate's 24 Republican members are against it. Sater introduced SB 518, which would expand the managed care system beyond the current area, the I-70 corridor from St. Louis to Kansas City, Mo., which serves children, pregnant women and custodial adults to the tune of 400,000 people.

"[State] Sen. [Paul] LeVota, [D-Independence] put an amendment on my senate bill to expand Medicaid, and that failed," he said. "By expanding the managed care system to the rest of the state, that would add about 200,000 more people. Managed care has been in existence for 18 years and has been proven to save state dollars and increase access to care.

"Even if I wanted to expand Medicaid, I wouldn't have the choice to because there's no sentiment to do it."

Trupiano said the Coalition hopes to see an expansion that would let the state purchase insurance for its citizens who are 100 percent to 138 percent of the poverty level, and one house bill put forward, HB 1901, includes such a measure.

"We have been working a lot on the senators, and what we've been hearing is they want to reform first, and our push back is that we can reform and expand at the same time," Trupiano said. "The current system has part of Missouri in a managed care system, and the other in a fee-for-service system, and Sater wants to move it all to a managed care system. We have concerns about the managed care system, because it will allow the denial of care to people who need it most, because that's how they make their money."

In a managed care system, includes a process of referrals and certain procedures may be denied by an insurer, leaving patients without care unless they are able to pay for it themselves. A pay-for-service system allows patients to get a service and have it paid for by the state.

Sater said the managed care system is the way to go because it puts more accountability on providers when deciding which tests to perform, managing the care to cut out unnecessary tests that would cost the state more money.

"Providers need to make sound medical decisions, and the managed care system tries to decrease unnecessary costs," he said. "In a fee-for-service system, the more tests that are run, the more money a provider makes. In managed care, there is a certain amount of money per patient, so providers have the incentive to not run as many tests. There is some denial of services, but there is a reason for those denials."

Sater said some states, such as Kansas and Texas, have already put their entire populations in the managed care system, but the fee-for-service model is still necessary for some on Medicare.

"We also have the blind, aged and disabled, and they are still on the fee-for-service system, and I don't think they should be overseen by a managed care system right now," he said. "You can't have one program for all the populations, because they all have different needs."

Trupiano said the advertisements in newspapers have been aimed at multiple senators in an effort to turn as many opinions as possible.

"We would love to have the support of all senators," Trupiano said. "There are 300,000 people in Missouri that fall into that Medicaid gap, and it's up to the legislature to take the federal money that's already there [via the Affordable Care Act expansion option].

"We put these ads in newspapers because we know the majority of Missourians want expansion, so we are calling on the citizens to make their voices heard."

Sater said part of the reason Senators are wary of the expansion is rooted in a distrust of the federal government. The expansion offer in the Affordable Care Act includes the federal government paying 100 percent of the cost for the first two years, 95 percent for the third and fourth years, and 90 percent for the fifth year forward, but Sater is not so sure those percentages won't change.

"A lot of senators are doubtful," he said. "We pay $2 billion a year in Medicaid costs, so if for some reason the federal government changed its mind and went from 90 percent to 80 percent, we would be on the hook for an extra $200,000. Medicaid costs also go up each year with new enrollments and the cost of care increases with new technology. We are paying $136 million more this year compared to last year without even changing anything.

"There are a lot of hard-working people that fall below the 138 percent required for Medicare, but they can barely afford rent, food, clothing or car insurance, and they don't have enough to pay for insurance. Those are the people I would like to help."

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