Officials urge legislators to reconsider Medicaid issue
Last week's failure of Missouri's Republican-led House of Representatives to pass the amendment approving Medicaid expansion will have lasting effects for the Nevada Regional Medical Center and area patients, said Judy Feuquay, the hospital's chief executive officer.
The proposed Medicaid expansion is part of the federal Patient Protection and Affordable Care Act that was signed into law March 23, 2010. ObamaCare, as it has been dubbed, has been controversial since its passage.
ObamaCare is intended to reform the health care industry, making affordable health care available for all Americans. Originally, the plan mandated states to participate in the incrementally enacted plan, but there have been some modifications since it was passed.
Last year, the U.S. Supreme Court ruled that states could opt out of or reject the Medicaid expansion portion of the plan that would cover people who earn up to 138 percent of the federal poverty level, which varies according to family size. The federal poverty level for a family of four is $23,550, with 138 percent of that amount being $32,499.
According to the Missouri Hospital Association, those guidelines would provide more than 300,000 currently uninsured Missouri residents the opportunity to be covered by Medicaid. Missouri lawmakers say the expansion would strain the budget. Feuquay thinks the budget needs amending. Feuquay said that many publicly owned hospitals operate in the red. But the NRMC budget is operating in the black thanks to "good stewardship" of hospital funds.
States are encouraged to participate with a financial incentive. The federal government will pay 100 percent of the cost for the first three years and 90 percent for seven years following that. The expansion will be implemented in 2014.
Health officials argue that if the state doesn't participate then states that do will be taking the federal money away from Missouri. Feuquay said some of the money comes from Missouri taxpayers and she hates to leave that money on the table for another state to walk away with.
"The money is there, so we need to take advantage of it now," she said.
State Sen. Ed Emery (R-Lamar) said the money is not really there.
Emery, who represents the 31st District, (Barton, Bates, Cass, Henry and Vernon counties) said he thinks the expansion will increase an already out of control deficit.
"Missourians rejected the whole Obama plan overwhelmingly," said Emery, explaining why he opposes the expansion and why he predicts it will fail in the senate.
Emery also said hospitals will feel the most impact of the measure's failure. With the expansion not passing and cuts in funding going into effect in 2014, "hospitals will have to figure some way to maneuver through it."
Whether state legislators change their minds and decide to join the expansion or stick to their original decision there are several implications for NRMC.
Chief Financial Officer Tommy McGee said those who have no insurance coverage "will still seek care" and even though they are not insured "they will get care."
Without the Medicaid expansion money, McGee says NRMC will lose approximately $4.4 million this fiscal year by caring for uninsured patients at its own expense. With the anticipated cuts in funding over the next six years, McGee said the hospital stands to lose another $2.2 million per year.
That spills over into higher costs for those that do pay. According to NRMC statistics, 27.3 percent of Vernon County children live in poverty and 19 percent of county residents are uninsured.
Medicaid expansion would allow NRMC to recover more of the costs of treating patients, which will increase revenue and decrease the cost of care, according to McGee. The federal government is moving toward a "pay for performance" type of structure. One way of doing that is by trying to be more supportive of outpatient care -- fewer and shorter stays in the hospital.
McGee said some procedures that used to mean a week's stay in the hospital are now reduced to three days. Less time in the hospital means reduced cost to the consumer. It also means the hospital can treat more patients and that means increased income.
Rural health clinics, such as those in Sheldon and Rich Hill, help reduce cost to consumers by reducing travel. Patients are more likely to go to the doctor if they don't have to travel as far. In the long run, that means they will be healthier.
Clinics also keep down the number of emergency room visits -- the most expensive kind of health care.
Feuquay said if health care costs can't be held in check and the hospital has to spend more and more of its money on patient care, cuts have to be made in other services. That means less money for new services or improving technology at the facility. New services and technology updates may result in a more efficient delivery and more economical health care.
Without up-to-date technology, hospitals have a difficult time recruiting qualified doctors and staff members. Reductions in staffing may become necessary.
A declining budget could result in steady or declining wages, which, in turn, could result in declining revenues coming into the city.
With nearly 450 employees, the NRMC health care system is the second largest employer in Vernon County.
Feuquay and others in the medical field are not sure where this issue will go from here.
Missouri lawmakers have repeatedly rejected Medicaid expansion proposals this legislative session, but Gov. Jay Nixon announced Wednesday after meeting with entire House GOP caucus that the expansion may still be alive.
Feuquay is joining others in urging the state legislature to pass an amended budget that would add millions in federal funds to the proposed 2014 budget of the state Social Services Department to expand Medicaid service. The Missouri Hospital Association endorses the amendment as does the state Chamber of Commerce.
On a local level the Nevada/Vernon County Chamber of Commerce supports Medicaid expansion. So does the NRMC foundation and auxiliary. The hospital staff has been trying to get the message out to the public by visiting civic groups talking on the radio and speaking with hospital staff and employees, Feuquay said.
To contact state Rep. Randy Pike call 573-751-5388, e-mail him at Randy.Pike@house.mo.gov or write him at Mo. House of Representatives, 201 W. Capitol Ave., Room 400CB, Jefferson City, MO 65101.
To contact Emery, call 573-751-2108 or e-mail him at Ed.Emery@senate.mo.gov or write to Emery at Mo. House of Representatives, 201 W. Capitol Ave., Room 4431, Jefferson City, MO 65101.