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Missouri Budget Project Report: Medicaid Expansion Has Most Critical Impact in Rural Missouri

Missouri Budget Project Report: Medicaid Expansion Has Most Critical Impact in Rural Missouri

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Published by ProgressMissouri
A Missouri Medicaid expansion would reduce the state’s uninsured population by more than one-fourth, bringing an estimated $1.56 billion in new health care funding and providing coverage for roughly 267,000 previously uninsured Missourians, according to a new analysis. The expansion would have the most dramatic impact in rural areas, reducing the uninsured by up to 31 percent.

“The entire state would benefit from the expansion, both by the reduction in the rate of the uninsured, and by the infusion of economic activity into the economy,” said Dr. Timothy McBride, Professor at Washington University in St. Louis. “However, rural counties will have a larger portion of their residents benefit from the expansion, so they will also see a larger positive impact in their economies.”

The Missouri Medicaid Expansion: Good for All Missourians, issued by Washington University health policy expert Dr. Timothy McBride, Saint Louis University Professor of Law Sidney Watson, and Missouri Budget Project Executive Director Amy Blouin, shows that Medicaid expansion would cover more people and attract more health care dollars in urban areas. However, due to several factors, rural areas would experience a greater reduction in the rate of the uninsured, and health care spending would have a larger impact on rural economies.

“Rural residents often have less employer-sponsored insurance and more residents living in poverty, creating higher rates of the uninsured,” said Watson. “Within 21 Missouri counties, more than 10 percent of the county population will be eligible for expanded coverage.”

As a result of a Supreme Court ruling earlier this year, states may choose to expand Medicaid as called for in the federal health care law, the Affordable Care Act. In Missouri, the expansion would extend eligibility from 19 percent of the federal poverty level to 138 percent. Governor Jay Nixon has indicated that he will include the Medicaid expansion in his budget to be released later this month. As legislators convene for the legislative session that begins Wednesday, they will begin discussing whether to expand Medicaid in Missouri.

“The expansion will have positive consequences for health outcomes and the economy throughout the state,” said Blouin. “But despite popular misconceptions, legislators should understand that the most dramatic impact will be on the rural areas that the majority of them represent.”

The full report can be found at http://mobudget.org/files/Medicaid_Expansion_Rural_1-2013.pdf
A Missouri Medicaid expansion would reduce the state’s uninsured population by more than one-fourth, bringing an estimated $1.56 billion in new health care funding and providing coverage for roughly 267,000 previously uninsured Missourians, according to a new analysis. The expansion would have the most dramatic impact in rural areas, reducing the uninsured by up to 31 percent.

“The entire state would benefit from the expansion, both by the reduction in the rate of the uninsured, and by the infusion of economic activity into the economy,” said Dr. Timothy McBride, Professor at Washington University in St. Louis. “However, rural counties will have a larger portion of their residents benefit from the expansion, so they will also see a larger positive impact in their economies.”

The Missouri Medicaid Expansion: Good for All Missourians, issued by Washington University health policy expert Dr. Timothy McBride, Saint Louis University Professor of Law Sidney Watson, and Missouri Budget Project Executive Director Amy Blouin, shows that Medicaid expansion would cover more people and attract more health care dollars in urban areas. However, due to several factors, rural areas would experience a greater reduction in the rate of the uninsured, and health care spending would have a larger impact on rural economies.

“Rural residents often have less employer-sponsored insurance and more residents living in poverty, creating higher rates of the uninsured,” said Watson. “Within 21 Missouri counties, more than 10 percent of the county population will be eligible for expanded coverage.”

As a result of a Supreme Court ruling earlier this year, states may choose to expand Medicaid as called for in the federal health care law, the Affordable Care Act. In Missouri, the expansion would extend eligibility from 19 percent of the federal poverty level to 138 percent. Governor Jay Nixon has indicated that he will include the Medicaid expansion in his budget to be released later this month. As legislators convene for the legislative session that begins Wednesday, they will begin discussing whether to expand Medicaid in Missouri.

“The expansion will have positive consequences for health outcomes and the economy throughout the state,” said Blouin. “But despite popular misconceptions, legislators should understand that the most dramatic impact will be on the rural areas that the majority of them represent.”

The full report can be found at http://mobudget.org/files/Medicaid_Expansion_Rural_1-2013.pdf

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Published by: ProgressMissouri on Jan 08, 2013
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Te Missouri Medicaid Expansion: Good for All Missourians 
The Most Dramatic Impact is in Rural Areas
Impact on the Uninsured by Region
 Te Missouri Medicaid Expansion: Good or All Missourians
Most Critical Impact in Rural Missouri, Reducing Uninsured by Up to 31 Percent  January 2013
Dr. imothy McBride; Washington University Sidney Watson, J.D.; Saint Louis University School of Law Amy Blouin, Missouri Budget Project 
Under ederal health care reorm, Missouri has a new opportunity to oer Medicaid insurance coverage to adultsstarting in 2014. I approved by Missouri lawmakers, Medicaid eligibility would extend rom the current 19percent o the ederal poverty level to 138 percent,
reducing the state’s uninsured by more than one-fourth,providing coverage for roughly 267,000 previously uninsured Missourians, and bringing an estimated $1.56billion in new federal health care matching funds into the state’s economy in 2014.
 Tis report estimates the impacto the Medicaid expansion atthe local level, concluding that
expanding Medicaid would helpevery region in the state, but  would have the most dramaticimpact in rural areas.
While theexpansion would cover morepeople and attract more healthcare dollars in the urban areas o Kansas City and St. Louis, thebiggest impact would be in ruralregions, reducing the uninsured by as much as 31 percent in Southeast Missouri.In contrast, the reductions in the uninsured would be lower in the St. Louis and KansasCity regions (26 and 27 percent respectively).(See Appendix or detailed tables).
 
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Te Missouri Medicaid Expansion: Good for All Missourians 
Expanding Medicaid Would Have Most Signifcant Impact on Rural Missouri
Missouri currently restricts eligibility or Medicaid to low-income children, pregnant women, people withdisabilities who are unable to work, seniors, and very low-income parents. Eligibility is limited or low-incomeparents to those earning less than 19 percent o the ederal poverty level (FPL), or approximately $292 permonth or a amily o three. Eligibility or Missourians with disabilities ends at 85 percent o the poverty level.
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  Te Medicaid expansion would extend Medicaid eligibility to 138 percent o FPL (the equivalent o $2,195 inmonthly income or a amily o three) or those including working parents, working adults without children, andMissourians with disabilities. Te expansion is ully ederally unded or the rst three years and requires only a 10percent state match even when ully phased in.Under the expansion, about 267,000 uninsured Missourians could gain access to health coverage, including working parents, other low wage workers, the recently jobless, high school and college graduates looking or ulltime employment, veterans, and the homeless, reducing the state’s uninsured by more than one-ourth, or 28percent.
Rural counties wouldexperience an evenhigher reductionin their uninsuredpopulations.
 Compared to urbanareas o the state, ruralMissouri counties canexpect to have a largerportion o their populationbenet directly rom theexpansion because rural areastend to have higher rates o uninsurance due to lower rateso employer-sponsored insurance,more residents living in poverty,and other actors.
2
Whateverthe cause,
as shown in the mapon this page, within 21 rural Missouri counties, more than 10percent of the county population will be eligible for the expandedMedicaid coverage, surpassing urban counties.
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Missouri Medicaid also has special coverage or low-income women with breast or cervical cancer, or people in need o amily planning services. Kaiser Commission on Medicaid and the
Uninsured, Medicaid: A Primer 
(June 2010).
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See, Te Current and Future Role and Impact o Medicaid In Rural Health, RUPRI Rural Health Panel, September 2012, available athttp://www.rupri.org/Forms/HealthPanel_Medicaid_Sept2012.pd.
Ever
 
y Part o the State Benefts
Percent o County Populations Eligible or Insurance Under the Expansion
 
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Te Missouri Medicaid Expansion: Good for All Missourians 
Local Economies Troughout Missouri Would Beneft rom Medicaid Expansion
 Te Medicaid expansion would bring signicant new spending into Missouri because the ederal Medicaid matchpays nearly all o the costs o expanding coverage inMissouri. Te match will pay 100 percent o the costs orthe rst three years (2014-16), with a gradual reductiondown to 90 percent in 2020 and beyond.In 2014, the Medicaid initiative is estimated to bringan additional $1.56 billion into the state’s economy, theequivalent o bringing a new large employer to the state.
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 Because a higher percentage o people in rural areas wouldbenet rom the Medicaid expansion, the impact o thisinusion o ederal dollars would in act be larger in ruralareas in Missouri.
 Without the Medicaid Expansion, Working Missourians Will Continue to Lack Insurance
I Missouri does not implement the Medicaid expansion, low-income, working Missourians will ace a signicantgap in potential coverage. Te health reorm law provides Missourians earning between 100 and 400 percento the FPL (approximately $11,000-$45,000 or an individual and $19,000-$77,000 or a amily o three) new ederal premium tax credits to purchase sliding scale individual health insurance plans through the newly createdHealth Insurance Exchange i they don’t have access to aordable employer-sponsored coverage. However,Missourians with incomes under 100 percent FPL will not have access to these tax credits. Teir only option isthe Medicaid expansion. Because the Medicaid expansion has a more signicant impact on rural Missourians, thegap in coverage without the expansion would more severely impact rural areas o the state. More detailed regionaland county-level data is available in the Appendix o this report.
19% FPL100% FPL
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Missourians Let in Gap Without Expansion
Similar to Bringing in a Major NewCorporation to the State? 
 Expanding Medicaid in 2014 would bring $1.56billion in new dollars to the state of Missouri.Tis is roughly equivalent to the total revenues of Panera Bread Company, which earned $1.8 billion in total revenues in 2012, and has its headquarters in Missouri.(Te St. Louis Regional Chamber & Growth Association (RCGA), 2012)
3
St. Louis Regional Chamber and Growth Association (RCGA), “Greater St. Louis is Home to 21 Fortune 1000 Companies,”http://www.stlrcga.org/x2629.xml

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