Rural Missouri lagging in health coverage

Missouri’s rural areas are lagging behind their urban counterparts when it comes to health coverage – and the state’s decision to decline the federal expansion of Medicaid is a significant factor, according to a study published this month.

Passed more than a decade ago, the Affordable Care Act (ACA) allows for generous reimbursement from the federal government for states that allow all citizens living under the federal poverty level to qualify for Medicaid, a joint state-federal program providing health coverage for poor and disabled people. Originally, the law required states to expand Medicaid, but a 2012 U.S. Supreme Court decision made this optional. Missouri’s Medicaid program generally covers some parents, people living with disabilities, pregnant women and children with low income. Working adults living below the poverty level do not qualify – about 34 other states do cover these adults, according to the Kaiser Family Foundation.

The Georgetown University Health Policy Institute Center for Children and Families found that, in states where Medicaid has been expanded, rural areas see a sharp increase in health coverage. Lower incomes in small towns and other rural areas are a factor in that increase. But in states where Medicaid has not expanded, coverage rates in rural areas remain low.

While health coverage for children and families remains a critical issue, access to healthcare – including whether providers are compensated at a fair rate and whether providers accept patients with Medicaid – is also an area in need of study discourse. Missouri’s last comprehensive review of providers accepting Medicaid was released about ten years ago.

MO Gov. Parson calls special session for education, drug…

Gov. Mike Parson announced this week he is calling for a special session of the Missouri general assembly to discuss legislative bills related to science education and drug courts.

The session will be concurrent with the annual “veto” session, in which legislators may vote to override a governor’s veto ruling for any bills from the traditional January-May session.

In a statement announcing the decision, the governor indicated he did not oppose new policy promoting drug courts or robust computer-science education in high schools, but he hoped legislators would, “come up with a more narrowly defined focus” on those policies.

The session will take place the week of Sept. 10-14.

How important is Medicaid and CHIP to children in…

Millions of children in the United States obtain health coverage through federal programs like Medicaid and the Children’s Health Insurance Program (CHIP). Recently, the Georgetown University Health Policy Institute Center for Children and Families launched an interactive map showing the impact of these programs locally.

Specifically, the map shows the percentage of children enrolled in either Medicaid or CHIP by congressional district as of 2016, the most recent year such data is available.

Missouri has eight congressional districts. In five of them, more than 30 percent of children are enrolled in Medicaid or CHIP. In one of them, it is more than 40 percent.

Both federally funded health programs have come under scrutiny as government agencies seek to contain costs, particularly related to Medicaid. Former Gov. Greitens, for example, called for $40 million in cost-containment initiatives in Missouri’s version of the Medicaid program. President Trump in May requested approximately $7 billion in unspent CHIP funds remain unspent to contain costs.

Congress could act on farm/food stamps bill after Labor…

U.S. Rep. Vicky Harzler, R-MO, will serve on a committee which could make sweeping changes to federal policies on food stamps, free or reduced school lunches and farm subsidies.

Both chambers of Congress have passed bills extending the federal Supplemental Nutrition Assistance Program (SNAP). Bill details differ significantly. The House farm bill, called the Agriculture and Nutrition Act of 2018, would reduce enrollment in the SNAP program and increase work requirements for recipients. The Senate version extends the program’s job-training program.

The House bill passed on June 17 by a largely party-line vote of 213-211. The Senate version enjoyed more bipartisan support and passed by a 86-11 margin.

Both bills now go to conference, with House and Senate leadership assigning members of the conference committee. On the House side, Missouri Rep. Vicky Hartzler will be among the committee members.

Negotiations on the conference committee bill are currently ongoing. A vote is not expected until after Labor Day, as the House is in recess from July 27-Labor Day, and the Senate is in recess from Aug. 6-10.

Update: Vote to cut children’s health program fails vote…

By a slim 50-48 margin (with two members not voting), the U.S. Senate blocked a proposal by the Trump Administration to cut $15.4 billion out of the $1.3 trillion federal spending bill Congress passed in February. The administration request called for about half – $7 billion – of the requested cut from funds earmarked for the Children’s Health Insurance Program, or CHIP.

The president’s proposal used a rare policy tool called “rescission”, which calls for funds earmarked for a purpose to not be spent by the government. Presidents rarely submit rescission proposals – the last one to do so was Bill Clinton.

Of the $7 billion in cuts to CHIP appropriations, approximately $2 billion had been set aside for the Child Enrollment Contingency Fund, which protects children in cases when their state of residence runs out of money for CHIP coverage.

The vote in the Senate fell mostly along party lines, with Republicans mostly in support and Democrats opposed. There were, however, two Republican defections: Senators Susan Collins of Maine and Richard Burr of North Carolina.

Opinion: Children’s health program needs support, not cuts

Not more than six months ago, the federal government for the first time in decades failed to re-authorize the federal Children’s Health Insurance Program (CHIP), which provides affordable health coverage for about 9 million children in the United States. Child advocates breathed a sigh of relief a few months ago when Congress finally reauthorized the program.

Now, CHIP is again the subject of efforts to curb federal spending. This week, President Trump announced an effort to cut $15.4 billion out of the $1.3 trillion spending bill Congress passed in March, using a process called “rescission”.

Budget rescission – used by Congress itself but rarely by presidents (Clinton was the last to do so) – is when money that has been appropriated but not spent is withdrawn. Read more “Opinion: Children’s health program needs support, not cuts” →