State Rep. Paul Curtman, R-Union

Two local state legislators are opposed to expanding Medicaid under the Affordable Care Act without first making reforms.

Meanwhile, there are about 215,745 Missourians who are ineligible for Medicaid and federal subsidies under the Affordable Care Act, according to the state.

“We really think Missouri should take advantage of the opportunity to close the coverage gap that’s leaving so many of our citizens with no options for health insurance,” said Jen Bersdale, executive director of Missouri Health Care for All.

But State Rep. Paul Curtman, R-Union, said he thinks expanding Medicaid without reforms could actually “undermine” efforts to help people and that it would be “fiscally problematic.”

Make Problems Worse?

The system is already struggling to deliver services and adding more people to the rolls will just “inflate” problems, Curtman said.

“The system by and large in my opinion has horrible customer service,” Curtman said.

People seeking Medicaid services have had trouble getting phone calls returned and have been put through a maze of people to contact, he said. It can be a time-consuming process for people whose cases are put on the back-burner, Curtman added.

“Before any expansion takes place I firmly believe that we have to make sure the system actually works for people, and right now it doesn’t work for a lot of people,” he said.

He said there are doctors in the House and Senate who are working on possible reforms to the system and he is following their lead and listening to their ideas.

Curtman said one idea to improve the Medicaid system is to better measure the productivity of the program by determining how many people’s needs are being met.

‘Great Deal’

Under the Affordable Care Act, the federal government will provide states with funding to expand Medicaid rolls to cover those making up to 138 percent of the federal poverty level.

The federal government says it will cover 100 percent of the cost of the newly eligible adults through 2016. The federal government’s share would gradually go down to 90 percent by 2020.

This is a great deal that Missouri is not taking advantage of, Bersdale said.

If the state accepted the federal dollars to expand Medicaid, more people could get health insurance, hospitals could be protected and jobs could be created, Bersdale said.

But State Rep. Justin Alferman, R-Hermann, said he does not take the federal government at its word that it will deliver on the funding.

Alferman said he has “zero appetite” for Medicaid expansion without reforming the program to require more personal responsibility.

“We currently have a program that is rampant with waste, fraud and abuse,” he said. “Throwing more money at a broken system never makes sense to me.”

But Bersdale said, “We certainly don’t think (the Legislature) should be trying to reform (Medicaid) before expanding it. We’re certainly open to looking at hybrid legislation that does both.”

Curtman said the cost of expansion will fall on Missouri when the federal government begins to reduce its share of the cost.

The state already struggles to fund education, corrections and highway infrastructure, he said.

As for the more than 200,000 who are ineligible for Medicaid and discounts under the Affordable Care Act, Curtman said he is not exactly sure about the demographics of the people in that category and that he would need to do more research. Those people could be addressed by reforming Medicaid, he said.

Medicaid expansion will be a topic going into the legislative session that starts Jan. 7, Bersdale said.

“We certainly are going to have people from all around the state really speaking up in support of Medicaid expansion,” Bersdale said. “We know that people in every community want it; we know that people in every community need it. We also know that there are elected officials in both parties, in both chambers who know that it’s the right thing to do.”