ST. LOUIS, February 24, 2022 — Missourians deserve to receive the coverage they voted for in August 2020. House Joint Resolution (HJR) 117 would undermine the will of the voters, threaten Missourians already receiving care with a risk of losing coverage, and jeopardize our opportunity to experience the economic growth and expansion numerous other states have experienced because of Medicaid expansion.

Residents are frustrated at the continued attempts to challenge expansion efforts. At a recent Saint Louis Regional Health Commission Patient Advisory Board meeting, board members discussed updates on Medicaid expansion and the obstacles encountered despite its passage. One of the advisory board members said, “Yes, we need to talk about that. I’m mad.” Those words resonated with the other members of the advisory board, as well as those of us who are receiving daily updates on the advocacy efforts for Medicaid Expansion. Our patient advisory board is comprised of individuals who have no insurance, are covered by Gateway to Better Health or Medicaid; many of whom have health care issues that require routine doctor visits. After the historic vote in August 2020 to approve Medicaid expansion in our State, our advisory board members were hopeful for a chance to have new or expanded access to health care coverage.

However, despite years of hard work advocating for improved access to care in St. Louis and the state of Missouri, despite 53% of Missouri voters approving an amendment that enshrined Medicaid expansion into the state’s constitution, and despite the Missouri Supreme Court’s affirmation of the will of the people of Missouri by ruling that the state is obligated to expand Medicaid eligibility, efforts continue to deny Missouri residents the health care they voted for…the health care they deserve.

If the General Assembly passes HJR 117, Missouri will take a huge step backwards in ensuring equitable access to care, effectively revoking the expansion of Medicaid. HJR 117 would allow the legislature to determine whether or not to fund expanded Medicaid and to place work reporting requirements on those in the expansion population. These busy work requirements create extra bureaucratic barriers and may cause Medicaid recipients to lose their health care despite being eligible both through prior eligibility requirements and through the constitutionally guaranteed requirements approved under expansion. Further, the wording of HJR 117 is confusing and misleading. Such language will result in voters accidentally approving added work requirements and removal of funding for expansion. In addition to eligibility, services including home and community-based care may be cut, meaning more Missourians may be forced to leave their homes and enter nursing homes to receive their necessary health care.

Should HJR 117 pass, the more than 275,000 Missourians who gained access to health care as a result of the 2020 constitutional amendment, will lose their right to move closer to receiving health equity.

Fortunately, while we have continued to fight for Medicaid expansion and improved access to care, the Saint Louis Regional Health Commission (“RHC”) has been able to provide a bridge in care to St. Louisians through our Gateway to Better Health Program. Since 2012, Gateway to Better Health has provided uninsured adults a way to access to health care until they are able to enroll in health insurance coverage options available through the Affordable Care Act. The program covers primary, specialty, and urgent care services for individuals up to 100% of the Federal Poverty Level. Since the implementation of the Gateway to Better Health program in 2012, the program has provided access to coverage for more than 66,827 otherwise uninsured St. Louis area residents.

However, Gateway to Better Health was intended to be a temporary program, and since Medicaid has been expanded, we have been working to enroll our Gateway patients in Medicaid, a more comprehensive coverage option with benefits such as hospital stays, ER visits, brand name medications, dental fillings and root canals, and much more. With the expansion of Medicaid, this temporary program has officially been rendered obsolete, and is extended only through the authorization of the existing Public Health Emergency (PHE). Once the emergency is no longer in place, this group of patients will join the many thousands who are now at risk of losing coverage and in danger of being unable to access care.

St. Louisans, along with all of our neighbors across the state of Missouri, have a constitutional right to health insurance via Medicaid expansion. At the RHC, we prioritize expanding coverage for the un- or underinsured and achieving health equity. Improving coverage and moving towards achieving health equity depends on the full implementation of Medicaid expansion. The people of Missouri deserve access to the health care they approved.

Statement from Angela F. Brown, CEO, St. Louis Regional Health Commission. This column ran in The St. Louis American and The Longview News-Journal in Texas.

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