Missouri’s Medicaid expansion aims to benefit low-income workers, but sign-ups still lag

Missouri is now the 38th state to expand Medicaid to low-income residents as part of the Affordable Care Act. It's been over a year since voters approved it, and after many delays, the first few thousand people enrolled this month. We begin our coverage by hearing from a few people now eligible for Medicaid about the long wait and urgent need for coverage, and Lisa Desjardins has more.

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  • Judy Woodruff:

    Missouri is officially the 38th state to expand Medicaid to low-income residents as part of the Affordable Care Act.

    It's been over a year since voters approved it, and, after many delays, the first few thousand people enrolled this month.

    In a minute, Lisa Desjardins will talk about the rollout, but we begin by hearing from a few people who are now eligible for Medicaid about the long wait and urgent need for coverage.

  • Nina Canaleno, Missouri:

    My name is Nina Canaleo, and I live in Kansas City, Missouri, and I work nights as a janitor.

  • Autumn Stulz, Missouri:

    My name is Autumn Stultz. I live in Springfield, Missouri. I work through CoxHealth at Home to do stay-at-home care for my mother, who is disabled.

  • Terrence Wise, Missouri:

    My name is Terrence Wise. And I'm a McDonald's worker from Kansas City, Missouri.

  • Amanda Reynolds, Missouri:

    My name is Amanda Reynolds. I live in St. Louis, Missouri.

  • Autumn Stulz:

    I just received the health care coverage through Medicaid expansion. In fact, it came in on Friday. I kind of did a little happy dance.

  • Terrence Wise:

    Right now, I currently have no health care coverage or benefits. I have recently applied for Medicaid, and I'm waiting on a response on my eligibility.

  • Nina Canaleno:

    They said I made too much money. Now, I made $18,000 a year. I'm not sure how that's too much money, because I can't even rent my own apartment. Now I do qualify.

  • Autumn Stulz:

    Once it hit the ballot and people put through it, it should have automatically been implemented. We should not have to fight our government to get what should have been given to us all along as a safety net.

  • Amanda Reynolds, Missouri:

    I'm a longtime cancer patient. I have had cancer off and on since 5 years old, so I have had six different forms of cancer. And as of last week, I just had surgery number 29.

    And when you don't have insurance and you have lived a life of cancer, even if you haven't lived the life of cancer, you're thinking, have I waited too long? Is it something that I'm not getting seen? Am I going to be able to catch it in time?

  • Terrence Wise:

    I'm 42 years old now, and the last time I visited a doctor, I was 18 years old. So it's been over two decades. And it's almost unimaginable to think that any human would go 365 days out of a year without being sick or having some health care problems.

  • Nina Canaleno:

    I have multiple sclerosis. T-cells attack your spinal cord and your brain, and it leaves me numb. There's a lot of people who can't walk. And you have to have MRIs every year. It's not cheap.

  • Amanda Reynolds, Missouri:

    Now I am a Medicaid client. And the first thing the doctor says to me is, that opens a whole new world for you in getting care. So, it was, like, major relief.

  • Autumn Stulz:

    I actually lost somebody very dear to me back in February. She's my sister.

    And if she had the medical coverage all along, when she first started getting sick, she wouldn't have passed on this year. And it took forever for her to be on Medicaid. The cancer and the bacterial infection that took her, it was absolutely horrific. And individuals like that is the reason why I fought so hard.

  • Lisa Desjardins:

    Those are four of the 275,000 people now eligible for Medicaid in Missouri.

    Under the new rules, anyone making up to 138 percent of the poverty level — that's about $30,000 for a family of three — can qualify. Previously, that was just $4, 600 at the qualifying level. And individuals could largely not qualify at all, only people in families or pregnant women, by and large.

    To tell us more, I'm joined by Jason Rosenbaum, politics correspondent for St. Louis Public Radio.

    Jason, we just heard from those four people. I know you have spoken with some of them as well. Even with this expansion, this is still an income level before full-time minimum wage work.

    How do you see and what are you hearing about who this expansion helps and how?

  • Jason Rosenbaum, St. Louis Public Radio:

    Primarily, this is going to help what is colloquially known as the working poor in Missouri. And you're right. This is — these are people that make sometimes below, like, $15 an hour, well below $15 an hour, but people that previously made too much money to qualify for this health care program.

    Missouri had one of the lowest eligibility rates in the entire country. There were some situations where a single mother or single father of one kid, if they made more than $4,000 a year, they couldn't qualify, even though their child could.

    So this is going to be a real lifeline for people like the folks you talked to, some of whom I have also talked to, who have had really serious health problems and are now going to be incentivized to go to the doctor and get them at least dealt with before they have to go to the emergency room.

  • Lisa Desjardins:

    It really strikes me that Missouri voters, including some Trump voters, firmly backed this when they went to the polls.

    Why is it that Republicans have been fighting so hard to try and block it?

  • Jason Rosenbaum:

    This has been a philosophical hill to die on for Missouri Republicans since at least 2005. That's the year that then-Governor Matt Blunt and the legislature made deep cuts to eligibility.

    And even after Missourians elected a Democratic governor in Jay Nixon in 2008, he was unsuccessful at raising eligibility, even after the Affordable Care Act passed, and the federal government was going to pay for all or the vast majority of Medicaid expansion.

    But what really tipped the balance in 2020 was that hospitals in Missouri just were fed up with the situation. And while Medicaid expansion is not going to completely get rid of the problem of uncompensated care, hospitals had been struggling to treat people that don't have health care coverage, especially in rural Missouri.

    So they primarily funded the 2020 ballot initiative. And the pro-side ran a very robust, a very well-funded campaign that had slick television ads up against an opposition of mainly Republicans that didn't have basically anything.

  • Lisa Desjardins:

    I know those supporting this expansion have also gotten help from the $1 billion almost from the American Rescue Plan that's now going to be coming into the state.

    But I'm curious. So far, it looks like just a few thousand folks have signed up for this expanded Medicaid. Do we know why so few?

  • Jason Rosenbaum:

    I think it's probably because a lot of people who would qualify for Medicaid don't have easy access to computers or phones, like we do.

    If you're making $10,000 a year, you may not be able to access the information that you even know that Medicaid expansion is here. So, it's really going to fall on social service organizations that primarily deal with Medicaid patients to reach out to some of these hard-to-reach communities, especially in rural Missouri, which doesn't have good Internet access at all, where you could find potentially thousands of people that could benefit from Medicaid expansion, and get the word out that this is available to them.

    We still — this is still a Republican state with a Republican governorship and a Republican legislature. The chances that the state is going to widely promote the fact that Medicaid expansion is here is, frankly, not very high.

  • Lisa Desjardins:

    Health care, such an important topic.

    Jason Rosenbaum, St. Louis Public Radio, thank you for joining us.

  • Jason Rosenbaum:

    Thank you

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