Jackson: Access to health care is domestic tranquility – St. Louis Post-Dispatch
When was the last time you read the Preamble of the Constitution? It starts âWe The People â¦,â remember? When you read it did you absorb the ideals it espoused or were they just words? It seems that our stateâs Republican legislators are determined to rewrite it as it relates to any issue they (or the citizens in their respective districts) donât personally agree with, particularly Medicaid expansion. Instead, Missouri has morphed the preamble into: We the people of the divided state of Missouri do not have representatives who are the least bit interested in upholding the wishes of the majority of the stateâs constituents. Justice, domestic tranquility, and providing for the common defense be damned. They are not concerned with the general welfare and have no plans to attempt to secure the blessings of liberty to anyone but themselves.
We have discussed and reported ad nauseam the current history of our Medicaid expansion since the voters approved it in 2020: The governor included the cost in his 2021 budget; Republican state legislators refused to fund it; the governor then removed it from the budget; and after a court determination, was required to advance it anyway.
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Of course, upgrading the stateâs antiquated computer system took months, resulting in lengthy delays in processing the applications. As of early February, there was a backlog of 73,000 cases pending. With the 64,210 cases that have been processed, that is still less than half of the 275,000 people whose eligibility was projected.
Now the legislators want a new constitutional amendment asking voters to reverse their decision. They have advanced a bill to have the programâs finances reviewed annually by the General Assembly. Justifiably, Medicaid eligibility is normally reviewed annually. But imagine if the financing of your employee health insurance or Medicare was continuously reviewed by the people whoâd refused to fund it originally. Many people could find themselves in limbo â eligible for coverage, but not covered. Only those people whose income is below 138% of the federal poverty level are potentially eligible anyway. The 2022 income limit in a one-person household is currently $13,590. Try living on that.
People will argue that Medicaid recipients didnât pay into any system as did the majority of workers and Medicare beneficiaries. (In 2022, age-eligible citizens who never paid in can still buy Medicare at the base rate of $647.50 a month without drug coverage.) I would counter that everyone in the state pays some sort of taxes â sales, gasoline, etc. â so stop judging.
In August 2020, Tod Palmer of television station KSHB in Kansas City wrote an article detailing the rural versus urban percentages of Medicaid beneficiaries based on MoHealthNetâs report. (The Census Bureau uses the density of the population to make the urban versus rural delineation.) Missouri has 114 counties and one independent city (St. Louis), the latter of which is classified as urban. Of these counties, only 14 are considered urban.
At the time of Palmerâs piece, 18.3% of the stateâs rural population was enrolled in Medicaid compared with 13.8% of urban residents. Yet, 67% of rural voters rejected Medicaid expansion in the November 2020 election. Weâll see what percentage of rural residents have filed for benefits since the expansion.
Like petulant little children, our legislators continue to offer bills that diminish the lives of the less fortunate, stomping their feet when being told no and searching for ways to ignore the votersâ will. From their perch in Jefferson City, they look down with judgmental eyes at the people below. Itâs doubtful that any of them lack health insurance, yet they deny the same to their constituents.
A great many medical facilities have closed in Missouri, partially due to a lack of funding. Yet those people in rural areas most determined to re-legislate Medicaid expansion are the ones suffering from the lack of availability of health care. Medicaid would provide preventive screening such as mammograms and colonoscopies that could save lives. It would provide prescriptions for chronic illnesses like high blood pressure, thyroid diseases, and even some diabetic supplies.
Bottom line: If people donât want Medicaid, then donât file. Just donât deny coverage for those who do. And maybe send the legislators a copy of the Preamble.
Janet Y. Jackson is a Post-Dispatch columnist and Editorial Board member.
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