KENNETT, Mo. -- In a filled-to-capacity room, concerned residents and area health-care providers met at Bootheel Area Independent Living Services on Wednesday to address Medicaid expansion and reform.

A Missouri panel known as the Citizens and Legislators Working Group on Medicaid Eligibility and Reform listened as people voiced concerns regarding the expansion of Medicaid and what reforms can be made to the system.

According to group vice chairman and state Rep. Ken Hampton, the group grew out of the recognition that "Medicaid expansion has been somewhat of a hot topic." He said the group is made up of legislators, providers and residents from throughout Missouri.

"We have tried to make it a point to go to several different areas in the state of Missouri," he continued. "Dunklin and Pemiscot counties have the highest percentage of Medicaid recipients in the state of Missouri."

The working group was formed by state lawmakers after Medicaid expansion was rejected several times during the 2013 legislative session.

Gov. Jay Nixon supported the expansion plan. It would have provided insurance backed by the government to 300,000 people who are now without coverage. The cost would have been $2.3 billion, with the state being responsible for 10 percent. Expansion of Medicaid will involve expanding to working people and families that can't afford insurance and already are paying taxes.

Federal funding

The Affordable Care Act under President Barack Obama allows for funding in full until the end of 2016 to states that expand adult Medicaid eligibility to incomes of 138 percent of the poverty level. Because of this, there will be no cost to the state until 2017. The cutoff will cover those individuals in households earning $15,850 or less each year, or an annual income of $32,500 for a family of four.

The year 2017 would see an increase in the state's cost to 5 percent and 10 percent by 2020. Current Medicaid cutoff in Missouri for custodial parents is $4,475 each year. This is representative of 19 percent of the poverty level. People without children are not eligible for the insurance.

First to speak at the meeting was John McMillan, who opposes Medicaid expansion. He is against any federal money coming into Missouri and is against expansion under the present system. He said a misconception is it will be funded free by the federal government, but rather that taxpayer money and funds from China would fund it.

On the other side of the discussion, providers, doctors, hospital executives and Medicaid recipients presented their reasons for supporting expansion. Time and time again, their points were the same: If something is not done for the system, either expansion or reform, it is possible hospitals will not have the funds with which to function and will not be able to treat the uninsured and the "working poor."

Also speaking in support of Medicaid expansion was Lester Tilley, who told the committee how Medicaid has helped him pay his medical bills. Tilley suffers from various ailments and has to take several medications. However, since the new regulations for Medicaid spend down have gone into effect, his out-of-pocket expenses have risen to $900 a month. He said that basically is what he receives in Social Security benefits. His co-pay, depending on the prescription, ranges from $300 to $600 a month. He said he sometimes has to go without medication until he and his wife have more money.

He said they are having a hard time financially. Tilley told members of the committee he worked hard all his life, has given to the community by serving 30 years as a volunteer firefighter and feels no shame in asking for help.

"If things don't change, there's going to be a lot of people hurt by this. A lot of people need help now," he said.

Health-care providers

Bootheel Area Independent Living Services executive director Tim Shaw related the story of Carolyn Caraway, a Medicaid patient who recently passed away. She was diagnosed with cancer in 2000 and was given six months to live. At the time, she had a working husband and two small children. Because she had Medicaid, she was able to receive treatment for her disease and lived for 12 more years. However, when her spend-down became too much for her, she was unable to keep up her treatments and had to quit taking them. Because of intervention from Bootheel Area Independent Living Services, she was able to resume her treatments, but passed away.

"The costs of not treating things early is much more expensive when you treat them later," Shaw said. He also touched upon the idea of managed care, of sometimes denying care.

"It will be a terrible thing for people with disabilities," he said, pointing out that sometimes a company really doesn't want to pay for care.

Committee member Dr. Steve Pu of Kennett said he thought the meeting went well. "We had a really good turnout, and I think we really had some excellent testimony," he said. "A lot of factual testimony but a lot of really heartfelt stories about challenges that, really, working people are facing in trying to access health care. I think the overall theme that I've learned from this committee is that everybody on that committee, regardless of what your political persuasion is, really want to help the people. I think everybody would like to do some type of expansion but I think they would feel a lot more comfortable about doing an expansion if they felt that the actual system, the Medicaid system, could run a little bit better [and] more efficiently." He said if the state is to invest so much in health care, they would like to know they are getting more from the money invested.

"I really feel that everybody's got their heart in the right place. It's just that there is a difference of opinion about whether the system runs well or doesn't run well," Pu said.

Pertinent address:

Kennett, Mo.