The Patient Protection and Affordable Care Act allows the states in this country to expand Medicaid eligibility for citizens who live on an annual income at or below 138 percent of the federal poverty limit. For a family of four, this is less than $33,000. Expansion would provide health insurance for Missourians who are childless adults, custodial parents, aged, blind or disabled.

In 2015 and 2016 the incremental cost of expanding Medicaid would be paid in full with federal income taxes. Beginning in 2017, up to 5 percent of the costs would become the responsibility of Missouri taxpayers. The amount borne by Missouri taxpayers will increase annually through 2020 and be capped at 10 percent annually. This will be approximately $119 million.

By refusing to use the federal dollars, the leaders of our state have made it impossible for 180,000 Missourians to obtain health insurance. I believe that this is a financial burden we can accept, and this situation has become an ethical test the state has failed.

Additionally, expanding the state's Medicaid commitment would help to address the situation where the costs of caring for the uninsured who use Missouri hospitals are borne by those Missourians, both businesses and employees, who are insured. This situation makes premiums higher than they would be if more Missourians had health insurance.

Our federal tax dollars are already paying for Medicaid expansion in Arkansas, Iowa, Illinois and Kentucky. I think it would be wise to bring some of this money home.

John Piepho, Cape Girardeau