Credit Governor Mike Parson / File photo

Governor Mike Parson signed an executive order earlier this summer creating a task force to look into something that could bring big changes to how Missourians get—and pay for—their health care.

The task force will look at applying for a waiver from the federal government on the Affordable Care Act, also known as “Obamacare.” These waivers allow states to bypass some federal rules and use their own creative ways to use the federal money in their states. KSMU’s Jennifer Moore asked Governor Parson about the waiver process Wednesday in Springfield. You can hear the interview here:

Parson said the main reason he created the task force is to drive heath care costs down and make the market more competitive.

“I think that’s really the focus of what we’re trying to do is find out what is the best way we can do that? One, for the everyday persons out there, [and] one for the business environment, and how can we be successful," Parson said.

He said a federal waiver would give Missouri more flexibility on the state level. The task force could recommend changes to the insurance "exchange" where people shop for health insurance and the possibility of covering more Missourians under Medicaid.

Using a waiver to expand Missouri’s Medicaid program

Some states have applied for a waiver that allowed them to expand Medicaid—the government health coverage plan for the poor and disabled—on their own innovative terms instead of just going with what was prescribed under the ACA.

The original ACA legislation made it mandatory for states to expand their Medicaid programs to include all residents who earned to 138% of the federal poverty level in income. According to the US Department of Health and Human Services, for a family of four, 100% of the federal poverty level is $25,750 in 2019.

However, when the US Supreme Court ruled on the ACA, it made the Medicaid expansion optional, giving states the choice whether to do so. For those states that choose to expand their Medicaid programs under the ACA, the federal government would pay for the vast majority of the expansion, with state taxpayers picking up 10 percent of the tab starting in 2020.

Parson said the task force may consider an innovative way to expand Medicaid and take advantage of those federal dollars.

“We’ll have everything on the table we can put on the table, and see what’s best for Missouri citizens,” Parson said.

He said he hasn’t been receptive to expanding Medicaid under the ACA as other states have because he believes Missouri’s Medicaid system is currently “broken.”

When asked what specifically needed fixing in the state’s Medicaid program, the governor said the list of eligible participants is inaccurate—including people living out of state and names of people who have died.

For more than five years, Republicans in the Missouri legislature have described the Medicaid system as “broken,” often referring to that as one reason for not endorsing the Medicaid expansion program through the ACA.

Chambers of Commerce and hospital associations have long been in favor of increasing the eligibility rules to include more Missourians on the Medicaid rolls.

Currently, childless adults without a disability, no matter how low their income, do not qualify for Medicaid in Missouri.

According to state data, approximately 70,000 low-income and disabled Missourians were purged from the state's Medicaid program in 2018. And about 60 percent of them lost coverage becuase they failed to reply to a renewal form that came in the mail. You can read more about that here.

Potential changes for rural Missourians

The executive order cites that in 43 Missouri counties more than 15% of the residents there are uninsured. Many of those are in rural Missouri. You can hear some of their personal stories from KSMU’s earlier reporting here.

Parson said he intends to make health care in rural Missouri a “top priority.”

“I came from one of those towns with 356 people. And the reality is, you don’t have doctors there, you don’t have medical services in those small towns. So one, you’ve got to figure out how do we get services to them, whether that’s telemedicine or we get a central office, or maybe it’s something mobile,” Parson said.

“If we don’t take care of them in the counties, you know, and they end up getting in worse situations, they end up just costing more money. So anything we can be on the prevention side of it will be important to me and how they look at that through the task force,” the governor said.

How other states are using waivers

Some of Missouri’s neighboring states have applied for and been granted federal waivers from the ACA.

In Illinois, the waiver is allowing state officials to use federal Medicaid money to treat low income residents with mental health and substance abuse needs.

Indiana also got a federal waiver while US Vice President Mike Pence was still governor there. It decided to include a requirement that low income people contribute to savings accounts, the money of which then goes toward their insurance costs. Indiana’s waiver model is seen by some states as a model for how to expand the government program in other places.

So far, Missouri has not received a dime of federal money earmarked for Medicaid expansion, since lawmakers here have opted not to expand the program.

The task force is expected to make recommendations to the governor by January 31, 2020.

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