JEFFERSON CITY, Mo. – The Missouri Chamber of Commerce and the Missouri Hospital Association on Wednesday layer out a dire case for the future of Missouri’s health care industry without Medicaid expansion in the state.

At a news conference at the Missouri Chamber of Commerce’s headquarters here in Jefferson City, Herb Kuhn, president of the Missouri Hospital Association, said members had cut 1,000 jobs already and are leaving more than 2,100 unfilled awaiting a decision from the state.

“We’re starting to see medical deserts,” he said, hitting rural Missouri harder than much of the rest of the state.

Kuhn said lack of Medicaid expansion, coupled with Missouri’s medical malpractice climate, is making it harder for hospital executives to recruit more doctors and nurses to the state. “We’re in the second tier of the second tier,” he said.

The two organizations pushing expansion laid out their case just days after five Senators took to the floor to voice their opposition to Medicaid expansion and said the issue should be considered dead moving forward.

Dan Mehan, president and CEO of the Missouri Chamber, said the reduction in the state’s 123,000-strong health care workforce may only the start of reductions in the industry. He noted that throughout the economic downturn, the health care industry stayed strong, and is only starting to weaken in the state as Missouri enters its first year without the federal dollars associated with expansion.

“It is the beginning of a trend,” Mehan said. “This problem isn’t going away, it’s getting worse.”

The way the law was set up originally was that in exchange for cutting disproportionate share payments to hospitals (which help cover uncompensated care), the federal government would help pay for an expanded Medicaid program. The Medicaid expansion was initially mandatory when the law was passed in 2010, but the requirement was struck down by the U.S. Supreme Court in its 2012 decision upholding the individual mandate provision.

Mehan said expansion is not a bad thing for the state’s coffers, and pointed to potential savings in the state budget by shifting some of the costs from the state to the federal government. Kuhn was more blunt.

“This isn’t a liability – this is an asset,” he said.

The two agreed that the situation in the capital is much more clear for members following candidate filing, and that the trend may shift moving forward. Mehan, whose organization offers prized endorsements to many candidate based on a number of issues, did not rule criticism of Republicans in 2014 if some legislation does not move forward.

“It depends,” he said. “We’d like to get a good package and see where the chips call.”

The two praised legislation sponsored by Rep. Noel Torpey, R-Independence, that would expand the program to up to 100 percent of the federal poverty level, and provide a subsidy for those making between 100 percent and 138 percent of the FPL (the federal requirement for expansion) to buy a plan in the federal health care marketplace. The Torpey plan also would require Medicaid recipients to maintain employment. His package would require several waivers tom the Department of Health and Human Services.