JEFFERSON CITY, Mo. – When the May 2011 tornado struck Joplin, Arielle Speer lost her home. Losing her house in Joplin forced the single mom to leave her full-time job that provided insurance to live in Oklahoma with her two children, one of whom has autism.
Across the border, Speer qualified for Medicaid assistance. But when she moved home to Joplin, she found herself in a precarious situation: She was one of the more than 14,000 individuals who do not make enough money to qualify for subsidies in the federal health care exchange but make too much to qualify for Medicaid.
Speer is one of the many Missourians stuck in the coverage gap that has been created by the state’s decision to not expand its Medicaid rolls to residents who make as much as 133 percent of the federal poverty level, or about $31,000 a year for a family of four. The decision for states to expand their programs was made optional by a 2012 decision at the U.S. Supreme Court that, ironically, upheld the law’s individual mandate.
Speer, who studies psychology at Missouri Southern State University, makes about $14,000 a year, well below the federal poverty level. Her children qualify for health care assistance in Missouri, but she is stuck in the gap.
“Missouri needs to step up,” she said. “Other states have recognized that their citizens need to have care. It’s time for Missouri to open their eyes. If I’m not healthy, that would leave two little children that the state would be responsible for. This would keep me healthy to work and take care of my kids.”
While Speer is wrapping up her day at work late this afternoon, the newly formed local chapter of Missouri Health Care for All has planned a candlelight vigil in Spiva Park to call on the Missouri Legislature to embrace a proposal that would close the coverage gap. The event was scheduled for the night before lawmakers return to Jefferson City for their annual legislative session. The session closes May 15.
Nearly half the states that have refused to expand their Medicaid systems under the 2010 federal health care law. The start of the 2015 legislative session marks the third year that Medicaid expansion has been debated in Missouri. In 2012, soon after Gov. Jay Nixon was re-elected to a second term, the Democrat announced his support for Medicaid expansion.
Rick Wiseman, one of the organizers and a local advocate for the National Alliance on Mental Illness, said 40 people had registered to attend the event but that the number could fluctuate depending on the weather. Wiseman said the event is to raise awareness about the coverage gap and the large population in Joplin’s corner of the state that remains uninsured.
“I believe that we should take care of our fellow man, and I know many people don’t agree with that, but as a great society, we owe that to the people who can’t take care of themselves,” he said. “Hopefully by standing on Fourth and Main with some banners, we can make more people aware.”
Missouri Health Care for All’s choice to hold a rally in Joplin (and their selection of it to base a new regional office) is not by accident. The region is home to two powerful lawmakers: Sen. Majority Leader Ron Richard, R-Joplin, and incoming House Budget Committee Chairman Tom Flanigan, R-Carthage.
Nixon had hoped that lawmakers would allow Missouri to accept more than $1 billion in federal assistance to expand the program through 2020. By then, the federal share of the costs of expanded coverage is set to drop down to 90 cents on each dollar, leaving the other dime to the state. The concern of Republican opponents such as Flanigan is that the issue is not just about one dime – it is about millions of dollars’ worth of dimes and the fear that the federal government might reduce its share, and in turn, ask for a greater share from Missouri.
“We had a tight budget year last year, have a tighter one we’re looking at now,” Flanigan said. “Anytime we throw money at a project, it has to come from somewhere. Our biggest area we have is education. I don’t think people want us to take money from Webb City, Carl Junction and Carthage, and put it into Medicaid expansion.”
Citing opposition from the leaders of both the House and Senate, Flanigan said the Medicaid focus over the next few months will likely be on reform rather than expansion. When asked about the coverage gap, Flanigan said Medicaid can only be paid for with “available money we have.”
“There’s a conundrum always with state programs,” he said. “Some people qualify, some qualify at a lesser level.”