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Failure To Expand Medicaid Hits Community Health Centers Hard

Missouri’s refusal to expand Medicaid will leave more than 56,000 patients who use community health centers without insurance, according to a report released Friday by researchers at George Washington University.

Similarly, Kansas’ refusal to expand Medicaid will leave more than 24,000 community health center patients without insurance, according to the report.

“In effect, the uninsured patients who would have been eligible under health reform will continue to forgo or delay care and remain at increased risk for more costly health problems that could have been prevented or treated earlier,” the report states.

The report — which addresses the impact of the Affordable Care Act on uninsured health center patients nationwide — says that, overall, 1.1 million eligible patients in the 24 states that have opted out of Medicaid expansion “are expected to remain without access to affordable coverage.”

Community health centers are nonprofit organizations that provide primary and related health services to medically underserved areas.

“Obviously, considering the population that we serve, most of our patients are Medicaid patients," says Dr. Sudeep Ross, chief health officer of Samuel U. Rodgers Health Center in Kansas City. "This is going to mean a lot of folks without insurance, and that’s unfortunate.

“What’s the saying? We’re robbing Peter to pay Paul. People are going to get sick no matter what income they have and will need medical care. Now, if there’s not insurance, they may put off medical care, but eventually they’ll wind up somewhere needing care.”  

Missouri has 23 CHCs; Kansas has 16. In 2012, Missouri’s CHCs served more than 438,000 patients. Kansas’ CHCs served more than 156,000.

Because both states have chosen not to expand Medicaid eligibility, the CHCs won’t benefit from the money they would get from Medicaid, which is much more than they can charge uninsured patients.

In Missouri, for example, CHCs will lose $38 million in Medicaid payments this year, according to the report. In Kansas, it means nearly $11 million in forgone payments.

Nationwide, CHCs in states that have chosen not to expand Medicaid will lose $569 million this year, according to the report. Health centers in states that did expand Medicaid will reap more than $2.1 billion.

“Say we would have received 2,000 patients from the expansion of Medicaid,” Ross says. “Now, say, we only get 1,000. Of course it affects the bottom line and the kinds of programs we designed.”

The refusal of Medicaid funding has economic implications as well.

“In addition to forgoing the major gains in overall cost savings from greater access to preventive services, these states will also forgo gains in job creation, labor income and productivity, and related tax revenues,” the report states.

Joseph Pierle, CEO of the Missouri Primary Care Association, which represents community health centers in the state, says the failure to expand Medicaid will place Missouri health providers at a competitive disadvantage to health systems in neighboring states that have expanded Medicaid.

"We're concerned those systems will poach providers that we have or that we're trying to recruit," he says. "This will exacerbate shortages, thereby making access for the uninsured even more of a challenge."

If all states were to expand Medicaid, 5.2 million uninsured health center patients would gain coverage, the report finds. 

"I can't think of any other health policy issue that has universal support from the health provider community, the business community, the faith community - where the support is huge - and yet is gaining so little traction," Pierle says.

Dan Margolies has been a reporter for the Kansas City Business Journal, The Kansas City Star, and KCUR Public Radio. He retired as a reporter in December 2022 after a 37-year journalism career.
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