What We Can Do In Missouri to Control Costs

When Obamacare was signed by its namesake exactly seven years ago, we were sold a utopian dream of health care for all, lower premiums, and no disruption in care for those who already had insurance. What we got, instead, was a trail of broken promises, misleading claims, and outright lies (anyone remember the “if you like your doctor, you can keep your doctor” promise that eventually became Politifact’s 2013 lie of the year?) about was what sold as the Affordable Care Act but bears little resemblance to “affordable”. It could quite plausibly be rebranded the “Unaffordable Care Act” and few would see the joke because of just how unaffordable health care has become.

About 155 million people are now paying higher premiums and deductibles. Millions were forced to cancel the coverage they had because of burdensome regulations and executive orders and eventually saw markets dwindle to fewer, more expensive coverage plans with fewer carriers. In fact, in 96 of the state’s 114 counties, Missourians have only one carrier to choose from. All of this equals less choice and higher cost for Missourians.

To put it simply, Obamacare has proven to be a broken system and a complete failure. And, who is picking up the cost of that failure? Missouri taxpayers are. Obamacare contains 20 new or higher taxes on American families and small businesses to the tune of more than $1 trillion in new taxes.

This broken and expensive system begs for reform and the debate is based on two very different approaches. There are those who believe we should give more power to the federal government to administer health care. This has resulted in a massive one-size-fits-all government bureaucracy that fails to address access to care issues and, instead, puts our country on an unsustainable course. The other approach is to empower individuals and families in their health care decisions while ensuring access to quality doctors. Our goal should always been to improve the access to and quality of health care without raising taxes and without putting the government in control of the healthcare decisions of Missourians.

Missouri is in experiencing its own problems with an expensive and ineffective government-provided health care system. Over the past 10 years, Medicaid spending has grown by 64% – over 45% more than the next closest major budget item. In fact, right now we are spending about $6 billion more on Medicaid than our children’s education. In addition to runaway costs, study after study has shown that people on Medicaid have health outcomes that are no better, and often worse, than those with no insurance at all. This all points to a program that is not working. One of the moral imperatives of the Medicaid program is that it is supposed to help those truly in need while also respecting those paying for it, the taxpayers. Opponents of Medicaid reform continually wield a straw man argument – that if you support reforming Medicaid, you oppose health care for the poor. But the truth is, if one doesn’t support reforming Medicaid, they’re doubling down on a failed system and shutting the door on real reforms that could provide quality health care to those who most need it.

We know that transparency and personal responsibility in health care is needed to bring down costs, increase quality of care, and cut down on overutilization and waste in the Medicaid system. In the private insurance market, most patients don’t know what they are actually paying for when they go to the hospital and don’t find out until they get their bill. Health care transparency language passed in Senate Bill 608 in 2016 will help patients make better decisions about the care they need and where they want to receive that care. Knowing the true cost of health care encourages competition and then the market will help drive down costs.

We also know it costs more to treat patients in the ER and that Medicaid patients use the ER more than other patients. Medicaid recipients also fail to show up for their doctor’s appointments at a much higher rate, forcing doctors to double and even triple-book appointments. Most private insurance plans require patients to cancel an appointment at least 24 hours in advance or they will be charged a missed appointment fee. Why don’t the same rules apply to the Medicaid population? Senate Bill 608 included provisions to charge a nominal co-pay for nonemergency use of the emergency room and creates a graduated missed appointment fee for patients that fail to cancel appointments ahead of time.

Last session, we also looked for ways to reduce fraud and abuse in Missouri’s welfare system. Another bill I sponsored, Senate Bill 607, requires the Department of Social Services to contract with a third party to verify eligibility for public assistance programs. Fraud and abuse in the system ends up diverting our resources away from those who truly need help.

One of our more innovative programs in the state, Show-Me ECHO, is showing approximately $8.3 million in Medicaid savings. Show-Me ECHO is a cost-effective, knowledge-sharing network that helps lead to better health outcomes for patients and can fundamentally change people’s lives. It expands access to best-practice specialty care to patients close to home especially in rural communities.

This session, I’ve introduced Senate Bill 28 which would allow Missouri to apply for a global waiver to administer Medicaid. The only way we are going to fix the state’s budget problems and improve the health of those on Medicaid is to control costs and give the state more discretion over the program. Right now, the federal government gives us little to no flexibility to make the program more efficient or rein in costs. Missouri should be able craft a sustainable program that stands the test of time and that fits our needs and priorities – not Washington, D.C.’s. Most can just look at the mess of Obamacare and the federal debt and realize the state can run the Medicaid program better than the federal government can.

We need realistic solutions to the health care problems of our state. Medicaid may be free to recipients, but the taxpayers are footing the bill, and the bill is out of control. Maintaining the status quo or scoring political points in not going to fix the problem. Nor will it fix problems in the private health insurance market. Think of what we could do if the regulations were cut in half. We could develop policies that encourage better health outcomes and patients to have more investment in their health care. We will continue to work on these polices as session continues, and we will also continue to keep our eyes on Washington as health care reform takes shape.

Sen. David Sater, R-Cassville

District 29