The destiny of all those who currently depend on Medicaid for their healthcare and those 177,000 who were cut in 2005 will soon be decided by the General Assembly when it passes the Senate Bill 577 under Missouri Health Improvement Act of 2007. It will replace Medicaid, which is to sunset in 2008. The proposal is the only option to choose from at the moment. However, the General Assembly has to decide if the current form that the HealthNet is proposed is the right one or it has to be reviewed and modified to meet the needs of those whom it is directed.
The proposal will target those who are presently eligible for Medicaid. This population and those who were eligible for Medicaid in 2005 but were cut out of it are extremely vulnerable populations: children, people with disabilities, elderly and those under the federal poverty line. These Missourians cannot afford private insurance. While it is important to consider the costs of the program to the state (the reason why the cuts were performed and Medicaid is to sunset), it is vital to understand the influence that absence of insurance had on peoples lives. Many people had gone through tremendous alterations in their lives, when they no longer had access to healthcare.
Just imagine, what would happen to each of us personally, when the medical services that we rely on have been taken away. It is hard to imagine, for those of us who never had this kind of problem, but this is the fact that more than 400,000 people in Missouri are experiencing. People stopped using therapies that supported their life. They can not see physicians when their health conditions worsened. In most cases, when the preventive care is not used timely, people end up in emergency rooms. The cost of emergency care is much higher than the cost of preventive care. There are many cases that the emergency care bills could not be paid by the people, who cannot afford the insurance. Now, if you consider the bills that are not paid, the state will need to fill in the gaps. However, the cost of the unpaid medical bills is not the only costs that the state will need to pay. Being without the access to healthcare will indirectly cost a state much more. If the workers are unhealthy, their productivity will decrease, which economically will decrease the revenues the state collects from the taxes. For this reason, when we consider the MO HealthNet, the most important thing is to make healthcare accessible and affordable for all Missourians.
MO HealthNet will not restore health care to all who were cut from Medicaid. Healthcare will be reinstated to only 1800 workers with disability and several thousands of children, including those in foster care under the age of 21. The rest of the 177,000 will remain uninsured. Also, MO HealthNet will encourage uninsured people to buy private insurance, by paying 1/3 of the premium costs. Although this is helpful for some, it will not suit everyone. It will be hard for people needing long-term care, especially persons with disabilities, to get the private insurance. Insurance companies need to make profits. Those who have disabilities or elderly use healthcare services regularly. This means that companies will not be willing to provide persons with disabilities with insurance easily. The state will have to think about additional measures to make sure that all uninsured have access to affordable healthcare.
MO HealthNets primary purpose is preventive care. However there are several preventive care services that are not included in the plan for the persons with disabilities: dental care, vision services and medical equipment (oxygen tanks, wheelchairs, etc) and therapies (occupational, physical and speech). Patients can earn additional services if they are engaged in healthy behavior. Healthy behavior means keeping appointments on time, being engaged in quit smoking and lose weight programs. Lets look at reality. Those who have mental illness are they going to lose their dental care or their vision test because they couldnt make the appointments? People need oxygen to live if going to participate in the healthy behavior. Their health is dependent on the oxygen they need to earn. Or should people start smoking now, so by the time they will need to earn point they should be engaged in quit smoking programs? Therefore, if one does not smoke or does not suffer from obesity, it will be hard to earnpoints to get their dental care or medical equipment. It is not a good plan to have to earn these vital and often unaffordable health care services. Earning points takes time. People need these services right away emergently; they can not wait a year to earn their points. These services should be available to all.
What are the alternatives? HealthNet seems to only cut costs. We need a program that will really make people of Missouri healthier as Gov. Blunt says! To be healthier, Missourians need access to healthcare in the first place. Our legislators need to carefully think through any proposals to replace Medicaid. If the MO HealthNet does not include all the needs that have to be addressed than it is not apparently a good option to choose from. Therefore, the best choice will be to extend Medicaid for one more year until the workable plan which has been presented.
Commentary by Mashura Akilova,
2007 MSW Candidate,
Washington University, St. Louis
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