The Affordable Care Act (ACA) expands Medicaid – the joint federal-state program that provides health coverage to the poor – to cover more parents and single adults. But states can refuse to expand their program, even though most of the funding comes from the federal government. Speaker of the Missouri House Tim Jones (R-Eureka) has already publicly declared that he will not move legislation forward to expand Medicaid. But refusing the Medicaid expansion will not leave Missouri with the status quo in regards to health care.
The ACA also cuts federal payments to hospitals for the uncompensated care they provide to the poor. When these decisions were made in Washington, it was assumed that hospitals wouldn’t miss the disproportionate hospital share (DSH) payments because more patients would have coverage through Medicaid and Medicaid would reimburse the hospitals. In essence, the Medicaid reimbursements would replace the DSH payments.
But what happens if Missouri refuses to expand Medicaid? Do the cuts in DSH payments still go forward? If so, smaller hospitals may have to close their doors. Will the Obama administration be willing to restore the DSH payments or find other ways to ensure access to health care in states not willing to take on the full Medicaid expansion?