Morning Edition; Jen Bersdale

It's Morning Edition on KRPS. 2020 was a year like no other in recent memory. That includes the passage of Medicaid expansion, Missouri. Joining us this morning is a person who led the fight for expanding Medicaid and Missouri, the Executive Director of Missouri Health Care for All, Jan Burstdale. Jan, thank you for joining me on Morning Edition. Thanks for having me. It's now middle of January 2021. Governor Mike Parsons been sworn in and the legislative session is now underway. So for those across Missouri watching Medicaid expansion unfold, where do we stand today? So it's really early in legislative session. There's a lot still to come including the governor's budget recommendations and then of course the budget work that the legislature will do. But right now, you know, we are certainly expecting that the legislature will honor the vote of the people, which as you noted was a sizable margin. And so yeah, the houses out of session right now, but when they are back, we expect that they'll start working on the budget and really get going on things. And so the first big deadline will be March 1st when Missouri has to have

our state plan amendment, basically the plan for how we're going to do this to the federal government. So I know we're all watching for that deadline. But right now, you know, we are certainly assuming that our legislators will do the right thing and implement this as well. And you brought up Governor Mike Parsons' state of the state speech. I believe that is taking place on January 27th. That's a Wednesday next week. And the reason I wanted to talk to you early in the process of this is that even if you just watch one year, you know how slow the Missouri legislation can work, especially during the coronavirus early on, it seemed that the Missouri legislative, both houses, the state Senate and the House, wanted to continue to meet in person. They didn't want to pass a law saying that they could meet online and vote in line. And here this week, we have the Missouri House out in the Missouri state Senate in. Do you think this, the slowdown will affect these dates or solid dates. They can't be pushed.

Can they? No, they're in the Constitution. So, you know, it really is on the legislature to to meet those dates. Just as they meet the dates in the Constitution for passing the budget every year. And when this program does go into action later this year, how many measurements will it affect? And will we see that number rise due to the pandemic? So the official number based on, you know, the Washington University research that was done before we even filed was north of 230,000 uninsured Missourians will gain coverage. I think it's certainly fair to, you know, guess that that may increase because of the the job losses that have happened during the pandemic. But, you know, I would take that all the more reason why it's critical to get it up and running. I do want to mention the last few years also voters in Maine, Idaho, Nebraska, Utah, and Oklahoma. They've approved similar ballot measures to expanding Medicaid. Now we have Missouri to that list. And I want to highlight that five of those six states I just mentioned

are Republican or red states. What do you think voters in red states lately over the past couple of years have been voting in favor of expanding Medicaid? Well, first off, it's happening in red states because those are the states where our lawmakers haven't passed this on their own. But I think, you know, we have said from the beginning, this shouldn't be a political issue, this shouldn't be a partisan issue. We know that people across the political spectrum want their neighbors to have access to healthcare. And that's really what this is about. So, you know, it's been politics really stopping it up. And so once we got, you know, once we could cut through the politics and the the partisanship that unfortunately is common in our legislature right now, Missourians knew that this was something that would be good for everyone. And bring them bringing up politics. One of the repeated criticisms of Medicaid expansion, regardless of the state's past and is that it'll cost the state too much money on front, right? Because this is a federal reimbursement program. Is that accurate? Yeah, so Medicaid has always been a federal state partnership. So,

Missouri pays part of the cost. The federal government pays part of the cost. And they pay actually the majority of the cost. Medicaid expansion in particular is a really great financial deal for the state because the federal government will pay 90% of the cost for the increased population. And that's, you know, for as long as we've got it. And actually, we will be saving so much on programs where we currently spend money that it sounds counterintuitive. But the state will actually come out ahead financially because we will be able to cover these folks through this program where the federal government is paying most of the cost. Can you put that into dollars? Is there any way to speculate on how much that would save the state of Missouri? So, you know, there's a range and it depends on a number of factors, but the estimate from Washington University, which also was then the estimate that the state auditor put in the ballot measure, was up to a billion dollars in savings a year. You know, could be less, could be more. You know, but I think maybe what's more helpful is people hear that and think,

you know, how could that possibly be true, right? How do you cover 230,000 more people and save money? And that is because we have a lot of these folks covered currently through programs that Missouri pays, you know, a lot more money for the more than the 10 percent will pay for the new population. So, for example, we have a state program that we provide Medicaid to people who are blind and low vision. And we pay 100 percent of that cost as a state. Most of those folks will qualify under this new program based on their income. And so the state will go from paying for 100 percent of their, their care to paying 10 percent of their care. And there are a number of populations like that. And so that's where we see some of the savings. The state is supposed to have a plan in place by July 1st. That is just short, about five and a half months away. Or so, you know, these things come up quick, especially how slow the Missouri, let's say, legislature works sometimes. When will residents of Missouri see the impact? Is this going to be

directly, you know, in the in the weeks and months after July 1st that we're going to be able to see this or is it going to take longer? So actually, we are supposed to have our plan done by March 1st. July 1st is when, according to the constitutional amendment, Missourians can start enrolling. So, you know, that is something that we will certainly be tracking to make sure that it's moving ahead, you know, at a good speed and, you know, that we don't miss that March 1st deadline. But it should be that July 1st, Missourians can start enrolling in this coverage. And, you know, I personally know a number of people who have been waiting a long time and can't wait to get that coverage. And do you have any apprehension that these deadlines won't be met when Governor Parson last year was commenting on it when it passed? He didn't sound thrilled with it. He said they're going to use an implement, whatever the voters of Missouri pass. I remember watching that speech online and he seemed very apprehensive. Do you have any indication that the governor won't follow through with us?

We haven't seen that indication yet. Certainly, there are a lot of eyes on the governor to make sure that it gets done and it gets done cleanly and on time. You know, but I, the governor is his duty to implement a constitutional amendment adopted by Missouri voters. And so, we'll be watching, but, you know, I'm pleased that so far, the indications seem to be that he will honor the will of the voters, you know, regardless of how maybe the personal, personally feels about the issue. Yeah, the only reason I bring this up is apprehensive is that my person is a, he's a, in a way, he's a one-term governor. He filled out the rest of Eric Ratton's term and he can't run again. And I can see the governor saying, well, you know, I know the Missouri voters voted for this, but there's nothing that he can be held accountable because he can't run again in four years. Do you ever worry about that? You know, that's always been a factor in politics and if somebody, you know, do they have a

future election on the line and the decisions that they're making? So, right, he can't run again for governor. You know, sometimes that is freeing, right? Someone doesn't have to worry about kind of the implications with party donors. But, you know, right now, what we're looking at is he is the governor of the state of Missouri. Voters passed this. It's not a law, it's in the state constitution. And so, you know, again, it's our expectation that he will do the right thing and implement it. And, you know, we've said a lot of people will be watching and making sure that happens. That's everything else you like to add or for listeners to know about. I think it's just important to note, you know, that behind all of the politics, we're talking about health care for people that everyone recognizes they need. People have been waiting a decade for this. And of course, if it was important before, it's even more important now that we're in the middle of a global pandemic that shows no sign of going away anytime soon, unfortunately. And so, you know, it's critical for people to get it implemented. And I think it's going to be just

a really great day, you know, when people who have suffered for so long can finally get coverage, not be uninsured in the middle of the pandemic. And, you know, I think it's one of the best things to come out of 2020. A lot of people like to joke about, you know, how rocky the year was, but this is really a high point. And it's going to help a lot of people. Jen Burzdale is the executive director at Missouri Health Care for All. Thank you, thank you for speaking with me. Thank you so much for having me.