On April 29, Families USA released a report that profiles two residents in neighboring states: Iowa, which chose to accept federal funds to extend health coverage to more adults through Medicaid, and Missouri, which has rejected federal funds to do the same. Our report shows how a state’s choice to extend health coverage can make a real difference in people’s lives. It also shows that if a state chooses not to extend coverage, that choice is not only a great injustice—it threatens access to care for Americans who need affordable, quality health care.
Nearly every day, you encounter hardworking people engaged in a job that you rely on—a daycare aide who cares for your child, a cashier who rings up your coffee, or a carpenter working in your neighborhood. But if you live in a state that hasn’t expanded Medicaid, there is a good chance that many of these people—even though they are employed—do not have health insurance.
We recently examined data from the 24 states that have not expanded Medicaid to determine how many of those residents who could benefit from expanded health coverage are working—and which types of jobs they hold.
In most states, the health care sector is among the industry sectors with the largest employment. Health care jobs tend to pay more than a state’s median wages, and growth in this sector can have a positive economic effect on other areas of a state’s economy. Many organizations, ours included, have written about the effects of Medicaid expansion on a state’s economy. Recently, Missouri (a state that has not yet expanded Medicaid) compared its employment growth in the health care sector to that of select Medicaid expansion states.
Missouri’s 1115 waiver program, named the Missouri Mental Health Crisis Prevention Program, was recently submitted to the Centers for Medicare and Medicaid Services (CMS) and is awaiting approval. The goal of Missouri’s waiver is admirable. Unfortunately, this special population waiver program spends more to provide less coverage for fewer people.