Much has changed since Freeburg native Father Sylvester Bauer helped establish what is now Mercy St. Francis Hospital in Mountain View 64 years ago.
Many of the residents of that area in south-central Missouri were indigent, so the Daughters of St. Francis of Assisi and lay staff members provided a large portion of their services at little or no cost.
The ongoing evolution of healthcare, along with a lack of available sisters, has rendered that model inadequate, while costs continue to escalate.
Ten years ago, the federal Affordable Care Act (ACA) changed the way the government helps hospitals, including hundreds of small, regional hospitals like Mercy St. Francis, serve patients who cannot afford to pay for treatment.
Specifically, the ACA shifted funding away from federal reimbursements for emergency-room visits, toward helping states pay for making Medicaid available to more people.
Medicaid, established in 1965, is a federal program administered through states to help provide healthcare to people who are least able to pay for it.
Missouri’s version of the program is called Mo HealthNet. It provides health insurance coverage for the elderly poor, the disabled, children and low-income pregnant women/custodial parents.
However, able-bodied adults in Missouri only qualify for MO HealthNet coverage if they earn less than 22 percent of the federal poverty level.
That comes to $5,764 per year for a family of four.
All the while, the shifting of funding from emergency room visits to Medicaid funding was designed to save money. But in states such as Missouri that have not provided broader access to Medicaid, it has created difficulties for hospitals that must still help people without insurance who cannot pay.
Unless something changes, that will eventually threaten access to hospital services in isolated, rural areas of the state.
Numerous legislative efforts to increase Medicaid eligibility in Missouri through the years have failed, prompting proponents to turn to an amendment to the state’s Constitution.
The state’s Roman Catholic bishops have endorsed this amendment, which will appear on a statewide ballot on Tuesday, Aug. 4.
Passage would require a simple majority from voters.
The amendment would expand Medicaid eligibility to qualifying Missouri residents whose income is at or below 133 percent of the federal poverty level — namely, $36,156 per year for a family of four.
It is estimated that between 200,000 and 250,000 additional adults and children would enroll in MO HealthNet if the proposed expansion were implemented.
The federal government would pay 90 percent of the additional cost, with the state paying the other 10 percent.
The U.S. Census Bureau reported in 2018 that 566,000 — 9.4 percent — of Missouri citizens do not have health insurance.
The Missouri Catholic Conference (MCC), public-policy agency for the state’s four Roman Catholic dioceses, citied research showing that in most cases, Medicaid expansion improves access to care, utilization of healthcare services, affordability of care, and financial security among the low-income population.
“It also results in reductions in uncompensated care for hospitals and clinics, improving operating margins and financial performance, thereby helping these providers continue to provide care, especially in remote areas,” the MCC noted.
Brock Ingmire, manager of state policy and advocacy for St. Louis-based Ascension Health, which operates hospitals in more than 20 states, said the effects of Medicaid expansion would be very noticeable in rural areas.
“Medicaid expansion is not the only single-step solution to solving our rural healthcare problems,” he stated. “But there is no doubt that a long-term solution can’t be seen without Medicaid expansion as part of it.”
In a recent MCC podcast (mocatholic.org/news-and-events/mcc-podcast), he said Medicaid expansion in other states has steered more people toward preventive care and cut down on untreated chronic health conditions and unnecessary but expensive visits to hospital emergency rooms.
He pointed to a Kansas Hospital Association’s 2019 internal analysis that predicted an 18-percent decrease in uncompensated care for urban hospitals, a 26-percent decrease for rural hospitals and a 45-percent decrease for frontier hospitals (serving areas with less than six individuals per square mile) if Medicaid were to be expanded in Kansas.
The Catechism of the Catholic Church states that concern for the health of its citizens requires society to “help in the attainment of living conditions that help citizens grow and reach maturity: food and clothing, housing, healthcare, basic education, employment, and social assistance,” (CCC No. 2288).
Many low-income earners in Missouri go without health insurance coverage altogether because of the high cost of health insurance premiums, even when coverage is available through their work or on the health insurance exchange.
This puts them at risk for chronic health problems and prevents early diagnosis and treatment of disease.
“Too many Missouri citizens, including many who are working to support themselves and their families, lack access to affordable healthcare coverage,” the MCC stated. “Missouri’s hospitals also depend upon Medicaid reimbursements to help their bottom line. Providing greater access to health coverage by expanding the Medicaid program will save lives, ensure better outcomes for our most vulnerable families, and is consistent with the bishops’ commitment to life.”
In a joint statement, the state’s Roman Catholic bishops said they support this effort “because of the unmet healthcare needs of the working poor and to ensure the continued delivery of care to those who need it most through the Missouri healthcare system, including Missouri’s Catholic hospitals.”
The statement’s signatories include: Archbishop Robert J. Carlson, apostolic administrator of St. Louis; Bishop James V. Johnston Jr. of Kansas City-St. Joseph; Bishop W. Shawn McKnight of Jefferson City; and Bishop Edward M. Rice of Springfield-Cape Girardeau.
With bipartisan support, federal funding for abortion has been prohibited under the Hyde Amendment each year since 1976.
“We offer this support,” Missouri’s bishops stated, “understanding that current federal law includes pro-life protections in Medicaid through the Hyde Amendment. We encourage Catholics and others of goodwill to give serious consideration to supporting this effort to expand the Missouri Medicaid program.”
For more information about Amendment 2 and Medicaid expansion in Missouri, visit: