51黑料

CLINTON, Mo. 鈥� Craig Thompson, chief executive of Golden Valley Memorial Healthcare, choked up Wednesday while trying to explain how a looming vote on a federal budget bill could affect his hospital鈥檚 ability to care for rural residents in a several-county area halfway between Kansas City and Springfield.

The proposed changes to the Medicaid program could shutter his hospital system, Thompson said, which not only means the loss of an emergency department, but the loss of primary care offices and specialty services.

About 80% of Golden Valley鈥檚 patients are on Medicaid, he said. Most of them are farmers, ranchers, small business owners and children. They would find themselves sicker and miss more days of work or school.

鈥淥ne of my greatest fears with this, and there鈥檚 a lot them,鈥� Thompson said, 鈥渋s what these cuts would do to access to maternity care. If we were to stop delivering babies, there鈥檇 be another huge maternity care desert in the portion of the state that we care for.鈥�

Hospital leaders, patient advocacy groups and health policy experts across Missouri continue to raise alarm bells during this week鈥檚 final stretch to an expected vote by the U.S. Senate on a sweeping federal budget bill.

They warn that cuts to Medicaid and other health programs will have devastating impacts that will leave tens of thousands of Missourians without health insurance, shutter rural hospitals and strain state finances.

Missouri stands to lose $23 billion in federal Medicaid funds over the next 10 years, said Sheldon Weisgrau, vice president of health policy at the Missouri Foundation for Health, at a press conference Wednesday organized by the nationwide nonprofit Protect Our Care.

鈥淲e can鈥檛 lose sight of the huge economic impact that Medicaid has on our state and our economy,鈥� Weisgrau said. 鈥淲hen we are looking at reducing billions of dollars in federal funding a year, we are looking at a less vibrant economy. We are looking at lost jobs. We鈥檙e just looking at a less robust state.鈥�

Trump wants bill by July 4

The Senate is debating the U.S. House-passed version of the legislation known as the 鈥�,鈥� which would reduce federal Medicaid spending by about $800 billion and reduce hundred hundreds of billions in funding for the Affordable Care Act over the next 10 years. President Donald Trump has urged Congress to get a final bill to his desk by July 4.

Republicans argue the cuts will only affect those who do not actually qualify for the health coverage, able-bodied people who choose not to work and undocumented immigrants.

鈥淭he Senate is in the process of making the Big Beautiful Bill even more beautiful. I look forward to working with my colleagues to strengthen Medicaid for those who need it, especially for Americans with disabilities, by cutting fraud and abuse out of the system,鈥� Republican U.S. Sen. Eric Schmitt of Missouri said in a statement.

However, providers and patient advocates say such massive cuts will disrupt access to health care for all of the more than 1.2 million Missourians covered by Medicaid 鈥� a complex federal and state funding partnership that covers health services for the elderly, disabled, pregnant women, children and the working poor.

鈥淭here鈥檚 only three ways that states can deal with funding losses of that magnitude,鈥� Weisgrau said. 鈥淭hey can reduce benefits, they can reduce enrollment in the program, or they can reduce what they pay providers. Most likely, they will do all three.鈥�

About 210,000 Missourians would lose health coverage by 2034 as a result of the proposed Medicaid cuts and changes to the Affordable Care Act, according to a state-by-state analysis of the House-approved bill by the Center for American Progress using projections by the Congressional Budget Office.

Some versions of the proposed bill will end the 90% federal contribution for poor adults covered under Medicaid expansion, which Missouri voters approved in 2020. About 350,000 Missourians are currently covered under the expansion.

Dr. Karen Joynt Maddox, a Washington University cardiologist at Barnes-Jewish Hospital who advocated for the expansion, said newly insured patients are now able to see a doctor for high blood pressure and prevent heart attacks or strokes.

鈥淔or many of our patients who are working multiple jobs but still not making ends meet 鈥� waiters, salesclerks, Uber drivers 鈥� or for those who get too sick to work and lose their insurance as a result 鈥� Medicaid is the difference between being able to afford cancer treatment or going without,鈥� Joynt Maddox said. 鈥淚t鈥檚 literally lifesaving.鈥�

Provider tax targeted

Also on the chopping block in the bill is a state tax levied on medical providers such as hospitals, which nearly all states use to generate billions of dollars a year to help pay for their share of the Medicaid program and increase reimbursements for providers.

The Senate鈥檚 version of the bill would gradually lower the current provider tax rate, which has hovered around 5.5% a year in Missouri, to 3.5% by 2031. The Missouri Hospital Association warns the reduction will cost the state $1.1 billion annually.

Dave Dillon, spokesman for MHA, said Missouri will either have make cuts in other areas such as education and transportation, or reduce what are already low reimbursement rates for Medicaid providers 鈥� which could lead to loss of providers or dismal care.

鈥淲e are rated at the bottom of the pile of states,鈥� Dillon said. 鈥淚t鈥檚 hard to improve those numbers when you are taking assets and resources away.

Many are expected to lose Medicaid coverage under the bill because of new administrative obstacles such as work requirements for able-bodied adults. But not because they don鈥檛 really qualify, advocates say.

About 90% of Missourians under age 65 with Medicaid are already working or would qualify for an exemption due to disability, caregiving or enrollment as a student, according to the Missouri Budget Project. Research shows that enacting work requirements causes large portions of eligible people to lose coverage solely because of administrative errors.

Rural hospitals are especially vulnerable to the cuts because a much bigger portion of their patients are on Medicaid, and they are already operating on razor-thin margins.

In Missouri, where one-third of rural providers are considered at risk of closure, rural hospitals are projected to lose 21 cents of every Medicaid dollar under the proposed changes, according to data released this week by National Rural Health Association.

Effect on state budget

A spokeswoman for Missouri Gov. Mike Kehoe said Wednesday that officials in the governor鈥檚 office and two agencies that administer Medicaid benefits are monitoring the still-evolving proposal in Congress.

The push to shift more costs to the state comes as Missouri is poised to deplete a surplus of revenue it garnered during the COVID-19 pandemic through the accumulation of federal emergency relief aid.

The state budget awaiting Kehoe鈥檚 signature puts the projected surplus at an estimated $700 million after lawmakers added in millions of additional spending on items including tornado recovery costs in 51黑料.

Kehoe could veto some of the new items placed in the blueprint by lawmakers worth more than $400 million in order to plan ahead for any federal reductions.

Cindy Clark, chief executive of Emmaus Homes, which serves 250 people with intellectual and developmental disabilities in the 51黑料 region through small group homes and community services, was among several advocates for people with disabilities raising alarm bells this week.

The biggest issue for families of clients, Clark said, is uncertainty over how the state with handle the cuts. If they reduce payments to providers, she said, that could decimate the huge gains the agency has made in filling vacancies and reducing turnover since the COVID-19 pandemic.

Families also fear services could be cut, which means their loved one would not learn the skills needed to become more independent.

鈥淭he concern is two-fold, that we will be turn into a crisis-based system as well as an underfunded crisis system,鈥� Clark said. 鈥淭hese are all things that keep us up at night.鈥�

Kurt Erickson of the Post-Dispatch contributed to this report.