Hospitals in Show-Me State Play the Shame Card

In an attempt to illustrate the impact of losing federal Medicaid funding, the Missouri Hospital Association is using data linking the effects of poverty, poor health, and life expectancy in the state and making comparisons to rates in Third World countries.

When elected officials in Missouri decided last year against expanding their Medicaid program under the Affordable Care Act, the Missouri Hospital Association commissioned a report detailing the economic impact of losing the estimated $1 billion each year in federal funding.

Unfortunately, using common sense to explain an obvious point didn't work.

Now the MHA is trying a new tactic: Shame.

Of course, MHA won't call it a shame campaign. They're much too smart to openly embarrass the state and federal lawmakers they're trying to win over. However, shame is clearly the theme that rings through in MHA's report linking the effects of poverty, poor health and life expectancy in Missouri and comparing them with those of Third World countries such as El Salvador, Vietnam, and Angola.

It would be hard to live in any state with these sorts of health statistics and not be embarrassed. For example, MHA reports that:

• Eleven counties in southeast Missouri and the City of St. Louis have average life expectancies less than 74 years. By comparison, Missourians living in these areas can expect to live two years less than the residents of Vietnam and Venezuela, and one year less than Hondurans and Lebanese. On average, they will enjoy the same life span as the population of Iran.
• At 71.3 years, Pemiscot County would have the 85th lowest life expectancy in the world if it were a country—just below El Salvador with an average life expectancy of 71.4 years.
• In 2011, 75% of Missouri's uninsured adults were in the workforce. However, many low-income blue collar and service industry workers lack access to employer-sponsored insurance, while Medicaid coverage is limited.
• In 2013 a single working parent of two can earn no more than $9.59 per day to qualify for Medicaid in Missouri. By contrast, the average daily income in Angola is $13.35. Because of these strict eligibility standards, a large number of Missouri's uninsured are low-income working adults in blue collar and service collar industries.
• On average, an uninsured Missourian was treated in a hospital emergency department every minute of every day in 2012. Throughout the last eight years, ED visits by the uninsured have increased 83% in Missouri, from more than 300,000 in 2004 to nearly 560,000 in 2012.

"Sadly, depending on where you live, your community may be part of Missouri's downward spiral in health status," MHA President/CEO Herb B. Kuhn said in prepared remarks. "The gaps in life expectancy between communities with higher incomes and increased access to care, often separated by mere miles, are profound. That's bad for Missouri and the state's economy."

If it's any consolation, Missouri already ranks 42nd in health status according to America's Health Rankings – close enough to the bottom that it wouldn't be a long drop.

MHA spokesman David M. Dillon says the state's hospitals are hopeful that state legislators and the general public will be motivated to change the status quo once they understand that Missouri health statistics rival those of Third World countries.

"One of the important parts of this report versus a lot of the more academic stuff we have done in the past is that it shines a pretty bright light on comparatives and gives individuals an opportunity to understand it in a way they might not otherwise," he says.

"If you look at the state of the state, there is this preconception about what Medicaid covers and who it covers and you'd think we have two metros so it's an urban problem. Well, not so much. It is very much a rural problem."

Dillon is picking his words carefully. That's because Missouri's hospitals did not create this "preconception" that they now have to overcome. In coarser terms, the report shows that refusing Medicaid expansion dollars hurts rural whites as much if not more than it hurts urban blacks.

The data also show that most of these blacks and whites who could be served by the Medicaid expansion are holding down jobs that provide no health benefits. These people are not the "moochers" and "takers" that some would have us believe. Their common denominator is poverty.

"The low Medicaid eligibility level being $9.59 a day for income just tells you that even adults with children would have a very hard time being eligible," Dillon says.

There is some hope that Missouri elected officials are coming around. The Missouri House and Senate have each formed interim committees to examine the Medicaid expansion to see if they can find a compromise proposal during the 2014 session. Dillon says many lawmakers understand what is at stake.

"There are a lot of them in public who would say 'no' but there are also a lot who would acknowledge what the economic benefit of it is and the impact on their constituents. They want to say 'yes' but there has to be a program that is very Missouri-specific," he says. "That is what you are seeing in other states and last week and this week we have seen governors in other states talk about this issue and create plans that were very tailored to the politics and the needs of their states."

"We are hoping that reports like this help shape the public perception of the problem because frankly, as a community, we get really wrapped up in things like discussing the federal poverty level and most people don't have any connection to that term in their lives," Dillon says.

"That is why we were making an effort this time to talk about what those numbers means and make comparatives to what they might mean. Life expectancy was a good benchmark, so it was going to be easier to show comparatives on [that metric]. Talking about the negative health implications and what they mean is vital."

"It is one thing to talk about what happens in Jefferson City," he said. "It's another thing to put it into the context of how people live their lives."