Dave Dillon Archives - Missourinet

Parson comments about Missouri House anti-Medicaid expansion funding effort

March 31, 2021 By Alisa Nelson

The Republican-controlled Missouri House of Representatives has given initial approval to defunding a Medicaid expansion effort approved by voters last year. The chamber could choose to use the governor’s $1.9 billion budget request for the expansion to instead help seniors in nursing homes, the developmentally disabled, expand mental health programs, add more public defenders, and for K-12 transportation costs.

Gov. Mike Parson

Here is what Gov. Mike Parson, a fellow Republican, has to say about the House’s effort.

“We’ll have to see how that goes in the Senate there. We did put the money in the budget for that. People did vote for it. Although I didn’t support it (expansion) at the time but the reality of it is, the people of the state voted for it. I thought it was my obligation as governor to make sure we try to get it implemented,” Parson tells Missourinet affiliate KDRO in Sedalia. “We’ll see though. The House voted against that – a little different maneuver I want to say, I guess. We’ll see what the Senate does and we’ll see how it comes out at the end of the day.”

Last year, 53% of Missouri voters approved a ballot measure to expand government-funded health care coverage to about 275,000 low-income adults. Per the measure, the expansion would start in July.

Under the expansion, 90% of the funding comes from the federal government. Missouri picks up the tab for the remaining 10%.

Missouri House Budget Committee Chairman Cody Smith of Carthage hsa been leading the anti-expansion effort.

“The state’s portion of that is in the hundreds of millions of dollars. The power of appropriation belongs solely to the General Assembly. Because the Constitutional amendment did not have a mechanism with which to pay for it, the General Assembly in Missouri has to decide how do we prioritize Medicaid expansion versus all the other budgetary needs we have in this state. So, it’s not a matter of can we carve out the money for this as much as it is a matter of what are we not prioritizing in place of this,” he tells Missourinet. “It is yet to be determined how the General Assembly will ultimately do that, but the implementation of Medicaid expansion requires an appropriation. Again, that is the job of the General Assembly. I’m not interested in pushing this to the courts to decide. I think our job as the General Assembly and as appropriators is to create a balanced budget year over year and that is a matter of prioritizing some needs over others. I’m not trying to set up a Constitutional battle that could ultimately be set up in the courts.”

Some House Democrats say Republicans are ignoring voters by not funding the expansion. They have called on the governor to ensure the effort is funded.

In excerpts from a statement from Missouri House Minority Leader Crystal Quade, D-Springfield, she says Republicans need to stop with the political grandstanding and games.

“The only thing House Republicans have done is declare they would rather bankrupt the state Medicaid program than respect the clear will of the voters and fulfill their most basic oath to follow the constitution. They would rather cling to extreme partisan dogma that holds our state back than accept the tremendous economic and public health benefits expansion will provide. This fight is so unnecessary and little more than a destructive temper tantrum by petulant children who didn’t get their way,” says Quade. “So, after expansion takes effect three months from now and more Missourians enroll, the program at some point will run out of spending authority if House Republicans are successful in defunding Medicaid in the final state budget. That will require the legislature to return for a costly special session to pass a supplemental budget bill to fund Medicaid for the full year. And if Republicans refuse to provide full funding in a supplemental, then the battle will shift to the judicial branch, where it inevitably ends with a court ordering Republicans to comply with the constitution. Every medical organization and patient advocacy group in the state supports expansion. Even the Missouri Chamber of Commerce – as Republican of a group as there is – supports expansion.”

Missouri Hospital Association spokesman Dave Dillon tells Missourinet the fate of this effort has yet to play out.

“We are not currently in a place where we believe that that nuclear option of Medicaid not being expanded is the likelihood,” says Dillon. “Whether this was a first point of negotiation, whether this was a last repudiation of the Affordable Care Act before it’s implemented, any of that is hard to know because there are other legislative paths and there are other activities that are going on that relate to whether we will actually expand on July 1. There is what they call a state plan amendment related to expansion that is close to being able to be send to the federal government to implement. It alone may create, if adopted by the federal government, an entitlement for this expansion. What we can’t know is if there will be lawsuits. We don’t know if the Senate will take action on it. So the essence of the challenge is this – there’s a lot of moving parts. But this isn’t a one and done. The effort isn’t over.”

The House budget bills require one more vote in support of them to get to the Senate.

Missouri primary election spotlight: Can the state afford to expand Medicaid?

August 3, 2020 By Alisa Nelson

A Medicaid expansion measure is one of the hot items at the ballot box in Tuesday’s primary election. Missouri voters will be asked whether to expand Medicaid to another 230,000 low-income adults. Currently, about 950,000 Missourians get government-funded healthcare. Under Amendment 2, Missouri adults earning up to $18,000 annually could qualify.

Missouri primary election spotlight: Can the state afford to expand Medicaid?

The clash between those for and against the plan has been largely about the way Medicaid expansion would affect the state’s bank account and philosophical contrasts. The messaging is very different depending on who you talk to.

During a statewide anti-expansion tour, State Treasurer Scott Fitzpatrick, a Republican, says the plan would cost the state another $200 million annually and would mean less money for other priorities.

“We fund prisons and if we want to close prisons and let violent criminals out of jail – that’s one option,” he says. “If we want to turn into Illinois and not fund our pension obligations – that’s another option and turn into a state with a junk credit rating. When you get down to it, one of the few discretionary items that we can decide how much money we’re going to spend without substantial consequences to the state is on education.”

Fitzpatrick, a former chairman of the House Budget Committee, says Missouri’s Medicaid obligations already make up about 40% of the state’s annual operating budget and it continues to grow each year.

“The state of Missouri already has a very generous Medicaid opportunities for families with children,” he says. “If you have a family and you have children and you are making less than 300% of the federal poverty level, which for a family of four is about $76,000, you can get your kids on Medicaid in the state of Missouri. If you are a pregnant woman and you need prenatal care and you don’t have access to health insurance and you are making less than 300% of the federal poverty level, you can get on Medicaid in the state of Missouri. The people that we are talking about, by and large expanding Medicaid to, are people who are working age, who are physically able to work and in many cases are choosing not to for whatever reason.”

State Representative Kip Kendrick, D-Columbia, insists the state would save money. Kendrick is the ranking Democrat on the House Budget Committee.

“Most states actually see a cost savings in the first year to two years and then that cost savings continues to grow,” Kendrick tells Missourinet affiliate KWIX in Moberly. “As more people come on, they tend to come on to that expanded role at a 90/10 (federal) match rather than a 60/40 (federal) match as you typically see in states that haven’t expanded. So, it’ll end up being cost savings for the state and provide greater access to healthcare and do a lot to shore up our hospitals and clinics around the state at a difficult time in the middle of a pandemic.”

A study by Washington University in St. Louis says Missouri would save about $39 million if the state expanded Medicaid. The analysis, done by the school’s Center for Health Economics and Policy, says the expansion would cost the state an estimated $118 million.

Sen. Bob Onder, R-Lake St. Louis, was also among a line of Republican legislators at the anti-expansion tour in Jefferson City.

“I would point out that the average Medicaid expansion state has seen cost overruns of 154%,” he says.

Onder, a practicing physician, says about 60% of the Medicaid expansion population already has private health insurance. If the ballot measure passes, he says they will be kicked off their insurance.

Gov. Mike Parson opposes the ballot measure and has the same financial stance as his Republican allies. During a press conference in May, Parson said the state budget is tough enough to handle with the coronavirus outbreak, let alone if Medicaid is expanded.

“There’s absolutely not going to be any extra money whatsoever,” says Parson. “Look, I don’t think it’s a time to be expanding anything in the state of Missouri right now. I’m telling you, we are going to have challenges going in to 2021 for sure when it comes to just meeting the budget with what we currently have.”

The Republican-leaning Missouri Chamber of Commerce says it backs the proposal that it says would lead to another 16,000 jobs per year for five years. Missourinet’s attempts to get the Chamber’s response about its support were not answered but in an initial statement expressing its position, President Dan Mehan called Amendment 2 a “pro-jobs measure” that will help fuel economic growth throughout our state.

“While this data makes a clear case for passing Amendment 2, the benefits of Medicaid expansion are even more significant during this time of economic hardship,” says Mehan.

Missouri Hospital Association spokesperson Dave Dillon tells Missourinet the healthcare group supports the expansion effort.

“It’s an important tool in getting people who need care some care and getting them comfortable with the idea of getting it when they need it. And that is to say that other parts of the Affordable Care Act were about keeping people healthy. You get paid – not necessarily for doing a procedure over and over again – but for the outcome of that procedure. To improve people’s health, requires you to put them in a system that you can help maintain their health. Medicaid can be that tool.”

Dillon agrees with the argument that Medicaid expansion is the vehicle for people who were never going to be able to afford to buy their own health insurance.

“But for us, if we’re going to set up a system of penalties for us not being able to keep individuals healthy – and by the way at the same time cost the healthcare system a lot more to treat in the wrong place at the wrong time – then we really need this as a tool in our tool belt to try to get those people to where if they need care for a chronic condition, if they are not even managing and don’t realize that they have diabetes, heart disease or the like, when they show up and need a stint or something really expensive, that’s an unnecessary cost. That’s a cost that we all bear because if that individual can’t pay for it, it’s going to be cost-shifted to people who can.”

He goes on to say the measure would save the entire healthcare system some money.

“There’s a hidden healthcare tax that everybody that’s got a commercial health insurance plan pays,” says Dillon. “That is attributable, in part, to the fact that we have a large number of uninsured and when they need care, they get it. They just don’t get it in an efficient place. They usually get it in the Emergency Department and then we have to write it off.”

Fitzpatrick, from southwest Missouri’s Shell Knob, says Medicaid expansion is billed as the “silver bullet” for struggling hospitals.

“I frankly don’t think that it is. I mean, it might help a little bit but frankly there are hospital systems out there that have problems that exceed what Medicaid expansion itself can solve.”

If Amendment 2 passes, Missouri would become the 38th state to expand government-funded healthcare coverage.

Polls are open Tuesday statewide from 6 a.m. to 7 p.m.

Missouri hospitals scramble to use new COVID-19 reporting system – or risk losing federal help

July 21, 2020 By Alisa Nelson

The federal government abruptly instructed the nation’s hospitals to shift last week to a new system of reporting COVID-19 data. Missouri Hospital Association spokesman Dave Dillon tells Missourinet they were given 72 hours to make the switch.

Missouri hospitals scramble to use new COVID-19 reporting system – or risk losing federal help

“That’s when the wheels started coming off the wagon because the state data is linked to the federal data,” he says. “We were forced into a model that we couldn’t immediately pivot on – both the Missouri Hospitals Association because we needed the rights to get it and hospitals because the datasets weren’t identical. It required changes within their workflows at the hospital and the process in place to upload the data.”

The state has roughly 150 hospitals.

The change resulted in the state and his office losing access to data that helps leaders respond to the coronavirus. Dillon says they both now have most of the access they need but the new challenge is ensuring all Missouri hospitals are using the latest system. Otherwise, the state cannot get an accurate view of hospital supplies available to respond to the virus, including ventilators, hospital beds and personal protective equipment.

“During a time that we’re seeing hospitalizations go up on a daily basis – and we don’t know exactly what they are today because our reporting on it stopped last week – but there is a good chance that we are at or above peak hospitalization that we’ve seen in Missouri. But we can’t know because we’re in the dark as we transfer to a new system. And that’s really, really a very dangerous place to be,” says Dillon. “The world doesn’t change just because we can’t see what’s going on, but a lot of bad things could happen during that time and you can’t manage them. And so, we don’t want to put out data before we can validate that data because we don’t want anyone to have to do anything that wouldn’t be the right thing to do.”

Dillon says to qualify for federal COVID-19 related aid, the federal government is also requiring hospitals to use the new database.

“In some ways, what they did was say ‘You have to shift and if not, then next time there’s an allocation of remdesivir, next time we have PPE or the like, that if you’re not reporting on this system, then you don’t qualify,’” says Dillon.

Remdesivir is an experimental drug said to help reduce the recovery time of seriously ill coronavirus patients.

According to Dillon, the federal government wants slightly different data and slightly more data reported. He says in some instances, the information the feds want is not defined well.

“It took months to put the first system in place to get all of the stakeholders bought in, to get them to report on time and to have them understand exactly what each measure meant. The absence of that clarity is as big of problem as anything technical,” he says. “Ironically, we were getting to a point where organizations were actually automating it. But the problem is if you change all the dataset at the same time you change who you are reporting it to, then what you were doing before isn’t necessarily the same as you are doing now. If you don’t get the right data in, it’s garbage in garbage out. And that’s really the problem.”

In the previous system, hospitals achieved about 99% compliance in reporting requirements.

Dillon says the reason for the switch has not been adequately explained. He thinks Centers for Disease Control and Health and Human Services might have been squabbling over who is in control of the data.

Missouri Hospital Association: There are laws we need changed in the short term to deal with coronavirus

March 13, 2020 By Ashley Byrd

As of this posting, two Missourians have tested positive for the coronavirus out of 73 tested. Others are being triaged through clinics, healthcare providers, telemedicine, and hospitals.

The burden on hospitals at this time is checking, testing and treating symptomatic patients who come into the emergency rooms– whether they have COVID-19 or not. That could change as more patients need acute care for the more severe symptoms.

Missouri Hospital Association spokesperson Dave Dillon says his members are and have been, preparing for months.

Here are excerpts from our interview:

Dillon: The changes are occurring really quickly. We have been working with our state’s federal Congressional delegation for literally months now to move to provide the tools that hospitals need to address this crisis in Missouri particularly but also nationwide because clearly this is something that is international.

The set of tools that hospitals need is very similar across the country.

Missourinet: Right now, are the hospitals ready?

Dillon: The hospitals are ready certainly for what we are seeing now. The goal is to not have something similar to what is currently going on in Italy, them being up against the far end of their capacity to deal with individuals who are sick, especially. The goal in Missouri and elsewhere is to avoid that level of this pandemic. If we take the right steps now through the way that we’re managing the crisis, partially through public health, partially through public information and partially through the way that hospitals interact with the worried well, as well as those who are infected with the virus, then we can flatten the curve.

Missourinet: You mentioned tools, what do you need to prepare?

Dillon: For hospitals, it’s essential to not only see those resources come down in the way of funding but also there are significant laws that govern how hospitals operate. What we need is a degree of flexibility in the laws so that we can ensure that we protect the frontline caregivers, protect the public who may think that they have the coronavirus but do not who come to us for care and in that environment become exposed.

Missourinet: Tell me about some of the specific laws, are they mandated by Congress?

Dillon: No, what it takes is action by the Administration and we are hoping, much like what we saw with the funding for this crisis, that members of Congress can pressure the Administration to quickly take the action that will be necessary to get the resources down to the front lines of care.

One of the most important is EMTALA, the Emergency Medical Treatment and Active Labor Act. That means that anybody who presents themselves to the hospital for care, whatever their problem is, the hospital is required to assess them and stabilize them. That law requires that every individual that comes in our door, that believes they have the coronavirus that we treat them in the hospital setting. That isn’t the best place for what we expect will be a surge of a combination of people who actually do have the virus and individuals who don’t.

It would make a tremendous difference to create a site off of the hospital campus or on the campus away from the emergency department where we can test and treat and not expose the frontline caregivers or people being tested.

Missourinet: What else do you need from the Trump Administration?

Dillon: The question is whether the Administration will properly resource the Cabinet-level positions and below that. For example, the Department of Health and Human Services that runs Medicare and Medicaid. The rules that govern those programs that take care of most of the seniors, the population that is most at risk. We want to make sure that all of the regulations that address care for them, whether that’s in a hospital, a nursing home or in the community, allow us to most effectively deliver care to them. That means that the federal government agrees to pay for things that are not even listed in the current payment scheme, whether that is testing for something that doesn’t have a test code.

All of these things are very small changes but allow a great degree of latitude in the way that care can be delivered.

Missourinet: Do your hospitals have all the test kits that they need right now?

Dillon: The answer is hard to give. The demand for testing is probably higher than the number of kits even available in Missouri. The real issue is whether a citizen can walk into their physician’s office or the emergency department and say, ‘I want to be tested, I think I have coronavirus.” A clinician can ask questions … and potentially eliminate that person who is likely to be at risk. So it’s hard to know what that right number is. Certainly, we would prefer to have more active surveillance of individuals who may be at risk but are not necessarily symptomatic would be optimal. There’s nowhere in the country that has the number of test kits that they would like to have at this point.