Medicaid expansion is the largest public health impact in Missouri that one well-known Independence doctor says she will experience in her lifetime.

Medicaid expansion is the largest public health impact in Missouri that one well-known Independence doctor says she will experience in her lifetime.

“We have an opportunity to make a decision about whether or not we choose to participate in that,” Dr. Bridget McCandless, executive director and co-founder of Shared Care Free Health Clinic, said Monday evening during the Independence Advisory Board of Health’s annual report to the City Council.

While McCandless isn’t a member of the Advisory Board of Health, she participated last month in a panel discussion to board members on Medicaid expansion, along with Charlie Shields, chief operating officer for Truman Medical Center-Lakewood, and Brian Colby, director of outreach and communications at Missouri Health Advocacy Alliance.
Dr. Howard Braby, the board’s longtime chairman, turned most of his time Monday over to McCandless to explain the potential impact of Medicaid expansion in Missouri and in Eastern Jackson County.

“It is going to have some significant effects,” Braby said, “no matter which way our legislature decides.”

The Shared Care Free Health Clinic, on U.S. 24 in Independence, serves low-income, uninsured adults with chronic disease. McCandless helped co-found the clinic in 2000 and has remained closely involved with it.

“This is the group of people for whom Medicaid expansion was designed,” McCandless said.

McCandless encouraged City Council members to endorse the Medicaid expansion, joining the Missouri Chamber of Commerce, the Missouri Hospital Association, the Kansas City City Council, the Kansas City Chamber of Commerce and the Independence Advisory Board of Health.

Understanding that Medicaid is often misunderstood and can be complicated to those who aren’t familiar with it, McCandless explained some of its elementary principles.

Medicaid, McCandless said, is a state and federal partnership to serve low-income individuals. Medicare is for the “care” of the elderly and the permanently disabled, she said, while Medicaid provides “aid” to those with low income.
Medicaid serves categories of individuals, including low-income/blind; low-income/elderly; low-income/pregnant; low-income/child; low-income/disabled; and low-income/parents.

“Nowhere on that list was low-income and sick,” McCandless said, “because that has nothing to do with Medicaid, as it is currently designed.”

The Affordable Care Act would expand that definition to just “low-income,” McCandless said, “so we don’t wait until people become disabled until we start taking care of them. This is going to address the issue of the uninsured for the working poor."

Uninsured individuals are all around us, including many who live and work in Independence, McCandless said, adding, “I would guess that you met at least 10 people who were uninsured today.”

The U.S. Supreme Court ruled last summer that the individual states would decide whether to participate in the Medicaid expansion. Missouri is in the process of deciding whether it will participate.

In the Independence area alone, 20,000 uninsured people will be eligible for Medicaid coverage, if Missouri chooses to participate, McCandless said.

“The state budget benefits substantially by the expansion of Medicaid,” McCandless said.

For example, she said, those in the corrections system and mental health hospitals now receive medical care funded through general revenue, and those expenses would shift to the expanded Medicaid.

“So, there are some immediate net benefits to the state budget,” McCandless said.

In response to those who are concerned about Medicaid expansion becoming a new federal tax, McCandless said the Affordable Care Act is paid by concessions already made by hospitals, whether or not Missouri chooses to participate in the Medicaid expansion.

McCandless also said Medicaid expansion would bring much improved access to mental health care.

“If you’ve tried to get anybody mental health services in Independence, they are sorely lacking. There is just not enough capacity for the number of people who need it,” she said. “Of course, I’m a physical health doctor, and I think that pales in comparison to the advantages we would see on the mental health side.”