Recently, editorialists of the News-Press authored an opinion piece entitled, “Remain cautious on Medicaid expansion.” The editorial concluded by opining that Medicaid expansion will cost too much and that all our legislators need to do is to make our state’s Medicaid system more efficient, thereby making it more budget friendly. This is the same stale rhetoric that has been voiced by the Republican-dominated General Assembly for years and says nothing about access. It’s all about dollars and cents.

Yet, 36 other states have expanded Medicaid without going belly-up. Ironically, Missourian’s tax dollars actually are being funneled to the states that have expanded Medicaid!

A study done by the University of Missouri found that expanding Medicaid in Missouri will have a positive effect on our state’s bottom line by creating 24,000 jobs, which in turn will generate $2.3 billion of tax revenues, and over the ensuing six years save $1 billion in insurance premium reductions.

Missourians need to realize that the desperately poor have no access to health care for their chronic conditions and are forced to seek emergency room care when their chronic conditions become acute, possibly leading to even more expensive hospitalizations. Hospitals then “shift” the expense of this uncompensated care to the insured in the form of increased premiums. This vicious cycle has been going on for years in Missouri.

To gain entrance into Missouri’s stringent Medicaid program is extremely difficult, and as a result 267,000 Missourians, most of whom live in rural areas, have no access to health care. Furthermore, rural hospitals have been placed in financial jeopardy and several have closed because we have not expanded Medicaid. The failure of rural hospitals puts entire communities at risk.

In 2010, the Affordable Care Act (Obamacare) was passed, with a key piece of that legislation being Medicaid expansion that expanded the income entry requirements for Medicaid from 100 percent of the FPL (Federal Poverty Level) to 138 percent of the FPL. Thus, an individual’s yearly income entry requirement would jump from roughly $12,000 to $16,000 and for a family of four from roughly $25,000 to $34,000.

If our state legislature would have voted for expansion in 2012, the federal government would have paid 100 percent of the cost for the first three years and 90 percent thereafter, an attractive financial incentive that has appealed to 36 states. Under the current Medicaid agreement, the feds pay 61 percent of the cost and the state 39 percent.

A staunch adversary of Medicaid expansion in our state and a Republican, Todd Richardson, has been appointed by our Republican governor to be director of our Medicaid program. One of his improved efficiency ideas is to privatize Medicaid by having the care of Medicaid patients managed by private insurance companies (this already has happened). We who have been in medicine for a while realize that insurance-driven managed care is in reality rationed care, with the emphasis on claim denial.

Forgotten in all the dialogue concerning dollars, is the moral imperative. We like to believe that we are a Christian nation, founded on Christian ideals, and yet our Republican state legislators continue to find ways to let the almighty dollar stand in the way of morality and the care of 267,000 fellow Missourians.

Dr. Robert Stuber is medical director of the City of St. Joseph Health Department.