After last week's Supreme Court decision upholding most of the Affordable Care Act, President Obama declared victory. But there was one major gray cloud -- or silver lining, depending on your point of view -- leaving open the question of Missouri's participation in the expansion of Medicaid envisioned by the federal health care law.
President Obama called the ruling "a victory for people all over this country, whose lives will be more secure because of this law."
While the Supreme Court upheld most of the health care law, its ruling gave states the ability to opt out of the expansion of Medicaid – this expansion was the major way Obama's health care law was going to cover people who are too poor to buy insurance.
The ruling leaves a big question mark here in Missouri where many lawmakers are dead-set against all things "Obamacare."
State Representative Ryan Silvey, a Republican who chairs the House Budget Committee, is against expanding Medicaid eligibility: "I can't imagine there's going to be support in the House or the Senate for it, to be honest."
He said the expansion would cost the state more than $100 million a year, starting in 2017. But the federal government would contribute far more -- as much as $10 billion by the end of the decade.
"Unfortunately, some initial reaction is the typical, sort of knee-jerk of, 'We can't afford this,'" said Ryan Barker, with the Missouri Foundation for Health. "Well, my question would be, 'Can we afford not to do this?' Because in the long run, if we keep letting our population get sicker and sicker and not access primary care, it really does just cost us more down the road."
The new Medicaid expansion would go into effect at the beginning of 2014. It would cover people in poverty, up to 133 percent above the Federal Poverty Level. Currently, that would be $30,657 a year for a family of four.