No, A Medicaid Expansion Would Not Be 'Medicaid Reform'
The Missouri Hospital Association and Missouri Chamber of Commerce promoted a report describing expansion of Medicaid under the Affordable Care Act as “reform.” Expansion, however, is not the same thing as reform. It adds a large new fiscal obligation without fixing the underlying program.
The organizations' advocacy also deserved context. Hospital groups had supported the Affordable Care Act and naturally favored the Medicaid component. The Chamber had previously backed expensive economic-development schemes such as Aerotropolis, so its support for another multibillion-dollar government program was not unprecedented.
The projected state cost of Medicaid expansion ran into the billions, on top of federal costs borne by the same taxpayers. Meanwhile, some of the polling and lobbying around the proposal involved actors who had also participated in earlier subsidy campaigns.
The recurring pattern was familiar: repackage a spending proposal with more appealing language and present it as economic development or reform. Missouri policymakers should recognize the distinction. Expanding Medicaid is an expansion of government; calling it reform does not make it one.
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