BJC President and CEO Steve Lipstein St. Louis Post-Dispatch Live Chat Transcript

Every Tuesday, the Post-Dispatch editorial board conducts a live chat with a local, regional or national newsmaker, giving subscribers a chance to interact with them one-on-one.

On Tuesday, April 29, 2014, Steve Lipstein, the CEO of BJC HealthCare, joined the board to talk about the prospects for Medicaid expansion in Missouri. Read the live chat transcript here.

good morning.
Steven Lipstein

April 29 2014 9:58 AM
good morning, steve.
debpeterson

April 29 2014 9:58 AM
And here he is, thanks for joining us: Steve Lipstein, CEO of BJC HealthCare.
tonymess

April 29 2014 9:58 AM
welcome to this live chat.
debpeterson

April 29 2014 9:59 AM
Let's start with a prediction: Steve, do you have any hope that the Missouri Legislature will take a serious run at passing Medicaid expansion before the end of the Legislative session?
tonymess

April 29 2014 9:59 AM
it 's good to be here
Steven Lipstein

April 29 2014 10:01 AM
Time is running short in this legislative session and a few state senators remain adamant
in their opposition.
Steven Lipstein

April 29 2014 10:01 AM
If the proposal that Sen. Ryan Silvey distributed to senators yesterday came to the floor, and survived a filibuster, do you think there are enough votes for it to pass?
tonymess

April 29 2014 10:03 AM
I don't know. The answer lies inside the Republican Caucus on the Senate side.
Steven Lipstein

April 29 2014 10:03 AM
You wrote a piece on our op-ed pages recently describing why BJC is cutting back in some areas of charity care, as a result of the Legislature's refusal to expand Medicaid. Can you explain why that is happening?
tonymess

April 29 2014 10:08 AM
Sure. BJC is not cutting back on charity care. As I shared with your readers, the amount of free and unreimbursed care provided by BJC is increasing. The upper threshold of eligibility for charity care was adjusted to $72,000 of household income, to reflect that these families are now required by federal law to have health insurance and that insurance is available to them at the federal Marketplace.

Steven Lipstein

April 29 2014 10:08 AM

http://goo.gl/zqvrPK
tonymess

April 29 2014 10:08 AM
For those watching, I just posted a link to the oped I referenced in last question.
tonymess

April 29 2014 10:09 AM
BJC is better prepared to cope with the legislative refusal to expand Medicaid than hospitals in smaller and largely rural communities. Will their difficulties have an impact on BJC, and if so, what will it be?
debpeterson

April 29 2014 10:09 AM
Expansion of Medicaid is associated with families who have household incomes below $32,000 a year, or roughly $2,000 a month after taxes, That expansion would cover over 200,000 Missourians.
Steven Lipstein

April 29 2014 10:10 AM
But the reality in Missouri, if Medicaid isn't expanded, is that the model doesn't work right, correct?
tonymess

April 29 2014 10:13 AM
BJC will experience the impact of the failure to expand Medicaid, but not nearly to the same extent as independent rural hospitals. We operate two such facilities in Sullivan MO and Farmington MO. These communities rely upon public programs such as Medicare and Medicaid provide insurance coverage that pays the local hospital and helps to
to sustain their missions,
Steven Lipstein

April 29 2014 10:14 AM
Does that mean patients from those areas will have to seek services at BJC?
debpeterson

April 29 2014 10:17 AM
I am not sure. Patients and families prefer to receive health care services close to home, close to family and friends, near schools, places of work and worship. It is a time of stress and anxiety and fear when one is sick or injured. Traveling long distances to receive needed medical attention is not consistent with a patient's perspective on high quality health care
and access.
Steven Lipstein

April 29 2014 10:18 AM
Hey Deb: So I spend too much of my time talking to folks in the legislative arena. I know you know quite a few people in the health care industry. How do they tend to view Medicaid expansion?
tonymess

April 29 2014 10:19 AM
They are mostly fearful about the loss of money to the state by the Legislature's refusal to act.
debpeterson

April 29 2014 10:19 AM
Steve, can you talk about the direct impact in St. Louis, jobs wise, if the Legislature wakes up and passes some form of Medicaid expansion? How would that influx of federal dollars, and increase in the number of people insured, affect our local economy in concrete ways?
tonymess

April 29 2014 10:19 AM
They are also concerned that hospitals will fail all across the state and that only the major urban hospitals will be able to continue to operate without the federal money that could be coming to Missouri.
debpeterson

April 29 2014 10:21 AM
I would add that the amount of foregone money that would come to Missouri from the federal government is close to $2 billion. That money would offset other reductions in payments to health care providers that are included in the Budget Control Act of 2011, the Taxpayer Relief Act of 2013 and the Affordable Care Act.
Steven Lipstein

April 29 2014 10:22 AM
A study cited by Forbes magazine says that failure to expand Medicaid in the 25 states that have failed to do so will result in as many as 17,104 avoidable deaths each year among low-income Americans who remain uninsured. That's a frightening statistic and yet, our Legislature remains fixed on this issue. What can people do to try to have an impact on this?
debpeterson

April 29 2014 10:25 AM
We need to understand what is at stake. In particular, rural communities rely on their local hospitals to provide access to health care services and along with the local school district, the hospital is among the largest employers in the community. These are community assets that will struggle and could fail in the absence of Medicaid expansion.
Steven Lipstein

April 29 2014 10:25 AM
Steve, you recently won the Citizen of the Year award in St. Louis. In your acceptance speech, you said this: "The single most important pathway to income earning potential is education." What concrete steps does the St. Louis region need to take to raise the level of education in our community?
tonymess

April 29 2014 10:28 AM
Great question. We at BJC are taking two steps - one at each end of the age spectrum. For our adult employees, we offer assistance with
and access to next step educational coursework to help each of our employees move up the educational ladder to greater professional opportunity. For newborns, we are linking new moms and dads to parent educators and to nurses who can help our newest citizens to reach 3rd grade in good health and on grade level for reading literacy.
Steven Lipstein

April 29 2014 10:28 AM
What you say about the impact on rural communities if local hospitals fail is so true. It would be absolutely devastating and the lost income and taxes for local schools would put entire communities at risk. Also, medical treatment for people in such communities is already stressed and without this additional money it's clear that many people will die.
debpeterson

April 29 2014 10:30 AM
Should St. Louis business leaders be focused more on education? On funding local schools? On encouraging the Legislature to increase funding for higher education?
tonymess

April 29 2014 10:30 AM
In your remarks accepting the Citizen of the Year award you say that a child's third grade reading status is an early predictor of life-long earning potential and life expectancy. That's why BJC is focusing on helping youngsters reach that grade-level literacy, correct?
debpeterson

April 29 2014 10:31 AM
Deb, that is why this falls on our elected leaders to act in the best interest of their constituents. While the debate is political, the impact can be devastating for people who live in our state.
Steven Lipstein

April 29 2014 10:32 AM
Yes, Steve. I couldn't agree more. Legislators need to stop the political posturing and do what's right for the people of Missouri.
debpeterson

April 29 2014 10:32 AM
That is correct. A college graduate has a life expectancy that is almost a decade longer than someone who does not finish high school - and third gra
de reading status is a predictor of who will finish high school and go on to college
Steven Lipstein

April 29 2014 10:33 AM
Steve, thanks very much for your time. We appreciate you being our first live editorial chat guinea pig. Our time is up!
tonymess

April 29 2014 10:33 AM
Thanks Steve and Tony.
debpeterson

April 29 2014 10:33 AM
Thanks Tony.
Steven Lipstein

April 29 2014 10:34 AM
Thanks Deb
Steven Lipstein

April 29 2014 10:34 AM
We will likely publish some of this conversation in print in coming days. And next time we'll ask our readers to not be so shy!