Missouri Votes to Expand Medicaid Over Objections of State's Republican Leaders

By Jason Hancock, The Kansas City Star

05 August 20

 

issouri became the 38th state to expand Medicaid eligibility on Tuesday, with voters shrugging off Republican opposition to narrowly approve a constitutional amendment providing health coverage to more than 200,000 uninsured Missourians. 

With 99% of polls reporting, the Medicaid expansion ballot measure, known as Amendment 2, was ahead by 74,000 votes.

“In the weeks and months to come as Medicaid expansion is fully and expeditiously implemented so that Missourians are no longer forced to choose between putting food on the table and seeing a doctor, today’s victory will be a true turning point in the history of the Show-Me-State,” said A.J. Bockelman, campaign manager for the pro-expansion campaign.

The state’s urban areas voted overwhelmingly in favor of expanded Medicaid. The rural areas voted against it by wide margins.

It was in the suburbs where the amendment ultimately prevailed, in areas that have been voting in support of Republicans for more than a decade.

That includes places like Platte County, which Republican U.S. Sen. Josh Hawley won in 2018. Yet 61% of the county’s voters supported Medicaid expansion.

The win caps nearly a decade of efforts by a wide-ranging coalition of groups across the political spectrum to expand Medicaid coverage in Missouri, including the Missouri Chamber of Commerce, Missouri Hospital Association, the Missouri Catholic Conference, the AARP and organized labor.

“This is an incredible victory for the state of Missouri and countless uninsured individuals, who will gain access to life-changing and lifesaving health insurance coverage,” said Lisa Lacasse, president of American Cancer Society Cancer Action Network.

Missouri’s Medicaid program does not currently cover most adults without children. Only the disabled, children and parents with incomes under 22% of federal poverty level — less than $5,800 a year for a family of four — are eligible.

That’s one of the lowest eligibility thresholds in the nation.

Republicans have blocked Medicaid expansion in Missouri for years, which created a coverage gap where more than 200,000 Missourians earn too much to qualify for Medicaid but too little for subsidies to offset the cost of private insurance through the federal Affordable Care Act, more commonly known as Obamacare.

Proponents of expanded Medicaid coverage in Missouri gathered nearly 350,000 signatures to put a constitutional amendment on the statewide ballot raising the level for coverage to 138% of the federal poverty line — about $36,000 for a family of four.

Idaho, Maine, Nebraska, Oklahoma and Utah have all in recent years expanded Medicaid through ballot questions following inaction by state lawmakers.

Supporters of expansion point to studies showing that it would not only provide health care to low-income Missourians, but it could also save money in the long run by drawing additional federal funding to cover a variety of health services currently paid for with state revenue.

Opponents dismiss the notion that expansion could save the state money. They argue the state budget is already stretched thin, and additional costs associated with health care would force lawmakers to cut other areas, such as education or public safety. 

The effort to expand Medicaid was dealt a blow when Missouri Secretary of State Jay Ashcroft, a Republican, employed a rarely used technique to expedite the signature verification process. That gave Gov. Mike Parson, also a Republican, the chance to move the question to the August primary instead of the higher turnout November ballot.

“Amendment 2 won today,” said Caitlyn Adams, executive director for Missouri Jobs with Justice Voter Action, “because no matter what we look like, where we live, or how much money we make, most of us want the same things — the ability to keep our families safe and well. Expanding Medicaid is a big step toward this goal.”