Voters in deep-red Missouri to decide on expanding Medicaid under Obamacare

Missouri voters will get the chance Tuesday to decide whether to expand Medicaid to low-income residents.

A ballot measure calls for enshrining Medicaid expansion in the deep red state’s constitution, which would make it harder for legislators to throw up hurdles to enrollment, such as work requirements. The Trump administration and many Republican state officials have sought to add work requirements, premiums and other mandates to Medicaid, which make it more difficult for folks to qualify for coverage.

An estimated 230,000 residents — who earn less than roughly $18,000 a year — would gain coverage. Currently, childless adults aren’t eligible for Medicaid, and neither are parents with incomes greater than roughly $4,800 a year for a family of four, according to a report from the State Auditor’s Office.

Missouri, however, would have to kick in at least $200 million a year — states have to shoulder 10% of the cost, with the federal government picking up the rest.

The initiative began long before the coronavirus pandemic but took on increased urgency amid the outbreak. Supporters have sought to tie the ballot measure to the renewed focus on health care coverage and access.

Medicaid expansion would be a boon to the state’s hospitals, decreasing the number of uninsured patients they treat and funneling more than $1 billion in federal funds to the state annually. Some 15 hospitals, including 10 rural institutions, have closed since 2014.

“Not only was the lack of expansion hurting our health care systems and our health care coverage here in Missouri, but it’s starting to really take a toll on our economy,” said Jack Cardetti, spokesman for the Yes on 2:Healthcare for Missouri campaign, noting that hospitals create many jobs.

Volunteers are raising awareness of the ballot initiative, which garnered nearly twice as many signatures as needed, and a retired ambulance is making stops across the state to urge residents to approve the measure. It’s also supported by the state Chamber of Commerce, among other groups.

But the effort has also attracted opponents, including Republican Gov. Mike Parson, the state chapter of Americans for Prosperity and United for Missouri, a grassroots organization that advocates for limited government.

Medicaid costs can quickly balloon, said Carl Bearden, CEO of United for Missouri and former chair of the state House Budget Committee.

“Even in good years, it’s tough to come up with,” he said, adding that the state recently had to cut $700 million from its budget as the pandemic cut into tax revenues.

Five states have expanded Medicaid by ballot

Missouri is the sixth state run by Republicans to consider expansion, a provision of the Affordable Care Act, at the ballot box.

Oklahoma voters narrowly approved expansion in June. Maine was the first, in 2017, followed by Nebraska, Utah and Idaho a year later.

“It’s proving the point that when you put health care in front of voters even in deep red states, they want more health care, not less,” said Jonathan Schleifer, executive director of The Fairness Project, which has helped organize the ballot campaigns.

Still, in all of the efforts prior to this year, elected officials delayed implementation or attempted to add restrictions to the program. Medicaid expansion recently began in Nebraska, and tens of thousands of people have enrolled in each of the other states.

Advocates have their eyes on Florida and, possibly, Mississippi, Wyoming and South Dakota, for 2022, Schleifer said.

Some 13 states, all with either Republican governors or GOP-led legislatures, have yet to adopt Medicaid expansion, which began in 2014. More than 2 million Americans fall into this so-called coverage gap, according to the Kaiser Family Foundation.

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