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Missouri Health Care Advocates Claim Victory On Medicaid Expansion, 230,000 People To Gain Coverage

Nika Cotton started a tea and coffee shop in Kansas City, Missouri, so she could watch her children while she works.
Alex Smith
Entrepreneur Nika Cotton of Kansas City, Missouri, says she will gain coverage under Medicaid expansion as she grows her new tea and coffee shop.

Medicaid expansion opponents warn that the pandemic's economic effects will strain Missouri's budget.

Despite strong opposition from Republicans, health care advocates claimed victory late Tuesday in their campaign to expand Medicaid.

Amendment 2 creates a state constitutional amendment that will open Medicaid eligibility to include healthy adults starting on July 1, 2021.

Missouri's Secretary of State's office reported on Wednesday morning that 53.25% of voters had approved expansion and 46.75% of voters had rejected it.

"It's a huge day for Missouri," said Traci Gleason, vice president with the Missouri Budget Project, which advocated for expansion. "It's something we have long needed in order to strengthen our state. This is something that will improve the health of our communities."

Medicaid expansion, which states have the option of adopting as part of the Affordable Care Act, opens eligibility in the program to individuals and families with incomes up to 138% of the federal poverty level. The federal government covers 90% of expansion costs.

Researchers from Washington University in Saint Louis, estimated in 2019 that around 230,000 Missouri would enroll for Medicaid if it were expanded. The study showed expansion would save the state an estimated $39 million dollars a year largely by eliminating the need for other state health spending.

Gleason said the adoption of expansion reflects an interest in both boosting the economy and providing equal access to health care.

Expansion opponents, however, warn that high enrollment in the program could lead to the state’s 10% share of the costs to become a significant burden for the state, especially when state revenues are down.

“When state revenues fall, it begs the question, how are you going to pay for this?” said Ryan Johnson, senior advisor for United for Missouri, a conservative policy advocacy group, in late July.

“We’re concerned that they are going to have to raid public education, and that’s a disservice to the kiddos who hope to go back to school this fall, the teachers, the administrators and everyone involved in the public education system.”

Missouri’s Republican Governor Mike Parson has already withheld nearly $449 million dollars from the 2021 fiscal budget, with education taking the hardest hit, due to declining revenue.

Health care experts agree that the economic effects of the pandemic, including high unemployment and lower state revenue, could strain the capacity of state Medicaid programs.

However, health care advocates argue that the influx of federal dollars and the jobs that would result from expansion would help the state and individuals as the economy recovers.

“If we’re worried about the economy and we’re worried about people working, Medicaid expansion is actually a way to encourage people to work and not have that worry we’re going to lose health insurance for themselves or their families,” said Ryan Barker, Vice President of Strategic Initiatives for Missouri Foundation for Health.

Medicaid expansion has been fiercely resisted by Republican lawmakers and was placed on the ballot as the result of a petition.

Expansion advocates enlisted the Fairness Project, a Washington DC-based campaigning organization, in developing and executing their campaign strategy. The Fairness Project has been involved in successful Medicaid expansion campaigns in numerous mostly conservative states, including Maine, Utah, Idaho, Nebraska and Oklahoma, where voters approved expansion on August 30.

Missouri YES on 2 campaign material made almost no mention of the Affordable Care Act, which has been unpopular in Missouri, and some of its flyers didn’t even use the words “Medicaid expansion.”

The YES on 2 campaign was supported by a wide range of interests, including the Missouri Chamber of Commerce, the Missouri Hospital Association, the NAACP, the AFL-CIO and the AARP, among other groups.

Opponents included Governor Parson and other Republican lawmakers, Missouri Right To Life, Missouri Farm Bureau and Americans for Prosperity.

In the days leading up to the election, the “No On 2 in August” campaign sent a mailer suggesting that expansion would lead to an influx of undocumented immigrants seeking health care, even though undocumented immigrant are not eligible for Medicaid and would not be under expansion.

The flyer, which featured a man in a medical mask emblazoned with the Mexican flag, read “Amendment 2 Means Illegal Immigrants Flooding Missouri Hospitals…While We Pay For It!”

The No On 2 in August campaign did not respond to requests for comment on the flyer.

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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