Missouri voters OK Medicaid expansion to cover more low-income adults, defying GOP leaders

SPRINGFIELD, Mo. – Medicaid expansion is coming to the Show-Me State.

Missouri voters on Tuesday backed a plan to offer public health insurance to hundreds of thousands more low-income adults 53%-47%, defying Republicans who blocked it at the statehouse for years and implored voters to reject it on the ballot.

The result, driven by strong showings in the major metro areas, means any lawful adult resident earning up to 138% of the federal poverty line – around $17,600 a year for individuals and $36,150 for a family of four – will be eligible for coverage starting July 2021.

The change to a program that currently cuts most parents off at 21% of the poverty line and completely excludes most childless adults is expected to make a substantial impact on the newly eligible.

Research suggests they’ll have better access to care, see their financial health improve, and in some cases, add years to their lifespans.

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They’re also expected to bring tens of thousands of children onto the rolls with them, which experts say could counter a troubling rise in the number of uninsured kids in the state.

Victoria Altic, a Springfield mother of two who has struggled with medical debt, could scarcely contain her excitement as the final votes came in.

"I can't even articulate how amazing and happy I feel that we're finally doing this after so many years," she said in an interview. "I'm so proud of how Missourians came together, gathered all the signatures and did this ourselves, because we couldn't rely on our legislators."

The expansion is also expected to have a significant impact on the state’s health care industry, which poured millions of dollars into the campaign.

Research suggests the change will lead to declines in uncompensated care at hospitals, especially those in rural areas, and potentially support thousands of new jobs.

Herb Kuhn, who leads the Missouri Hospital Association, said in a statement the change could also help streamline the Medicaid system itself.

"Our commitment moving forward is to work with all partners to build a better program for this newly covered population, as well as for all Missourians enrolled in Medicaid, and for taxpayers," he said.

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The exact effect on the state’s budget remains to be seen, however.

The federal government covers 90% of expansion costs, but the state covers the rest, and the Department of Social Services has predicted a budget hit of more than $200 million per year.

Researchers at Washington University in St. Louis projected expansion would actually save Missouri money, as it has in other states.

But both of those estimates came before the pandemic put tens of thousands more Missourians out of work who may qualify for aid, and the debate over paying the tab seems certain to continue when the Republican-dominated legislature reconvenes in January.

And while the expansion was proposed as a constitutional amendment to guard against changes, lawmakers could put work requirements or other restrictions on the ballot in the future.

With that prospect looming, many statements from backers couched Tuesday's results as one step in a longer process.

In an official statement Tuesday night, A.J. Bockelman, who managed the "Yes" campaign, said voters' approval meant the work of providing health care for more people could now "begin in earnest."

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Top Democrats were eager to make a point of continuing the fight, too.

State Auditor Nicole Galloway, who won her party's nomination for governor earlier in the evening, said in a statement that her Republican opponent, Gov. Mike Parson, can't be trusted with the new program given his opposition to it.

"The future of Medicaid expansion in Missouri depends on who is in the governor’s office next year when it comes time to implement it," she said.

House Minority Leader Crystal Quade said the issue should also play into races for seats in the legislature.

"Now more than ever we will have to fight to defend healthcare for Missourians by flipping seats in the November elections," Quade wrote in a tweet.

Opponents were a little less talkative.

Parson, who once called expansion a “massive tax increase that Missourians cannot afford,” made no mention of the issue in a speech to supporters or in numerous social media posts afterward.

But a lower-profile “No” campaign, which enlisted a slew of GOP officials from Lt. Gov. Mike Kehoe to freshman House members to make videos condemning the idea as a Bernie Sanders-style boondoggle, eventually released a statement Wednesday morning with a bitter warning.

"With the passage of Obamacare expansion, Missourians will be footing the bill for a program whose only guarantee is one of rising costs that remain uncapped," it said. "When the dust settles, the costs will be clear, reminding Missourians to be careful what you wish for."

Regardless of what happens next, the vote virtually assures Missouri will be the 38th state to expand Medicaid under the Affordable Care Act and the sixth to expand Medicaid via the ballot in an effort to get around hostile Republican leaders.

Neighboring Oklahoma became the fifth in June.

Tuesday’s result also marked the latest in a string of victories for Missouri progressives at the ballot box, following votes to increase the statewide minimum wage, crack down on lobbyist gifts and strike down an anti-union “right-to-work” law championed by former Gov. Eric Greitens in 2018.

This article originally appeared on Springfield News-Leader: Medicaid expansion: Missouri voters approve Amendment 2