These thoughts were written by Maggie, one of our 2020 summer interns. The opinions expressed herein do not reflect those of Civitas other than respect for the value of open dialogue.
Check out more information: Who Could Medicaid Reach With Expansion in Missouri?
As of now, 38 states, including Washington, D.C., have expanded Medicaid, leaving 13 states who have not, such as Missouri. Recently, Maine, Idaho, Nebraska, Utah, and Oklahoma had the chance for voters to vote for Medicaid expansion, and it passed! State lawmakers have rejected passing this in the legislature, so now voters have a chance to expand Medicaid. However, in September of 2019, Healthcare for Missouri announced its attempt to put Medicaid expansion on the November ballot, receiving enough signatures and Secretary of state verification to automatically be put on as a ballot initiative, yet Governor Mike Parson moved it from November to August, in what seems like a way for less people to vote for it and a political move for his contested gubernatorial race. He claimed that Missouri needs as much time as possible to prepare fiscally if Medicaid expansion passes because of the “already depleted general revenue” and of COVID-19 revenue drops. Oklahoma’s Republican governor did the same thing, yet voters still passed Medicaid expansion. Parson also stated his plan to “uphold the will of the people” if Medicaid expansion does pass because the Kansas City Star Editorial Board announced in late 2019 that Republican lawmakers could still make their version of Medicaid expansion during the 2020 legislative session. However, the only Medicaid expansion bills introduced in the 2020 session were presented by Democrats and failed.
In terms of the Missouri legislature, in 2018, SB371 was introduced to put Medicaid expansion on the ballot in November of 2018; however, it did not get through committee. Since then, Missouri residents have pushed for it. Eventually, in 2019, Healthcare for Missouri worked with The Fairness Project to make it a ballot initiative. During the summer, the needed 172,000 signatures were gathered, and at the deadline, they had almost twice what was needed, 350,000 signatures.
Medicaid is known as MO HealthNet in the state and is the national and state program helping people with low incomes cover medical costs. Missouri has not expanded Medicaid with the 2010 Affordable Care Act (ACA). Adults who are not disabled and without children are not eligible no matter how low their income is, and parents are only eligible if their incomes are lower than 22% of the poverty level, amounting to around only $380 per month for three people. Under Medicaid, individuals who are older, blind, and disabled are eligible in addition to infants under the age of one if their family’s income is under 196% of poverty, children ages 1 to 18 if their household income is under 150% of poverty, and pregnant individuals whose income is under 196% of poverty. Medicaid also supports 1 out of 5 Medicare beneficiaries. The ACA wanted Medicaid expansion in every state and for everyone who makes less than 133% of poverty. However, the Supreme Court ruled in 2012 that states would not be penalized if they opt out of Medicaid expansion.
By expanding Medicaid, Missouri will be able to give health insurance to about 300,000 Missourians, who earn up to 138% of the federal poverty level, which equates to around $17,600 for individuals and $30,000 for a family with three people. Currently, hundreds of thousands of Missourians do not have health insurance options in the state, especially those who do have a job, which is often low-income individuals, those in school, and minorities. The Medicaid expansion ballot initiative would specifically expand those who are eligible under the 2010 federal healthcare law by President Barack Obama, which gives more federal funding for states that expand Medicaid. In addition, Medicaid expansion will close a coverage gap that leaves 113,000 without healthcare, not eligible for anything from Medicaid, and unable to afford private insurance. Childless adults or single parents of two who make over $3,612 a year, which is 18% of the poverty line, do not qualify currently. It will also create almost 25,000 jobs across the state and save billions of tax dollars in Missouri. Importantly, it will support hospitals, especially rural ones, through budget cuts and job and service losses because just this year, hospitals have had vacancies and cuts in over 3,000 jobs. Medicaid expansion is not just for physical health; it will provide more mental services as well. The problems Medicaid expansion fixes outweigh any con argument out there. Missouri’s Medicaid right now does not provide for parents, and its income eligibility threshold for them is one of the lowest in the country, which is approximately one-fifth of the poverty level. Nearly 700 Missourians will continue to die annually if the state does not expand Medicaid.
If Missouri continues to prevent Medicaid from expanding, the state will have given $17.8 billion in federal funding, that is if the ACA is not dismantled by Republicans. Missourians still have to pay federal taxes, in which they have been paying for other states’ Medicaid expansion since 2014. In 2022, they would have paid $7.3 billion in federal taxes for Medicaid without having it in their state. Additionally, Missouri hospitals, especially those with large uninsured populations, do not have the funding to provide for everyone and meet the need. This will continue to happen if Missouri does not pass Medicaid Expansion. Because Missouri has not expanded Medicaid, hospitals will lose an estimated $6.8 billion between the years of 2013 to 2022.
Other updates on this ballot initiative include two lawsuits against it that were dismissed by a Missouri judge. The lawsuits came from a conservative advocacy group called United for Missouri and Americans for Prosperity-Missouri, wanting to take it off the August ballot because it argued there was no funding for it. The Cole County Circuit Judge, Daniel Green, decided it does not require lawmakers to put revenue from the state into it and thus allowed it to stay. Nicole Galloway, Missouri’s Auditor who is running for Governor, predicts Medicaid expansion will save Missouri around $1 billion.
Republican leaders in Missouri are against Medicaid expansion due to funding and the state’s budget, yet both the Missouri Chamber of Commerce and Industry and the Missouri Hospital Association support the ballot initiative. They see it as a way to help the economy grow in Missouri by creating more jobs and revenue as well as helping rural hospitals because 10 have closed since 2014. Missouri has the opportunity to finally vote for the change the legislature could not give us. We need to join the majority of states and provide for people, especially during a pandemic, by voting to expand Medicaid.
