Voters to decide on Medicaid expansion Aug. 4

Should Medicaid coverage be expanded to include thousands of Missourians who are currently not eligible for the medical assistance program?

That question will be put to Missouri voters next month in the form of Amendment 2, the Medicaid Expansion Initiative.

Medicaid is a federal program that provides medical insurance to low-income people and individuals with disabilities. The Affordable Care Act, also known as Obamacare, allowed for the optional expansion of Medicaid coverage for people with incomes up to 138% of the federal poverty level.

As of this year, 37 states and the District of Columbia had expanded or have voted to expand Medicaid coverage. Missouri is one of 13 states that has not.

Generally speaking, eligibility for the Medicaid program in Missouri is limited to those who are older than 65, people who are blind or disabled and adults with dependent children with an annual household income at or below 22% of the federal poverty level. For a family of three, the 2020 poverty level is $21,720 and 22% of that is $4,778.

Coverage is also available to infants, children and pregnant women in households with incomes that fall below various poverty level percentages.

If approved in the Aug. 4 election, Amendment 2 would expand Medicaid eligibility in Missouri to adults between the ages of 19 and 65 whose income is no more than 138% of the federal poverty level. The amendment would also prohibit any additional restrictions or requirements for the expanded population to qualify for Medicaid coverage.

If passed, the measure will have no direct impact on taxes, but the state estimates passage will have a one-time cost of about $6.4 million. By 2026, it’s estimated the amendment will have an annual net fiscal impact ranging from costs of at least $200 million to savings of about $1 billion.

Missouri currently receives reimbursement from the federal government amounting to about 65% of its Medicaid costs. If Amendment 2 passes, the reimbursement would reportedly increase to 90%.

Amendment 2 supporters say the measure will not only benefit thousands of low-income Missourians in need of health care coverage, but it will also help keep many of the state’s rural hospitals from closing and would create more than 16,000 jobs annually over the next five years.

“Amendment 2 will keep rural hospitals and urban clinics open by bringing $1 billion of our own tax dollars back from Washington, instead of going to the 37 other states that have expanded Medicaid,” according to Jack Cardetti, a spokesman for the Yes on 2 campaign.

According to a report from the Missouri Foundation for Health, Medicaid expansion would expand the state’s economic output by $2.5 billion a year.

Proponents of the measure include the Missouri Chamber of Commerce and Industry, the Missouri Hospital Association, AARP Missouri and numerous health-related organizations.

In announcing its support for Medicaid expansion in early June, the Missouri Chamber called the amendment a “pro-jobs measure” that will “help fuel economic growth” in Missouri.

Both Cape Girardeau health care systems have issued statements in support of the amendment.

“Saint Francis Healthcare System is in full support of the expansion of Medicaid coverage to more individuals in Missouri,” according to a statement Saint Francis issued earlier this week.

In expressing his support for Amendment 2, SoutheastHEALTH president Ken Bateman said Missouri is losing “over a billion dollars of federal money each year by not passing Medicaid expansion.”

Last year, Bateman said, Southeast provided more than $13.5 million worth of charity care to those unable to pay.

“We see the human side of the problem which is why we support helping all Missourians have access to great health care, not just now, but in the future,” he said.

A political action committee calling itself Missourians for Healthcare has raised more than $5.8 million as of this week in cash and in-kind donations in support of the amendment’s passage.

The largest contributions have come from the Missouri Hospital Association and the association’s Health Care Issues Committee which combined have given nearly $1.9 million to Missourians for Healthcare.

Amendment 2’s opponents include Gov. Mike Parson, Lt. Gov. Mike Kehoe and Missouri Treasurer Scott Fitzpatrick.

“I don’t think it’s time to be expanding anything in the state of Missouri right now,” Parson said in a recent statement about the amendment.

Kehoe has echoed the governor’s sentiment.

“Medicaid expansion is financially unsupportable and unsustainable,” he said in reference to the ballot initiative. “In the short term it will require cuts to education. In the long term, it will result in higher taxes for Missourians.”

State election finance records list one political action committee, No on 2 in August, in opposition to the measure. According to an online report, that committee had raised $200 as of this week.

A simple majority is required for Amendment 2’s passage.