Advocates see gains under Medicaid expansion

Mike Genet
Campaign workers David Woodruff, left, and Jason White, right, deliver boxes of initiative petitions signatures to the Missouri secretary of state's office in Jefferson City, Mo., on Friday, May 1, 2020.

Missouri voters, enough of whom petitioned to put Medicaid expansion on the ballot, will vote Aug. 2 whether to extend health-care coverage to Missourians who lack it.

“We have 300,000 uninsured Missourians, and we know that people who have adequate health insurance are more likely to get preventative care and seek mental health services,” said Bridget McCandless, former executive director of the non-profit Health Forward in the metro area. “It reduces medical debt and bankruptcy.”

“We certainly know that health is related to being able to get and hold jobs, and housing stability,” she said.

If approved by voters, Amendment 2 would expand Medicaid eligibility to adults between 19 and 65 whose annual income is up up 133 percent of the federal poverty level. In 2020, that’s about $36,100 for a household of four. Currently, Missourians who make about $3,600 or less are eligible.

The federal government covers 65 percent of the cost of Medicaid in states, and under the Affordable Care Act covers 90 percent for an expanded program. More than three dozen states have expanded Medicaid under the ACA, or Obamacare.

Proponents of Amendment 2 say giving more people access to health care is an economic benefit for the state. Missouri taxpayer funds already go toward the Affordable Care Act, and Amendment 2 means a greater return, they say.

Opponents, including Gov. Mike Parson, say expanding Medicaid, which already takes a hefty portion of the state budget, would lead to possible cuts in other areas such as education and roads.

Former state Rep. Ira Anders, D-Independence, remembers from his time in the General Assembly that when he and some colleagues pushed for expanding Medicaid in Missouri, they tried to appeal with the humanity angle.

“There’s people who don’t have insurance and can’t afford it, but they make too much to get Medicaid,” Anders said. “Without expanding Medicaid, you had hospitals closing. I can’t imagine what it would be like to not have health insurance, and then if you get sick not having a hospital nearby.”

The biggest arguments he fought, Anders said, was that it would cost too much, and some simply didn’t want to expand Obamacare.

After years of legislators not supporting expansion and voters ultimately taking matters into their own hands, Anders said it was unique and a pleasant surprise to see that, in addition to myriad medical groups, the Missouri Chamber of Commerce has thrown its support behind Amendment 2, citing in part the potential job growth.

Anders said he believes Medicaid expansion would at least be a net wash for the state, as it could stem the loss of health-care facilities in rural areas that receive a large portion of their income through Medicaid reimbursement.

“If you don’t have health insurance, you stay home until it’s really bad,” he said, “Then go to the ER, and that’s the most expensive type of care, and the hospitals are not reimbursed for that.”

“Taxpayers are the ones who provide the funds,” said McCandless, “but we’re not receiving that benefit coming back to the state.”

McCandless said she believes there’s a misperception of who receives or would receive Medicaid.

“In Missouri, it’s 70 percent white, highly rural, and more than 70 percent (of families) have a full-time worker,” she said. “Anybody that’s had health insurance can tell you, you never get rich having health insurance.”

Expanding Medicaid, McCandless, would draw in about 250,000 of those uninsured in Missouri, based on data from other states that expanded.

“A lot of people who are struggling,” she said, “and Medicaid expansion would help that.”