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What's At Stake When You Vote On Medicaid Expansion In Missouri

Crysta Henthorne

Missouri voters will decide in the Aug.4 primary whether to expand eligibility in the state’s Medicaid program to include people with higher incomes who may be healthy.

Health care advocates have been pushing for expansion for years, which states were given the option to do when the federal Affordable Care Act was approved in 2010.

Republican lawmakers have managed to fend off expansion in the state legislature, but health care advocates were able to get it on the ballot through a petition. Advocates aimed to get the measure on the ballot in the general election in November, hoping that the high voter turnout would help their cause.

But Governor Mike Parson, an expansion opponent, moved the measure to the August primary, citing the need for lawmakers to know as soon as possible about the future of Medicaid so they could plan for it in the state budget.

Who would be eligible for Medicaid under expansion?

Anyone in Missouri between the ages of 19 and 65 who makes up to 138% of the federal poverty level, or roughly $17,600 for an individual. This would include healthy adults without children, who are currently excluded from the program. A Washington University study published in 2019 estimated that around 230,000 additional Missourians would enroll under expansion.

Who would pay for it and how much would it cost?

The federal government would cover 90% of the cost for the newly eligible people, leaving the state to cover 10%.

The state auditor estimates that the final cost to the state could be at least $200 million per year, or expansion could save the state as much as a billion dollars per year.

How could Medicaid expansion save money?

Expansion would eliminate the need for some state health care spending outside of the Medicaid program. For example, if the state were to expand Medicaid, it would no longer need to pay for prison inmate health care, because inmates would be covered by Medicaid.

Additionally, the state would likely pay much less to reimbursement hospitals for providing compensated care.

The Washington University study estimates that the elimination of these and other expenses would add up to about $39 million in savings for the state.

What other effects would expansion have on the budget?

Another study produced by the Missouri Foundation for Health showed that expansion would boost economic output in Missouri by $2.5 billion due to the influx of federal money and the jobs that would be created.

Alex Smith / KCUR 89.3
Entrepreneur Nika Cotton (right), seated with her children, Kairo (middle) and Keziah (left), would qualify for Medicaid if it were expanded in Missouri.

Who supports expansion?

Missouri Chamber of Commerce, Missouri Hospital Association, AARP Missouri, Missouri NAACP State Conference, Washington University

Who opposes it?

Governor Mike Parson, Republican lawmakers, Missouri Right To Life PAC, Missouri Farm Bureau

How would the coronavirus pandemic affect expansion?

Medicaid expansion has been shown to have a positive budget effect in other states, but the economic effects of the pandemic may be changing the math of Medicaid expansion. Many states have seen Medicaid rolls increase this year at the same time revenue has decreased.

In Missouri, Medicaid enrollment grew by 8.8% from February to May, according to the Georgetown University Health Policy Institute.

Meanwhile, the general revenue collections in Missouri for fiscal year 2020 were down almost 7% from the previous fiscal year, according to a Department of Revenue report.

Parson and other opponents warn that high enrollment in the expanded program could cost the state hundreds of millions of dollars.

Expansion supporters, however, argue that Medicaid expansion is needed now more than ever to help people who are struggling.

However, if approved, expansion wouldn’t go into effect until July of 2021, by which time the economy may have fully recovered or be stuck in a recession or depression.

Entrepreneur Nika Cotton (right), seated with her children, Kairo (middle) and Keziah (left), would qualify for Medicaid if it were expanded in Missouri.
Alex Smith / KCUR 89.3
KCUR 89.3
Entrepreneur Nika Cotton (right), seated with her children, Kairo (middle) and Keziah (left), would qualify for Medicaid if it were expanded in Missouri.

Copyright 2020 KCUR 89.3

Alex Smith began working in radio as an intern at the National Association of Farm Broadcasters. A few years and a couple of radio jobs later, he became the assistant producer of KCUR's magazine show, KC Currents. In January 2014 he became KCUR's health reporter.