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Missouri Becomes 38th State To Expand Medicaid

Missouri voters approved expanding Medicaid in the August 2020 primary election
Nat Thomas
St. Louis Public Radio
Missouri voters on Tuesday approved expanding Medicaid, the government-funded health insurance program for low-income residents and those with disabilities.

After discussing the idea for years, Missouri voters narrowly agreed Tuesday to expand Medicaid — giving roughly 250,000 additional people access to health care.

“This is a big deal,” said Tim McBride, former chair of the oversight committee for Missouri’s Medicaid program and an expansion supporter. “It’s about time. It’s important for the people in the gap population, and it’s a tough time now for the recession and COVID-19.”

The constitutional amendment passed 53% to 47%.

Amendment 2, which expands the government-funded health insurance program for low-income Missourians and those with disabilities, will cover adults whose annual income is 138% of the federal poverty level or below. For 2020, this was $17,600 for an individual and roughly $36,000 for a family of four.

A federal match guarantees that the state is required to only pay 10% of the costs associated with expansion; the federal government pays 90%. Currently, Missouri is on the hook for 35% of the tab without expansion, taking up roughly one-third of the state’s $35 billion budget.

Gov. Mike Parson, and several other Republicans, have spoken against expansion, calling it a “massive tax increase that Missourians cannot afford.” But supporters of Amendment 2 say it will likely help the financial health of the state.

According to a study conducted by the Institute of Public Health at Washington University, expanding Medicaid could save the state $39 million in the first year, and by 2024 the state could save a total of $932 million. In the worst-case scenario, however, it could cost the state an additional $42 million.

McBride said the expansion will help drive down the annual cost for the state.

“We are one of the lowest-taxed states in the country and we have this limit on our revenues, so it’s creating a big issue when you have a Medicaid program that grows faster than the state revenues,” McBride said.

Voters fill out their ballots for Missouri’s primary election at Old Bonhomme Elementary School in Olivette on Tuesday morning. Aug. 4, 2020
Kayla Drake
St. Louis Public Radio
Voters fill out their ballots for Missouri’s primary election at Old Bonhomme Elementary School in Olivette on Tuesday morning.

The Missouri Chamber of Commerce and Industry, usually a top ally of Parson, called Medicaid expansion a “pro-jobs measure.” The group cited a study claiming it would expand Missouri’s economic output by $2.5 billion.

But opponents remained skeptical Tuesday night. “We’re going to have to take a close look at what other states have done,” said state Rep. Mary Elizabeth Coleman, R-Arnold. “I still don’t know where we’re going to get the money.”

Coleman, who was fiercely opposed to expansion, said there will need to be difficult discussions when lawmakers return for the 2021 legislative session. Republicans have floated the idea of passing work requirements, and Coleman said she “can’t imagine that wouldn’t become part of the conversation.”

She said she believes the state will also need to cut some services that are already provided for the Medicaid population.

“My heart just breaks that we’re maybe going to have to cut services for the most vulnerable,” she said.

Now that voters approved the idea, the Legislature, which is dominated by Republicans who opposed it, will put the plan in place. It’s not totally clear what the program will look like, and some have floated the idea of implementing work requirements. However, any plan likely won’t be fully functional until 2022.

Governor and attorney general races

Gov. Mike Parson won the Republican nomination, while State Auditor Nicole Galloway captured the Democratic nomination for governor. The two have been exchanging jabs for months.

In the race for state attorney general, Rich Finneran won the Democratic primary. He beat Elad Gross with 55% of the vote. Finnernan will face Republican incumbent Eric Schmitt in the November general election.

Finneran is a University City resident who most recently worked for the Bryan Cave law firm. Before that, he served as an assistant U.S. attorney during most of Richard Callahan’s tenure as the U.S. attorney for the Eastern District of Missouri.


Follow Jaclyn on Twitter: @DriscollNPR

Jaclyn is the Jefferson City statehouse reporter for St. Louis Public Radio.

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