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Missouri's Medicaid Expansion Ballot Initiative Gains Momentum

For sickle cell patients, opioids are often the only pain relief. But growing rates of addiction among the general public mean emergency room doctors are more cautious than ever in prescribing those powerful medications, causing challenges.
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Without health insurance, St. Louis residents end up in emergency departments, said St. Louis Health Director Fred Echols, a supporter of a Medicaid expansion ballot iniatiative.

The petition to put a Medicaid expansion in Missouri to a statewide vote has garnered more than 25% of the needed signatures to place the measure on the November 2020 ballot, according to campaign officials.

The effort to extend eligibility for the state-sponsored health insurance program to those making up to $18,000 a year also has received support from several high-profile state organizations, including Washington University and BJC HealthCare.

Public health officials also are supporting the effort led by Healthcare for Missouri. St. Louis Health Director Fred Echols said earlier this month that many people in the city don't have access to medical care and could benefit from coverage under Medicaid.

St. Louis has a significant number of people who are vulnerable and don’t have access to necessary medical services, he said.

“The evidence is our health outcomes,” Echols said. 

Nearly 25% of the city’s residents live at or below the poverty line and can’t afford insurance, Echols said. That means when they’re faced with a medical emergency, they ignore it or go to the emergency room, which can put them in medical debt or bankruptcy.

“By expanding Medicaid, we’ll address a lot of these issues,” Echols told the St. Louis Board of Aldermen’s Health and Human Services Committee two weeks ago. “Not just access to health care but financial well-being for individuals in our community.”

Health care for Missouri workers must gather 172,000 signatures in six of Missouri’s congressional districts by May 3 to put Medicaid expansion before voters next year.

The campaign is “on track” to qualify, said AJ Bockelman, Healthcare for Missouri campaign manager.

Missouri is one of the 17 states that hasn’t expanded Medicaid. Most of the states that have taken the expansion did so through their state legislatures, an effort that's been unsuccessful in Missouri.

That the issue has been discussed in Missouri for years could work in the effort’s favor, Bockelman said.

“We’re seeing that heightened public awareness around what health care has meant to people at a level that I think has been hyper-focused, because this effort has been ongoing for so long,” he said.

Last year, three states carried by Donald Trump in 2016 — Idaho, Nebraska and Utah —  legalized Medicaid expansions through ballot initiatives.

After the start of the new year, the campaign will push its efforts beyond the metropolitan areas of Kansas City and St. Louis, he said. The campaign expects wide-ranging support in rural areas in central Missouri, Bockelman said.

“I think in particular those rural areas, those small interior cities where we’ve seen nine hospitals close around the state just since 2014, you have a sense in local communities it’s impacted them in so many different ways,” he said.

Studies have indicatedhigh uninsured rates in rural areas have contributed to declining hospital profits and closures.

Bockelman noted that several progressive ballot initiatives were successful in 2018, including a measure that legalized medical marijuana and a referendum on the state’s right-to-work law.

Follow Sarah on Twitter: @petit_smudge

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Sarah is the health reporter at St. Louis Public Radio.

Send questions and comments about this story to feedback@stlpublicradio.org.