The Leader concludes its Voters Guide for the Aug. 4 primary election. To assist an expected high number of people who will cast absentee and mail-in ballots, we have been posting profiles on candidates in contested races and ballot issues. The deadline to apply for an absentee ballot or mail-in ballot is today (July 22). For information, call the Jefferson County Clerk’s Office at 636-797-5486. If you know someone who needs a printed version of our Voters Guide, please send a self-addressed envelope with two stamps on it to: Leader Voters Guide, P.O. Box 159, Festus, MO 63028, or stop by our office at 503 N. Second St. in Festus.
Missouri voters will be asked on Aug. 4 whether they wish to expand Medicaid coverage across the state.
The issue, Constitutional Amendment No. 2, was placed on the ballot after a statewide petition drive. A simple majority is required for passage.
Amendment No. 2 proposes to expand Medicaid eligibility to Missouri residents ages 19 to 65 whose income is at or below 138 percent of the federal poverty level, which is $17,608 for one person and $36,156 for a family of four.
Medicaid is a publicly funded medical insurance program. Operated in this state as MO HealthNet, it provides health insurance for low-income children and parents, seniors, pregnant women and people with disabilities. A non-disabled adult with children currently can qualify if their income is less than $5,550 a year for a family of four. Adults who are not parents are not eligible, regardless of income.
In December, 846,554 of Missouri’s 5.4 million residents were enrolled in Mo HealthNet.
The Affordable Care Act, which passed in 2010, directed states to expand Medicaid coverage to adults with incomes up to the level in Amendment No. 2. Under that plan, beginning this year, the federal government would cover 90 percent of the cost of expansion, with states funding the rest.
Missouri officials, however, have resisted the expansion.
So far, 37 states and Washington, D.C., have expanded or voted to expand Medicaid, while 13 states have not.
Opposition or support of the Medicaid expansion has largely been along partisan lines, with many Republicans against the issue and many Democrats favoring it.
More than 300 organizations have endorsed the ballot initiative to date, including business groups, organized labor, church leaders, patient advocates, doctors, nurses, hospitals and health care groups.
The case for Amendment No. 2
Yes on 2, a group advocating for the passage of Amendment No. 2, estimates that it will bring $1 billion a year in federal money to the state, will help preserve front-line health care jobs and provide resources to financially faltering hospitals in rural areas.
The group cites the results of independent studies, including a recent analysis from the state Auditor’s Office, that annual savings in the state budget resulting from Medicaid expansion are expected to reach $1.013 billion by 2026.
Without Medicaid expansion, the group states, Missouri is responsible for a greater share of health care costs than other states that have approved it.
Yes on 2 says some of the groups that would benefit from having more access to Medicaid include expectant mothers, people with disabilities and women diagnosed through breast and cervical cancer screening programs. For example, instead of paying 35 percent for a pregnant woman already eligible for Medicaid, the state would pay 10 percent if Amendment No. 2 is passed.
Information from the group gives the example of Arkansas, where it said officials report using Medicaid expansion savings of more than $400 million over three years to cut state income taxes.
Healthcare for Missouri, a coalition of more than 250 groups, also has endorsed Amendment No. 2.
Information from that group cites a Washington University study that found that if Medicaid expansion had occurred in 2020 and 315,000 residents were added to the program, Missouri would have saved nearly $40 million.
In addition, a recent report from Missouri Foundation for Health predicted an average increase of more than 16,000 jobs each year following Medicaid expansion.
The case against Amendment No. 2
State Rep. Mary Elizabeth Coleman (R-Arnold) is one of a multitude of Republican officials who oppose the proposal.
“Everyone can agree that health care is too expensive,” Coleman said in a statement. “Costs continue to rise. Missourians often can’t get the care they need. So will Medicaid expansion and Amendment 2 on the August ballot fix those problems? No.”
She said Medicaid expansion will result in less coverage for the most vulnerable and would cover only about half of the 555,000 Missouri residents – about 9 percent of the state’s population – who are now uninsured.
Coleman said Missouri now offers the most generous coverage in the nation and spends nearly 40 percent of the state’s operating budget on benefits, up dramatically from 18 percent in 2000.
“The goal of expansion is to open up the program to a new population of able-bodied, working-age, childless recipients,” Coleman said. “It is predicted to cost taxpayers upwards of $15 billion in the next five years, almost $1 billion of which will be from state general revenue.”
Coleman said she does not know how Missouri will pay for its 10 percent share of the cost to insure the additional estimated 230,000 people who would be added to the program.
“The governor calls Medicaid expansion, ‘A massive tax increase Missourians can’t afford,’” Coleman said. “Remember, states, unlike the federal government, cannot deficit spend. Other states have offset to fund increased enrollment by issuing new taxes, increasing premium costs for those currently on Medicaid or reducing coverage for those covered.
“I don’t think Missourians would support new taxes or reduced coverage for our most vulnerable who depend on this coverage,” she said.
Coleman said if Missouri expands Medicaid, it will add to the rapidly growing federal deficit.
“If we vote to have more government spending, it is true there will be more money in doctors’ and hospitals’ pockets. Why do you think they are pouring hundreds of thousands of dollars into the campaign to pass Amendment 2?” she said. “Even proponents admit they don’t know where the state’s share will come from.”