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Missouri voters usher in Medicaid expansion

by World Health Now
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Dive Brief:

  • Missouri voters narrowly approved Medicaid expansion in Tuesday’s primary election, becoming the latest state to usher in Medicaid expansion through a vote of its people, circumventing a GOP-led state legislature that has long been opposed to the measure.
  • Of the nearly 1.3 million votes cast, just over 53% voted in favor. There was about an 82,000 vote differential between those in favor of the measure and those against. The expansion is set to take effect July 1, per the language of the original petition, paving the way for an estimated 230,000 Missourians to gain access to health insurance coverage.
  • Tuesday’s vote was to provide an amendment to the state’s constitution, which may impede Republican Gov. Mike Parson and the state legislature from delaying or stopping its implementation. 

Dive Insight:

Missourians turned out to the ballot box to guarantee healthcare coverage for more residents at a time of significant upheaval as the novel coronavirus pandemic has spurred unprecedented job loss, sickened millions and killed thousands. At the same time, millions have lost insurance along with their jobs.

“Access to healthcare has never been more important than it is right now,” A.J. Bockelman, the Missouri campaign manager for the initiative, said in a statement.  

Now, adults without children with incomes of up to $18,000 will be able eligible to receive Medicaid coverage in the state. Currently, adults without children are not eligible no matter what their income. And an adult with children (and no disability) can qualify for Missouri Medicaid if their income is below 22% of the federal poverty line, or less than $5,500 for a family of four. Now, that same family is eligible for coverage with an income of up to 138% FPL, or $36,000, according to the Missouri Foundation for Health.  

Some were concerned about low turnout after Parson moved up the vote on Medicaid expansion to the August primary instead of the November election that typically garners a higher turnout. Yet, Parson contends he moved up the ballot initiative in the event it passed and said it would give the state more time to prepare.  

Medicaid expansion was never supposed to be a choice left to states to decide. The Affordable Care Act was designed to blanket all states with Medicaid expansion, but the Supreme Court ruled in 2012 that forcing states to adopt expansion was unconstitutional and made it optional for states. 

The decision has resulted in a patchwork of states choosing to expand the program. Thirty-eight states including D.C. have so far expanded the program while 13, including Missouri, have not.

More recently, a wave of red states captured victories at the ballot box after taking the issue straight to voters. Prior to Missouri, voters in Oklahoma just narrowly passed the measure in a vote earlier this summer. 

Yet, it hasn’t been smooth sailing for some states that garnered the approval of voters. Despite the win on election day, some state lawmakers have thrown up barriers, refusing to implement the program. 

For example in Maine, then Republican Gov. Paul LePage refused in 2018 to implement the will of the people who voted for expansion and said he’d rather go to “jail” before putting the state in the “red.” LePage previously vetoed multiple bills that would have expanded Medicaid. Expansion finally occurred in Maine after Democratic Gov. Janet Mills took over as governor in 2019.  

Despite previous backing from former political heavyweights in the state, such as Kit Bond, a Republican senator, and some of the state’s largest employers, expanding Medicaid never gained enough traction in the state’s capitol to become a reality. 

As other red states gathered enough signatures to take the issue to the ballot box, expansion proponents in Missouri kept a close eye on the results, hopeful a similar strategy could be deployed here. 



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