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Medicaid expansion on ballot

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Polk Countians will join voters across the state Tuesday, Aug. 4, to decide the future of Medicaid expansion in Missouri. 

Multiple local races are also on the ballot, but the Medicaid issue is the only question Polk Countians will find in this year’s August primary, Polk County Clerk and elections authority Melinda Robertson confirmed. 

According to the Missouri Hospital Association, Medicaid expansion was placed on statewide ballots because Missourians collected signatures from nearly 350,000 voters — “more than twice the number of signatures required.”

The issue asks voters to approve an expansion, authorized by the Affordable Care Act, of Medicaid insurance to uninsured adults and children whose incomes are at or below 138% of the federal poverty level, which is $28,676 a year for a family of three.

Jack Wang, communications associate for Healthcare for Missouri, a group pushing for the measure, told the BH-FP Wednesday, July 15, a yes vote would help more Missourians with limited income and resources offset medical costs. The program also offers benefits not normally covered by Medicare, including nursing home care and personal care services. 

Expansion offers even more benefit to residents of rural areas like Polk County, he said. 

According to data supplied by Healthcare for Missouri from the Center for Health Economics and Policy, “about one quarter of the population lives in rural areas, but about one third of covered by the expansion will be from rural areas.”

The Missouri Hospital Association said people enrolled under expanded coverage would be more likely to seek care when they need it and less likely to delay care, leading to better health outcomes. 

The expansion, according to supporters, would benefit not only rural residents, but rural health care providers and hospitals as well.

Since 2014, 10 rural hospitals in Missouri have closed — including the Southwest Missouri Psychiatric Rehabilitation Center in Cedar County and the Sac-Osage Hospital in St. Clair County — according to the Missouri Hospital Association. The association said around half of Missouri’s rural hospitals operate with a negative margin.

All of the counties in the bottom quartile for health insurance coverage in Missouri are rural, per the association. 

Supporters have said better compensation would be a boon to rural health care providers. 

“The Missouri hospitals provide approximately $1.5 billion in uncompensated care annually,” according to the Missouri Hospital Association website. “Caring for all Missourians, without regard to their ability to pay, is a fundamental part of hospitals’ community-supporting mission.”

Reducing uncompensated care spending would allow hospitals to address health-related challenges in their communities, the hospital association said. 

“With expanded Medicaid coverage for low-income working Missourians, hospitals and health care providers will have additional capacity to focus on health, rather than health care,” the association said. 

There are other overall economic benefits, Wang said, citing the Missouri Foundation for Health.

“Highlights include an average increase of more than 16,000 new jobs each year and extensive gains in jobs outside of the Kansas City and St. Louis metropolitan areas,” he said. 

Support for the measure has come from across the board, Wang said. 

“We've received strong support among conservative and business groups, including the endorsements of the Missouri Chamber of Commerce and Industry, the AFL-CIO, and the AARP of Missouri.”

The measure does have detractors, including Carl Bearden, CEO of United for Missouri. 

Bearden said his group has long been opposed to Medicaid expansion, citing several issues, including “significantly increased costs” projected by the Department of Health and Senior Services. They’re a reliable source on the issue, Bearden said. 

“They are the ones who run the Medicaid program on a day-to-day basis and are more in tune with what it takes to implement the proposed expansion,” he said. 

Bearden said the organization also believes that if the expansion is approved, the state will be unable to afford both it and maintain funding for education and other priority areas and that “Missouri will lose the ability to craft specific plans that provide fiscal responsibility through reduced costs to taxpayers and provides better results for recipients under subsection 4 of the proposed amendment.”

Missouri State Treasurer Scott Fitzpatrick has echoed Bearden’s concerns. 

"The incredibly large price tag of expanding Medicaid will require massive cuts to our state's education funding levels or an increase in your tax bill or both,” Fitzpatrick said in a news release. 

Bearden said expansions in other states have led his organization to believe that Missouri will see higher enrollment and costs than projected, which would eventually lead to other budget cuts. 

“(The) state is in highly uncertain fiscal condition due to the impact of COVID and following policies, which will significantly increase the number of enrollees beyond those that are already under projected,” he said. 

House Budget Chairman Representative Cody Smith said COVID-19 has been detrimental to the state’s economy. 

“More than $1 billion have been cut from the state’s general revenue budget in recent months,” he said in a news release. “Just this month, services requiring state support have been drastically reduced, including elementary school funding, college scholarships and support services for those in need.” 

Smith called possible costs associated with Medicaid expansion a “knockout blow to the state budget as more services will be cut or eliminated to pay for the health care of able-bodied adults.”

The Missouri Hospital Association said while an overwhelming cost to state government is a common argument by opponents, “this has not been the case in states that have adopted expansion.” 

The association cited research by Health Management Associates, saying “the full cost of well-designed and well-synchronized Medicaid expansion in Missouri could be covered by replacing state-only funded enrollees with the expansion’s 90% federal match, offsetting other Medicaid enrollees that would be matched at a higher rate, and through other policy and operational adjustments.”

Gov. Mike Parson’s office did not respond to a request for comment by press time Tuesday. 

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