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Missouri votes to approve Medicaid expansion, overriding GOP opposition

August 5, 2020
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Voters wait in line to enter a polling place at Halls Ferry Elementary in Florissant, Mo., on Tuesday. (Michael B. Thomas/Getty Images)
Voters wait in line to enter a polling place at Halls Ferry Elementary in Florissant, Mo., on Tuesday. (Michael B. Thomas/Getty Images)

Missouri became the latest state to approve the expansion of Medicaid under Obamacare as voters on Tuesday approved the measure in a referendum conducted concurrently with the state’s primary. 

Amendment 2, which will provide health care to more than 230,000 low-income people in the state, passed by about 6 points with heavy support in the urban centers of St. Louis and Kansas City. Missouri was one of 13 states dealing with a “Medicaid gap,” as its Republican-controlled Legislature declined to accept the Affordable Care Act’s Medicaid expansion provision. 

The expansion provides federal funds to help low-income Americans get health care, with the federal government picking up most of the cost. Without the expansion, residents who make too much to qualify for Medicaid but not enough to make use of health care insurance subsidies may find insurance unaffordable.  

President Trump, an opponent of Obamacare, won the state by 16 points in 2016. In 2018, Missouri voters opted to expand the minimum wage and legalize marijuana for medical purposes via the ballot box. 

Thirty-eight states and the District of Columbia have expanded Medicaid. The 12 states that have not are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Grassroots activists who supported Amendment 2 celebrated the victory and credited hundreds of thousands of conversations with voters either in person or via text and phone call. The measure was also supported by hospitals, which spent millions promoting it, and by the state’s Chamber of Commerce, which called Amendment 2 a “pro-jobs measure that will help fuel economic growth throughout our state.”

Republican leaders in Missouri, including Gov. Mike Parson, were against the measure, citing the potential cost amid the coronavirus pandemic. However, a study from Washington University in St. Louis found that passing the measure could “save the state $39 million in the first year and $932 million by 2024.”

Gov. Mike Parson at a 2019 press conference in Jefferson City, Mo., to discuss the status of license renewal for the St. Louis Planned Parenthood facility. (Jacob Moscovitch/Getty Images)Gov. Mike Parson at a 2019 press conference in Jefferson City, Mo., to discuss the status of license renewal for the St. Louis Planned Parenthood facility. (Jacob Moscovitch/Getty Images)
Gov. Mike Parson at a 2019 press conference in Jefferson City, Mo., to discuss the status of license renewal for the St. Louis Planned Parenthood facility. (Jacob Moscovitch/Getty Images)

“I don’t think it’s the time to be expanding anything in the state of Missouri right now. There’s absolutely not going to be any extra money whatsoever,” Parson said. His Democratic opponent in November’s gubernatorial election, state auditor Nicole Galloway, supported expansion and has made Parson’s resistance to the expansion part of her campaign.

Missouri is the second state this year to expand Medicaid via ballot initiative, following Oklahoma, which passed a similar measure by a razor-thin margin earlier this summer. In 2018, voters in the traditionally red states of Idaho, Nebraska and Utah voted in favor of Medicaid expansion. Maine did the same in 2017.  

The Trump administration has been attempting to overturn Obamacare in the Supreme Court ever since Republicans in Congress failed to eliminate it in 2017. Even some conservatives who favor repeal of the ACA, including the Wall Street Journal editorial board, expect the lawsuit to fail when the justices hear it later this year. 

If the lawsuit is successful, an estimated 15 million Americans who rely on the expansion would lose their insurance, while tens of millions more with preexisting conditions could also be denied coverage.

Jonathan Schleifer is the executive director of the Fairness Project, a nonprofit organization that pushes progressive ballot measures at the state level and assisted pro-expansion groups in Missouri. He told Yahoo News in 2018 that the attempts to repeal the ACA have increased its popularity, something corroborated in recent polling, including a June Fox News survey that showed record-high support for the program.

“Every attempt to repeal the ACA increasingly clarified two things for Americans: what was at stake for them and their families and just how committed opponents of the ACA were, even if it meant millions losing coverage and personal costs skyrocketing,” said Schleifer. “It became clear to Americans that they could not count on D.C. nor their statehouses to do the right thing. So they decided to grab a clipboard and take their future into their own hands.”

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