Voters decide Tuesday whether Missouri becomes the 38th state to expand Medicaid under the Affordable Care Act.
Supporters say the measure, known as Amendment 2 on the ballot, would provide preventative care to the working poor and stabilize hospital finances, especially in rural areas. Opponents, including Republican state lawmakers who have resisted the measure for years, point to a growing Medicaid budget that could take funding from education and other state needs.
Amendment 2 was placed on the ballot after advocates gained enough signatures across the state. Similar voter-led initiatives have passed in Nebraska, Oklahoma and other conservative states.
A yes vote would provide health care coverage to over 270,000 Missourians who are at or below 138% of the poverty line.
“Most the folks that this affects, our working individuals, they just fall in the gap,” said Patt Dillon, vice president for advocacy and government relations at Mosaic. “They make too much for Medicaid, they don’t have benefits through their employer, and they can’t afford regular insurance on the exchange.”
Mosaic Life Care is in support of Medicaid expansion and believes it would help a portion of Missouri to health care while helping support rural hospitals, which have taken a hit.
The expansion, if approved, would cost $2 billion total. The federal government would pay 90% and the state of Missouri would be on the hook for around $200 million.
Missouri State Rep. J. Eggleston, R-Maysville, believes the $200 million is too much and the Missouri general budget will have to take a hit somewhere to pay for it.
“From what I’ve seen in other states, I think it would be more detrimental than beneficial for us to expand,” Eggleston said. “I think it will erode work ethic, it’ll be very costly to the state taxpayers. And the state is going to have to take money from some other program.”
Eggelston said traditional Medicaid is intended to help those who cannot help themselves, whereas Medicaid expansion is only for able-bodied adults who can help themselves, he said.
Eggelston expressed concern about a constitutional amendment that lawmakers would be unable to change in the future. The measure includes language that would prevent work rules for Medicaid recipients.
“What will happen with Amendment 2 is we are enshrining today’s language into the Missouri Constitution forever where it can’t be changed, and that could pose some real risk to finances and to the program itself down the road,” Eggleston said.
Dillon said the time is up for Missouri to pass through Medicaid in line with the Affordable Care Act as 37 out of 50 states already have done so. He said that with rural hospitals closing since 2014, Medicaid expansion could give them a fighting chance as they would not be giving as much uncompensated care. Hospitals would receive a 30% rate from Medicaid patients.
“This would help at least soften that (uncompensated care) and our rural hospitals are fragile, 50% of our rural hospitals operate in a negative margin, and we don’t want to lose rural hospitals,” Dillon said.”They are so important to those communities. So this will help stabilize that a little bit.”
Eggleston said he believes the expansion would not be a significant help to rural hospitals.
“There is some uncompensated care that they are now getting the 30% rate on that they weren’t before, but everyone who had insurance who lost it to go to Medicaid, it went from about a 70% compensation down to a 30%, and because of that, In the end, they didn’t really gain much at all,” Eggleston said.
According to Becker’s Hospital Review, 120 rural hospitals closed between 2010 and 2019. Texas, a state that did not expand Medicaid, had the most closures with 20.