The battle lines are drawn over efforts to expand Medicaid in Missouri.

Missouri House Speaker Elijah Haahr, in a story on, expressed concern that a Medicaid expansion will blow a hole in the state budget.

Medicaid is a state-federal program that provides health coverage to low-income and disabled children and adults, but expanding the program under the Affordable Care Act requires a 10-percent state match. Medicaid already consumes about one-third of the state’s $29 billion operating budget, so any increase in spending could divert funds from other state priorities, like education.

House Democrats counter that expansion saves money in the long run because it reduces the burden of uncompensated care, which is a cost that hospitals and patients with insurance ultimately have to cover. The North Carolina Rural Health Research Program, in a nationwide study, found that five Missouri hospitals have closed since 2010.

This debate has gone on, more or less, since passage of the ACA allowed states to expand Medicaid. The goal of expansion was to provide coverage to the working poor.

Now, two developments inject a new urgency into this question. One is a report that Missouri’s Medicaid enrollment has dropped by 100,000. This led to calls for an investigation to see whether this is due to Missouri’s healthy economy or tougher scrutiny of enrollees who make too much money to qualify.

The other issue is the prospect of a citizen-driven ballot initiative to bypass the legislature and expand Medicaid in Missouri. This should come as a concern to the legislature’s Republican majority, following voter end-arounds on right-to-work, medical marijuana and ethics.

You can see a trend here. Legislators, and ultimately all Missourians, have been burned with voter-driven measures that prove more expansive than what was considered in the General Assembly.

Think of home-grown marijuana and uncountable redistricting czars. What could be lurking inside an amendment to expand Medicaid?

We don’t want to find out. The best bet isn’t for lawmakers to write a blank check for the expansion of Medicaid, but to seize control of the debate with an honest discussion on the costs vs. the benefits as well as the reasons behind the state’s declining Medicaid rolls. Is it because of increased employment opportunities, or are too many working poor finding themselves in the gap between government programs and private insurance?

Both Democrats and Republicans should go into a debate knowing that they might not like the answers. They should be willing to ask the right questions, instead of once again deferring to voters.