An estimated 230,000 low-income adults could gain health care coverage if Missouri voters approve a Medicaid program expansion that the state's Republican-led Legislature has repeatedly blocked.

Advocates of the expansion turned in petitions Friday to the Missouri Secretary of State's Office in Jefferson City seeking to put a proposed constitutional amendment on the ballot in November. According to the group Healthcare for Missouri, nearly 350,000 state residents signed the petition, or about twice as many as required to get the measure on the ballot.

Supporters say the expansion is needed to assist workers who fall in the state's Medicaid coverage gap by earning too much pay to qualify for Medicaid but too little to afford private insurance.

"By and large, these are people who have jobs and are working full time, but those jobs don't provide health insurance," said Alan Zagier, a spokesman for Heathcare for Missouri.

Zagier said Medicaid limits in Missouri are among "the most stringent of any state."

"Single adults without children are not eligible, no matter how little they earn, and adults with children only qualify if they earn less than 22% of the Federal Poverty Level — about $3,700 a year for a parent with one child."

The group maintains that many of those without coverage are on the front lines of the coronavirus outbreak, working low-wage jobs in grocery stores, nursing homes and hospitals.

“The need for Medicaid expansion was apparent before the outbreak and only becomes more critical as the pandemic continues," said campaign manager A.J. Bockelman. "It’s time to help the workers hit hardest by this crisis and bring billions of our tax dollars home to create jobs once this outbreak is under control.”

Millions of Americans gained health care coverage with the expansion of Medicaid under the Affordable Care Act of 2010. But a 2012 U.S. Supreme Court decision left Medicaid expansion up to the states.

Missouri is among 14 states that have resisted expansion of their Medicaid programs.

The Affordable Care Act provides a higher federal funding share to states that approve expansion of their Medicaid programs to those who earn up to 138% of the federal poverty level, or about $17,600 for an individual and $30,000 for a family of three.

Gov. Mike Parson and other Republicans in the Legislature believe the expansion would necessitate a substantial tax increase. Advocates cite a Washington University study that suggests expansion would save the state $1 billion by 2026 through the return of more tax dollars to the state and the reduction of many of the health care costs the state is currently paying.

State Sen. Bill White, R-Joplin, believes it would cost the state at least $200 million more a year. He says there is no guarantee the federal government will maintain the 90%/10% funding share ratio provided in the Affordable Care Act.
 The signatures on the petitions turned in Friday will need to be validated before the proposed amendment can be placed on the ballot in November. Oklahoma voters will be deciding a similar measure June 30.

States bordering Missouri that have adopted Medicaid expansions include Illinois, Iowa, Nebraska and Arkansas.

Arkansas expansion

According to Healthcare for Missouri, expansion of the Medicaid program in Arkansas saved the state $400 million over the course of three years, allowing the state to cut taxes and reduce payments previously allocated to the uninsured.

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