Our View

We've not been shy in our support for expanding Medicaid in Missouri.

For years, we asked lawmakers to make it a priority. When that didn't happen, we encouraged Missourians to sign petitions that finally put it before voters. And now we urge you to vote "yes" Tuesday on Amendment 2.

While some Republicans are leading the opposition, this is not a partisan issue. To date, more than 300 organizations have endorsed it, included the Missouri Chamber of Commerce and Industry, which called it a "pro-jobs measure that will help fuel economic growth." It cited a report by the Missouri Foundation for Health, which concluded that expanding Medicaid will bring in thousands of jobs, most of which will pay well, and that the measure will boost the state's economy.

Mercy Hospital Joplin and Freeman Health System have each endorsed it.

The principal objection seems to be that Missouri will have to come up with $200 million or so to cover its share of the expansion costs (with the federal government paying the rest) and that could hurt schools and other state programs. Other states haven't found that to be the case. In fact, The Commonwealth Fund concluded: "Studies that examine the fiscal impact of Medicaid expansion on specific states or the effects across all states find consistent results: Expansion leads to significant budget savings and significant revenue increases (even without imposing additional taxes). Consequently, the actual net price of expansion is well below the sticker price to states of 10 percent. In some cases, states’ net price is negative. Medicaid expansion can provide states with additional resources to fund other priorities or cut taxes.

"Given that each states’ Medicaid program is different, fiscal effects and pathways to savings vary widely. Not every state that expands Medicaid will experience large savings in their traditional Medicaid programs, but many will. Not every state will experience large savings outside Medicaid, nor revenue growth, but some will. While the paths may differ, the available evidence points in the same direction: States pay, at most, only a small fraction of the cost of Medicaid expansion."

But should Missouri revenue be adversely affected, there is a solution at our fingertips.

Literally at our fingertips.

Missouri's cigarette tax — 17 cents per pack — is not only the lowest in the country but is embarrassingly, shamefully, sinfully low. We could go up by $1.60 a pack and still be below the national average. There sits hundreds of millions of dollars that could be used to help pay for expanded health care. And because tobacco is one of the drivers of our health care problems, it seems only fitting to make it pay for our health care solutions.

We know Missourians only a few years ago rejected previous competing proposals to raise the cigarette tax, but that was because tobacco companies had their hands all over those campaigns, building in trapdoors, beneficial clauses and loopholes as well as ways to punish competing companies.

If we need the money, give Missourians a clean shot at raising the cigarette tax.

Regardless of the economic impact, making health care available to another 200,000 Missourians is simply the right, decent thing to do.