Our View

Missouri should expand Medicaid coverage, but because the Legislature will not, the issue should be put before voters through the initiative petition process.

Why are lawmakers unwilling to act to expand Medicaid coverage? Money, they say.

"We have not (expanded Medicaid) in the state, and I do not see us doing it through the Legislature," Sen. Bill White, R-Joplin, said in a front page story in today’s Globe. "There are big concerns with the affordability of Medicaid expansion."

Rep. Cody Smith, R-Carthage, chairman of the House Budget Committee, echoed those concerns. "If we obligate ourselves to spend more money on Medicaid, those dollars have to come from other programs," he said. Further, he objects to voters using the initiative petition process to “bypass the Legislature.”

However, the expansion — originally mandated for states under the Affordable Care Act but made optional in the wake of a Supreme Court ruling — has also been strongly resisted by conservatives in part because of resentment and resistance to the passage of that act, “Obamacare.” Most states expanded the program to provide health care to more of those who couldn’t afford it. Missouri is among 14 states, including Kansas and Oklahoma, that have not expanded the program.

The resistance is based on cost opponents say, but the federal government will pick up the majority of the bill. For an estimated $2 billion expansion, Washington would pay $1.8 billion. Still no small change for the state — $200 million to be funded by state taxpayers. Yet the Kaiser Family Foundation, a nonprofit that looks at health care issues, estimated in 2016 that 199,000 uninsured adults in Missouri would be eligible for Medicaid under an expansion. That is nearly 200,000 people who are not insured who would be provided health coverage.

A report earlier this year from Washington University's Center for Health Economics and Policy concluded that a Medicaid expansion in Missouri "is approximately revenue-neutral and could create cost savings."

Providing routine health care brings benefits. A healthier workforce — most of those covered would be people working but not making enough to afford health coverage — and reduced costs that come from the broken system of treating people without coverage in emergency rooms would save us a lot. Savings projections have ranged up to a billion dollars.

Initiative petitions in 2018 passed in three conservative states — Utah, Idaho and Nebraska — have passed the issue through initiative petition. Because of conservative legislatures' inclination to reverse such popular votes in subsequent sessions, the measure here will likely be one for a constitutional change to make reversal more difficult.

Medicaid expansion makes sense. It will make the lives and health of many Missourians immeasurable better. Helping those struggling for decent health care should not be a partisan issue.

Pending a reading of the text of the petition, we urge you to support the initiative process and to support the expansion measure once it is on the ballot.

Recommended for you