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Medicaid Expansion Initiative – Yes or No

By Shari Harris

In the August 4 primary election, Missouri voters will decide whether to expand Medicaid. There are good arguments for both sides of this issue, and no one has 20/20 foresight to be able to say exactly what the impact of the Amendment would be. Here are some of the facts.
• The Medicaid Expansion Initiative is on the ballot as an initiated constitutional amendment. This means a petition was signed by the required number of voters to put the amendment on the ballot.
• The wording used on the ballot says that a “yes” vote will “adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133 percent of the federal poverty level, as set forth in the Affordable Care Act; will prohibit placing greater or additional burdens on eligibility or enrollment standards, methodologies or practices on persons covered under Medicaid Expansion than on any other population eligible for Medicaid; and require state agencies to take all actions necessary to maximize federal financial participation in funding medical assistance under Medicaid Expansion.”
It also reads, “State government entities are estimated to have one-time costs of approximately $6.4 million and an unknown annual net fiscal impact by 2026 ranging from increased costs of at least $200 million to savings of $1 billion. Local governments expect costs to decrease by an unknown amount.”
A “no” vote will oppose the Amendment.
Many prominent health care organizations, associations, foundations and politicians have expressed their support for either side of this issue, demonstrating the serious repercussions if it passes, or if it fails. Don’t underestimate the importance of your decision regarding this vote, as there are strong arguments for both sides. Some of these are presented below.

• Missourians pay federal taxes that are disproportionately sent to the thirty-seven states that have expanded their Medicaid rolls. The federal government initially funded 100 percent of the cost of the state expansion of Medicaid, decreasing gradually to 90 percent in 2020 and thereafter.
• The Affordable Care Act did not provide tax credits to adults with household incomes below the federal poverty line, as states were anticipated to expand Medicaid to cover these individuals. In the 13 states that have not expanded eligibility, many of these people neither qualify for Medicaid or for federal tax credits to purchase health insurance.
• The economic hardships associated with COVID-19 have resulted in job losses and loss of health insurance for many Missourians, at a time when concerns for potentially costly healthcare to treat the virus are high. This could add to the burden on rural hospitals, already seeing increases in uncompensated care costs before COVID-19.
According to Missouri Foundation for Health, “local hospitals would lose $6.8 billion in uncompensated care costs if we do not expand Medicaid by 2022.” 


• Although the federal government currently will reimburse at 90 percent, they are able to change that rate at any time, leaving the state liable for the cost.
No on 2 In August reports, “Amendment 2 is conservatively projected to cost $200 million in state general revenue and $1.8 billion in federal funding every year. It is projected to increase current Missouri Medicaid rolls from 950,0000 participants to more than 1.2 million participants.
“In the history of our state, never has there been a new $200+ million cost mandated on our general revenue fund without an enormous ripple effect across other services Missouri provides,’ said House Budget Chairman Rep. Cody Smith.”
• Medicaid expansion could impact the right to life with increased access to surgical abortions and to “morning after” pills.

• The economic hardships associated with COVID-19 have resulted in a loss of revenue for the state. At a time when the state budget is being drastically cut in all areas, a $200 million cost added to the budget will mean more extensive cuts will have to be made elsewhere. Gov. Parson expedited getting the vote on the primary ballot in order to find out as soon as possible if the state would have to make plans for those budget cuts.


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