Get to know the ballot issues — Amendement 2: Medicaid coverage

South KC Perspective

Amendment 2: Medicaid coverage for uninsured low income adults

By John Sharp

Missouri voters will get the opportunity August 4 to decide if Missouri will join 37 other states that have taken advantage of available federal funding through the Affordable Care Act that will pay 90% of the cost to expand Medicaid coverage to uninsured low income adults.

Missouri constitutional amendment 2 was put on the ballot by an initiative petition drive that garnered nearly 350,000 signatures.  If approved, it is expected to make Medicaid coverage available to about 230,000 adult Missourians who currently have no health care coverage.

The ballot language asks voters whether they want to “adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133% of the federal poverty level, as set forth in the Affordable Care Act”.

It also requires state agencies “to take all actions necessary to maximize federal financial participation in funding medical assistance under Medicaid Expansion”.

Medicaid expansion would help adult Missourians who make too much to qualify for Medicaid in Missouri (which has one of the most stringent income caps for Medicaid in the country) but don’t make enough to afford coverage through the health insurance exchange.  Most single adults don’t qualify for Medicaid coverage in Missouri.

Those caught in this coverage gap often include people nearing retirement age who have lost their employer-provided health insurance.

The Affordable Care Act provided for the expansion of Medicaid nationwide to persons with incomes at or below 133% of the federal poverty level, plus a 5% income disregard, effectively setting the income cap at 138%.  However, a 2012 U.S. Supreme Court ruling prohibited the federal government from withholding funds from states that refused to expand Medicaid, essentially making expansion optional for the states.

Several states recently have expanded Medicaid through statewide votes of the people when their legislatures failed to do so.  Maine voters approved expansion in 2017, and voters in Idaho, Nebraska and Utah all approved expansion in 2018.

On June 30 of this year, Oklahoma voters very narrowly approved a constitutional amendment to expand Medicaid despite active opposition by its Republican governor and much of the state’s Republican leadership.

By expanding Medicaid through the constitutional amendment process, any attempt to repeal or undercut expansion also would have to be approved by the voters.

The exact financial impact to state and local governments in Missouri is debatable.  The ballot language notes that it is expected to decrease healthcare costs for local governments but have a one-time cost of about $6.4 million for the state.  By 2026, the ballot language estimates its annual financial impact to range from savings of about $1 billion to increased costs of $200 million or more for the state government.

Researchers at Washington University in St. Louis estimated the state government’s annual savings at over $1 billion by 2026.  In neighboring Arkansas, savings from Medicaid expansion allowed the state to reduce its income tax rates.

Since 2014, ten rural hospitals in Missouri have shuttered their doors in part because of their rising costs of providing care to indigent patients with no health insurance.

A study commissioned by the Missouri Foundation for Health projected Medicaid expansion would create over 16,000 new jobs in the first five years, including over 2,100 in the six-county Kansas City metropolitan area.

Medicaid expansion in Missouri has been endorsed by approximately 300 different civic and community groups and groups representing business and labor, emergency medical services, the faith community, healthcare and patient advocacy.

Major statewide groups supporting the effort include the generally conservative Missouri Chamber of Commerce and Industry, the Missouri AFL-CIO, and the Missouri chapters of the AARP and League of Women Voters.

In the Kansas City area it is supported by a host of organizations including the Civic Council of Greater Kansas City, the Greater Kansas City Chamber of Commerce, the Health Forward Foundation, the Southern Christian Leadership Conference of Greater Kansas City and the United Way of Greater Kansas City.

As of June 30, the Yes on 2 campaign had raised approximately $3.3 million to support the amendment.  A No on 2 committee had only raised $200, but other organizations could still step in to try to defeat the amendment in the closing weeks of the campaign.

If approved, the amendment will take effect on July 1, 2021, the start of Missouri’s next fiscal year.