Missouri Voters Approve Medicaid Expansion, 12 States Remain

Update August 10, 2021: Following legal challenges, Missouri began enrollment in the Medicaid expansion program, after a state court ruled that Missouri officials must implement the voter-approved Medicaid expansion immediately.

Earlier this week, Missouri voters approved a constitutional amendment to expand Medicaid via a ballot initiative by an 82,000 vote margin, becoming the 38th state to endorse expanding health care access for the most vulnerable people in their state. The move will go a long way towards closing the coverage gap for their most vulnerable citizens. Missouri’s uninsured rate is nearly 10 percent higher than the national average, with thirty-three states having a lower rate of people without coverage. It is expected that a quarter of a million low-income people will gain access to coverage with this successful expansion, including more than 40,000 children.

Missouri’s Community Health Centers played a pivotal role in building support behind the ballot initiative, committing $250,000 and joining forces with a broad-based statewide coalition of health care providers, advocates, business leaders (including all the major chambers of commerce), the faith community, foundations and political leaders to educate voters and counter misinformation from opponents of expansion.  Joe Pierle, CEO of the Missouri Primary Care Association, served as Treasurer of the statewide campaign.

“Missouri’s Medicaid expansion will make a difference in the lives of hundreds of thousands of people,” said Joe Pierle, Chief Executive Officer of the Missouri Primary Care Association (MPCA).  “We are proud of our efforts to get this important ballot measure across the finish line alongside a diverse coalition of stakeholders who understood this was the common-sense path for our state.”

It is well-documented that expanded Medicaid improves long-term health. Studies show that states that expanded Medicaid have more preventative cancer screenings and more cancers found at an earlier stage, a decrease in positive depression screenings, and an increase in prescription drug fulfillment for chronic conditions. States that expanded Medicaid saved the lives of at least 19,200 adults, while states that have not had at least 15,600 premature adult deaths. What is less documented is both the positive impact on the economy and state budgets, savings that can be reinvested into the public health system.

As detailed in a comprehensive report from Health Management Associates commissioned by MPCA in partnership with the Missouri Hospital Association, Medicaid expansion yields a significant financial upside for state governments.  Virginia and Arkansas realized savings of $421 and $444 million, respectively, after expansion. Relatedly, state governments routinely fund a significant amount of Medicaid-based services entirely on their own, without federal matching funds – this includes a majority of mental health, substance abuse and other services. A Medicaid expansion will provide Missouri with enhanced funding for services to low-income pregnant women, people with opioid and other substance use disorders, mental health and breast and cervical cancer care.

With Missouri’s victory coming on the heels of successful expansion in Oklahoma, it is critical to remember that there is work still to be done. KFF has estimated that if the 12 remaining states (plus Oklahoma and Missouri) expanded Medicaid, an additional 4.7 million adults could become insured. At a time when the national pandemic is causing skyrocketing unemployment and uninsured rates, Medicaid expansions are helping people access care they need.

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