Heads up! Missouri could be the latest red state to expand Medicaid on August 4th!

Back in 2018, I was all over the trend of deep red states putting ACA Medicaid expansion on the ballot after getting fed up with years of their elected leaders refusing to do so. Idaho, Utah and Nebraska voters all did exactly that, passing it by solid margins. Unfortunately, state Republicans got in the way (or at least tried to) in all three states, adding hurdles, barriers and caveats which have either delayed or partly weakened them.

Nonetheless, Utah and Idaho have both implemented Medicaid expansion to low-income residents (and thank God, given the current ongoing COVID-19 pandemic), while as far as I can tell, Nebraska is scheduled to launch their expansion program (called "Heritage Health") starting this October.

THIS year I'm afraid I kind of dropped the ball on two more red states which are doing the same thing this year. I wrote a couple of pieces about how both Oklahoma and Missouri launched ballot initiatives to expand Medicaid last winter, but the pandemic kind of sucked up all my attention this spring/early summer and I didn't write anything else about either one until after Oklahoma voters narrowly passed theirs a few weeks back, providing healthcare coverage to around 200,000 Sooners.

In Oklahoma's case, they even made sure to learn the lesson of the ID/NE/UT experiences: They made their wording bulletproof by embedding it into the state constitution, which means the governor and state legislators can't screw around with it. OK's Medicaid expansion program will be open to all eligible residents earning up to 138% FPL, period, without work requirements or other red tape.

Well, I'm making sure not to make the same mistake with Missouri, so here's your heads up:

On Tuesday, August 4, all Missourians will have the chance to vote Yes On 2 to bring more than a billion of our tax dollars home from Washington every year – money that’s now going to places like California and New York instead.

By bringing our tax dollars home, we can protect thousands of frontline healthcare jobs, help keep rural hospitals open, and deliver healthcare to Missourians who earn less than $18,000 a year. That includes thousands of veterans and their families, those nearing retirement, working women who don’t have access to preventive care, and other hardworking Missourians whose jobs don’t provide health insurance.

According to the MO Yes on 2 website, the numbers are even higher in the Show Me state:

Medicaid expansion closes that coverage gap and ensures that hardworking Missourians will have access to affordable healthcare. It helps people nearing retirement who have lost their insurance, those with chronic medical conditions, and all Missourians who earn less than 138 percent of the federal poverty level (that’s less than $18,000 for an individual or $30,000 for a family of three). Medicaid expansion would provide healthcare to more than 230,000 Missourians - including more than 50,000 parents and 18,000 near retirees.

Like Oklahoma, Missouri activists are being very smart here, learning the lessons from 2018 and actually amending the MO Constitution. Check out the ballot initiaitive language:

Do you want to amend the Missouri Constitution 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;
• 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?

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.

 Fair Ballot Language:

A “yes” vote will amend the Missouri Constitution 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.  Currently, Medicaid eligibility is set forth in state statute, but this amendment adds Medicaid Expansion to our constitution.  This amendment prohibits 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.  The amendment requires state agencies to take all actions necessary to maximize federal financial participation in funding medical assistance under Medicaid Expansion.  Federal law requires states to fund a portion of the program in order to receive federal funding (state match).  This amendment does not provide new state funding or specify existing funding sources for the required state match.

A “no” vote will not amend the Missouri Constitution to adopt Medicaid Expansion.

If passed, this measure has no direct impact on taxes.

It's important to note that the discrepancy between the 133% FPL and 138% FPL is due to an odd little clause in the wording of the ACA which basically says to knock 5% off of a household's Modified Adjusted Gross Income for purposes of eligibility.