Health advocates in Missouri have launched an effort to put Medicaid expansion on the ballot in 2020.
Medicaid expansion could mean coverage for more than 200,000 uninsured Missourians who earn less than $18,000 a year for an individual or $30,000 for a family of three, according to Healthcare for Missouri, the group spearheading the effort.
The campaign is comprised of hospital groups, physicians, patients and business executives. They need to secure at least 172,000 signatures to qualify to get on the ballot.
The campaign spent the summer exploring whether it was possible to pursue expansion with a ballot initiative before publicly committing on Wednesday.
According to the Missouri Ethics Commission, the campaign has so far received financial backing from The Fairness Project, a D.C.-based 501(c)(4) nonprofit. The group has contributed about $32,000 so far.
In a statement to The Hill, Fairness Project Executive Director Jonathan Schleifer said the group wants the 2018 election to be the beginning of a movement.
"The pro-health care wave that swept the country in 2018 was just the first leg of a relay — and voters in Oklahoma and Missouri are taking up the torch," Schleifer said. "Americans are tired of having to choose between putting food on the table and paying for lifesaving care — and they're going to continue to vote for change."
Herb Kuhn, president and CEO of the Missouri Hospital Association, one of the organizations supporting the effort, said rural hospitals in particular need Medicaid expansion to stay afloat.
Nine rural hospitals in the state have closed since 2014, Kuhn said.
“Hospital closures in rural communities have increased the distance to lifesaving care for Missourians suffering from traumatic injuries, stroke and heart attack,” Kuhn said in a statement. “Minutes count in medical emergencies. Medicaid expansion will help maintain access to emergency care in rural Missouri — benefiting those gaining coverage and all rural residents.”
Under ObamaCare, states have the option to expand Medicaid to cover more low-income adults, with the federal government picking up most of the costs.
But 14 states — most with Republican governors or legislatures — have decided not to go down that road.
In recent years, expansion supporters have circumvented that opposition by making their case directly to voters, who approved initiatives in Utah, Nebraska and Idaho last year. That followed a 2017 success in Maine.
But even if these initiatives succeed on Election Day, expansion isn’t necessarily a done deal.
When Maine voters approved Medicaid expansion by a 60-41 percent margin, then-Gov. Paul LePage (R) balked at implementing it, arguing it would bankrupt the state.
Similarly, GOP officials in Utah and Idaho are working on slimmed-down versions of Medicaid expansion that would offer fewer benefits and cover fewer people. The Trump administration has rejected those efforts to date.