Advocates in Missouri close in on Medicaid expansion ballot question

Advocates in Missouri close in on Medicaid expansion ballot question

Missouri residents are likely to vote on Medicaid expansion this fall after health advocates on Friday said they have secured enough signatures to put issue on the ballot for November.

The group Healthcare for Missouri said it submitted nearly 350,000 signatures, almost double the 172,000 required for a state ballot initiative.

The signatures will go through a verification process by the state, but the group said it was confident there were more than enough to qualify.


Advocates want to expand Medicaid to Missouri residents under the age of 65 who earn less than $18,000 a year. Expansion would benefit an estimated 230,000 residents, proponents said.

It would also help rural hospitals, whose officials say Medicaid expansion is key to preventing their facilities from running out of money. Ten rural hospitals have closed in Missouri since 2014.

Healthcare for Missouri, backed nationally by The Fairness Project, was able to secure the signatures before the coronavirus outbreak shut down public life in March. Signatures are due to the Secretary of State’s Office by Sunday.

“Voters in red and blue states alike want results, and they want health care that can’t be taken away on a whim by politicians. That was true before the COVID-19 pandemic, and it’s certainly true today," said Jonathan Schleifer, executive director of The Fairness Project.  

“The fact that so many of the essential workers who are keeping us afloat and are being celebrated as heroes still don’t have health care is outrageous,” Schleifer said. 

According to expansion supporters, many workers on the frontlines of the outbreak have essential, low-wage jobs. Due to Missouri's strict Medicaid requirements, they are likely to fall into a coverage gap — earning too much to qualify for Medicaid but too little to afford private insurance.


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 GOP legislatures — have decided not to go down that road.

Missouri Republicans have blocked expansion efforts for nearly a decade.

In recent years, expansion supporters have circumvented GOP opposition by making their case directly to voters, who approved initiatives in Idaho, Nebraska and Utah last year. Those victories followed a 2017 success in Maine.

A key player in those campaigns was The Fairness Project, a D.C.-based group that is also involved in expansion efforts in Oklahoma. Gov. Kevin Stitt (R) recently announced that Medicaid expansion would appear on the state's June 30 ballot.

But even if the measure is approved, expansion isn't guaranteed.

When Maine voters approved Medicaid expansion by a 60-41 percent margin, then-Gov. Paul LePage (R) balked at implementation. It took a Democratic governor elected two years later to follow through on expansion.

Similarly, GOP officials in Idaho, Nebraska and Utah tried to pass slimmed-down versions of Medicaid expansion that would offer fewer benefits and cover people.