Missouri voters on Tuesday approved Medicaid expansion to many of the state’s poorest adults, making their conservative state the second to join the Obamacare program through the ballot during the pandemic.
The Missouri ballot measure expands Medicaid to about 230,000 low-income residents at a time when the state’s safety net health care program is already experiencing an enrollment surge tied to the pandemic’s economic upheaval. The measure was up 52 percent to 48 percent, with 83 percent of precincts reporting, when the Associated Press projected the win for expansion.
A winning streak: Missouri becomes the sixth red state where voters have defied Republican leaders to expand Medicaid, just weeks after Oklahoma voters narrowly backed the program. No state has ever voted down such a ballot initiative in recent years, underscoring the popularity of Medicaid expansion even in parts of the country hostile to Obamacare.
The Missouri vote came as the state has faced one of the sharpest increases in coronavirus infections and now reports on average over 1,200 daily new cases, almost three times more than a month ago. It’s unclear whether the state’s rules around mail-in balloting could have affected turnout. Since the state requires mail-in ballots to be notarized, organizers expected most voters would head to the polls on Election Day.
Republican Gov. Mike Parson, who’s up for reelection, opposed the ballot measure, saying the state couldn’t afford the coverage expansion. Missouri’s Medicaid program has already seen enrollment rise nearly 9 percent between February and May, ranking among the largest increases nationwide.
The ballot initiative’s organizers focused on similar messages from other successful Medicaid expansion campaigns. They highlighted the federal support it would bring to cash-strapped rural hospitals, after 10 have closed since 2014 and others face financial peril. The federal government provides 90 percent of funding for Medicaid expansion, more generous than the 65 percent rate Missouri receives for its existing program.
“Quite frankly, Missourians are sick and tired of not getting their fair share. They pay their taxes, they’ve seen now 37 other states use that money to expand access to health care. Meanwhile, our economy’s clearly ailing here,” Jack Cardetti, the campaign’s spokesperson, said last week.
The ballot measure adds the Medicaid expansion into the state’s constitution, effectively barring Republican lawmakers from adding conservative elements to the program — like work requirements and premiums — as other states sought to do following similar initiatives.
Democrats had accused Parson of trying to sabotage the ballot measure by scheduling the vote for Tuesday’s primary, rather than November’s general election when turnout would be higher. Parson said the scheduling wasn’t politically motivated and was necessary to understand whether the state would be facing new spending commitments during the coronavirus crisis.
What’s next: The ballot measure requires Missouri to expand Medicaid by next July and formally notify the federal government by March 1.
There are now 12 states, mostly Republican-led, that haven’t yet expanded Medicaid. Virtually none have indicated they will give the program a fresh look because of the pandemic.