Medicaid expansion is among the first two petitions submitted for ballot measures to go before Missouri voters in the 2020 election cycle.

Secretary of State Jay Ashcroft announced Thursday that paperwork was filed November 7th, the day after last week’s midterm election, for efforts seeking to place issues on the ballot for the next big election which includes the Presidential race in two years.  The submission for Medicaid expansion in Missouri came the day after voters in three red states – Utah, Idaho, and Nebraska – passed ballot measures to expand the federal program.  36 states and the District of Columbia have now done so.

Submitting a petition is the first of numerous steps required to get it placed before voters.  Initial approval by the secretary of state can take a couple of months as the attorney general must OK language from a legal perspective and the state auditor is charged with determining the proposed petition’s financial impact on the state.

Petitions that end up being approved by the Secretary of State are then circulated for public signatures.  Ballot measures that don’t seek to establish a constitutional amendment require signatures from 5% of registered voters in six of the state’s eight Congressional districts, which will always be more than 100,000.

Gerald Peterson of Raytown, who filed the Medicaid expansion, submitted 30 petitions for the 2018 election cycle.  Of those, six were approved for circulation to gather signatures.  None of them made it to that ballot.  Among Peterson’s 30 submissions for 2018 was a previous version of Medicaid expansion.

Dave Dillon with the Missouri Hospital Association contends it’s too early to tell whether a ballot measure would be feasible in Missouri because many organizations are discussing what the election results mean for the state.  The hospital association actively supports Medicaid expansion.

Dillon thinks Missouri’s becoming more isolated after the three states passed expansion in this month’s election but says various parties must agree on way to move forward.  “It’s hard to dispute that Missouri is moving to the margins on Medicaid expansion,” said Dillon.  “However, it will take a coalition of organizations to build the support necessary to move it through the legislative or initiative process, and it’s not clear where all of those organizations are yet on the issue.”

Democratic strategist Jack Cardetti thinks interest in a ballot measure in Missouri could pick up momentum.  “I think you’ll see some talk of that, especially if nothing’s done this upcoming legislative session,” said Cardetti.  “I think you may see, sort of, a citizen-led initiative to get something like that going.”

Governor Parson’s newly appointed Medicaid Director, former Republican House Speaker Todd Richardson, says he wants to reform Medicaid, not expand it.

Richardson notes the Medicaid budget is now about 35 percent of Missouri’s $28 billion operating budget.  “The growth in spending is affecting nearly every other area of our state’s budget. At the same time, our health outcomes with Missouri HealthNet are not where they need to be,” said Richardson told Missourinet the day he was appointed.

Richardson says his mission is to have a sustainable program that produces better health outcomes at an affordable price for Missouri taxpayers.

Many supporters of Medicaid expansion contend it would provide a boost for financially strapped rural hospitals that treat a disproportionate number of low-income patients who have no health care insurance and can’t begin to cover the costs.

Four rural Missouri hospitals have closed since 2010, with Twin Rivers Medical Center in southeast Missouri’s Kennett being the most recent.  Kennett residents now must travel roughly an hour or more to the nearest hospital.  There are estimates calculating that 48 percent of rural hospitals in Missouri are operating at a financial loss.

If Missouri were to expand Medicaid, the federal government would cover no less than 90% of costs as of 2020 and a slightly larger percentage in 2019.  At 90%, Missouri would have to chip in $200 million annually on top the federal contribution of $1.8 billion to pay for expansion.  FamiliesUSA estimates that 293,000 people would be newly eligible for coverage if the state were to expand the program.

The proposed petition submitted for the 2020 election cycle would expand Medicaid as it’s offered through the federal government.  It would cover able-bodied low-income people between 19-and-64 years old who earn up to 138% of poverty level.

Dillon with the Missouri Hospital Association notes Republican lawmakers who control the state legislature have no interest in implementing the existing program in its current form.  “It’s been abundantly clear to the hospital community…that it’s not how Missouri lawmakers are interested in doing this,” Dillon said.

(Missourinet’s Brian Hauswirth contributed to this report)