A Medicaid expansion measure is one of the hot items at the ballot box in Tuesday’s primary election. Missouri voters will be asked whether to expand Medicaid to another 230,000 low-income adults. Currently, about 950,000 Missourians get government-funded healthcare. Under Amendment 2, Missouri adults earning up to $18,000 annually could qualify.

Missouri primary election spotlight: Can the state afford to expand Medicaid?

The clash between those for and against the plan has been largely about the way Medicaid expansion would affect the state’s bank account and philosophical contrasts. The messaging is very different depending on who you talk to.

During a statewide anti-expansion tour, State Treasurer Scott Fitzpatrick, a Republican, says the plan would cost the state another $200 million annually and would mean less money for other priorities.

“We fund prisons and if we want to close prisons and let violent criminals out of jail – that’s one option,” he says. “If we want to turn into Illinois and not fund our pension obligations – that’s another option and turn into a state with a junk credit rating. When you get down to it, one of the few discretionary items that we can decide how much money we’re going to spend without substantial consequences to the state is on education.”

Fitzpatrick, a former chairman of the House Budget Committee, says Missouri’s Medicaid obligations already make up about 40% of the state’s annual operating budget and it continues to grow each year.

“The state of Missouri already has a very generous Medicaid opportunities for families with children,” he says. “If you have a family and you have children and you are making less than 300% of the federal poverty level, which for a family of four is about $76,000, you can get your kids on Medicaid in the state of Missouri. If you are a pregnant woman and you need prenatal care and you don’t have access to health insurance and you are making less than 300% of the federal poverty level, you can get on Medicaid in the state of Missouri. The people that we are talking about, by and large expanding Medicaid to, are people who are working age, who are physically able to work and in many cases are choosing not to for whatever reason.”

State Representative Kip Kendrick, D-Columbia, insists the state would save money. Kendrick is the ranking Democrat on the House Budget Committee.

“Most states actually see a cost savings in the first year to two years and then that cost savings continues to grow,” Kendrick tells Missourinet affiliate KWIX in Moberly. “As more people come on, they tend to come on to that expanded role at a 90/10 (federal) match rather than a 60/40 (federal) match as you typically see in states that haven’t expanded. So, it’ll end up being cost savings for the state and provide greater access to healthcare and do a lot to shore up our hospitals and clinics around the state at a difficult time in the middle of a pandemic.”

A study by Washington University in St. Louis says Missouri would save about $39 million if the state expanded Medicaid. The analysis, done by the school’s Center for Health Economics and Policy, says the expansion would cost the state an estimated $118 million.

Sen. Bob Onder, R-Lake St. Louis, was also among a line of Republican legislators at the anti-expansion tour in Jefferson City.

“I would point out that the average Medicaid expansion state has seen cost overruns of 154%,” he says.

Onder, a practicing physician, says about 60% of the Medicaid expansion population already has private health insurance. If the ballot measure passes, he says they will be kicked off their insurance.

Gov. Mike Parson opposes the ballot measure and has the same financial stance as his Republican allies. During a press conference in May, Parson said the state budget is tough enough to handle with the coronavirus outbreak, let alone if Medicaid is expanded.

“There’s absolutely not going to be any extra money whatsoever,” says Parson. “Look, I don’t think it’s a time to be expanding anything in the state of Missouri right now. I’m telling you, we are going to have challenges going in to 2021 for sure when it comes to just meeting the budget with what we currently have.”

The Republican-leaning Missouri Chamber of Commerce says it backs the proposal that it says would lead to another 16,000 jobs per year for five years. Missourinet’s attempts to get the Chamber’s response about its support were not answered but in an initial statement expressing its position, President Dan Mehan called Amendment 2 a “pro-jobs measure” that will help fuel economic growth throughout our state.

“While this data makes a clear case for passing Amendment 2, the benefits of Medicaid expansion are even more significant during this time of economic hardship,” says Mehan.

Missouri Hospital Association spokesperson Dave Dillon tells Missourinet the healthcare group supports the expansion effort.

“It’s an important tool in getting people who need care some care and getting them comfortable with the idea of getting it when they need it. And that is to say that other parts of the Affordable Care Act were about keeping people healthy. You get paid – not necessarily for doing a procedure over and over again – but for the outcome of that procedure. To improve people’s health, requires you to put them in a system that you can help maintain their health. Medicaid can be that tool.”

Dillon agrees with the argument that Medicaid expansion is the vehicle for people who were never going to be able to afford to buy their own health insurance.

“But for us, if we’re going to set up a system of penalties for us not being able to keep individuals healthy – and by the way at the same time cost the healthcare system a lot more to treat in the wrong place at the wrong time – then we really need this as a tool in our tool belt to try to get those people to where if they need care for a chronic condition, if they are not even managing and don’t realize that they have diabetes, heart disease or the like, when they show up and need a stint or something really expensive, that’s an unnecessary cost. That’s a cost that we all bear because if that individual can’t pay for it, it’s going to be cost-shifted to people who can.”

He goes on to say the measure would save the entire healthcare system some money.

“There’s a hidden healthcare tax that everybody that’s got a commercial health insurance plan pays,” says Dillon. “That is attributable, in part, to the fact that we have a large number of uninsured and when they need care, they get it. They just don’t get it in an efficient place. They usually get it in the Emergency Department and then we have to write it off.”

Fitzpatrick, from southwest Missouri’s Shell Knob, says Medicaid expansion is billed as the “silver bullet” for struggling hospitals.

“I frankly don’t think that it is. I mean, it might help a little bit but frankly there are hospital systems out there that have problems that exceed what Medicaid expansion itself can solve.”

If Amendment 2 passes, Missouri would become the 38th state to expand government-funded healthcare coverage.

Polls are open Tuesday statewide from 6 a.m. to 7 p.m.

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