Less than two weeks remain to the Aug. 4 Election Day when Missouri voters will be asked if they want to expand Medicaid to provide more health coverage for hundreds of thousands of low-income residents.

Election Day: August 4

Medicaid ballot wording: Do you want to amend the Missouri Constitution to: adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133% of the federal poverty level, as set forth in the Affordable Care Act; prohibit placing greater or additional burdens on eligibility or enrollment standards, methodologies or practices on persons covered under Medicaid Expansion than on any other population eligible for Medicaid; and require state agencies to take all actions necessary to maximize federal financial participation in funding medical assistance under Medicaid Expansion? State government entities are estimated to have one-time costs of approximately $6.4 million and an unknown annual net fiscal impact by 2026 ranging from increased costs of at least $200 million to savings of $1 billion. Local governments expect costs to decrease by an unknown amount.

The Medicaid proposal is on the ballot because of statewide initiative petitions, gathered by supporters of expansion and signed by more than 340,000 Missourians.

The League of Women Voters’ information site, Vote411.org, provides the following summary of the issues:

If passed, Medicaid eligibility would be expanded to cover Missouri adults ages 19 to 65 whose annual income is $17,608 for an individual or $36,156 for a household of four. It would also prohibit any additional requirements or restrictions for the expanded population to qualify than for others who qualify now. It also requires the state to seek maximum federal funding.

Thirty-seven states plus the District of Columbia have implemented the program. Proponents say expansion would provide insurance coverage to more than 215,000 Missourians a year and that 90,000 children and 23,000 adults lost their coverage in 2019.

Proponents say states passing expansion have better health outcomes and lower morbidity rates. They say providing health care to those who can’t afford it is the right thing to do.

They also say the state would benefit economically through cost savings because of the higher federal match, thousands of new jobs created, increased economic activity up to $2 billion annually, and the expansion of health care infrastructure, particularly in rural areas where eight hospitals have closed. States which have implemented expansion have not experienced significant cost increases or repealed the program.

Opponents say that expansion could result in massive and unpredictable cost increases. They say that the state auditor’s assessment of costs could be biased. COVID-19 and economic downturns could significantly increase enrollment and federal funding is not guaranteed.

Opponents point out that major budgets that hurt higher education and other services had to be cut in 2019 because of increased Medicaid costs before expansion. They also say that health care providers could limit the number of Medicaid patients they will treat because of low reimbursements.

Election information on Vote411 comes directly from the candidates and campaigns and are unedited by the League of Women Voters. The League does not support or oppose any candidates, parties or ballot issues.