Missouri Voters Approve Medicaid Expansion

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Missouri Voters Approve Medicaid Expansion

On Tuesday, voters in Missouri voters approved expanding the state's Medicaid program by a margin of 53%-47%.


Starting on July 1, 2021, Missourians who are able-bodied, childless, and younger than 65 will be able to enroll in Medicaid if their household incomes are below 133% of the federal poverty level. The Affordable Care Act allows states to expand eligibility to include these individuals. Medicaid is a joint state-federal health coverage program, with the federal government providing some funding as well as setting certain rules for how the states can operate. 


Medicaid expansion has been a controversial topic in many states, especially ones where Republicans have the majority in the legislature. These states have largely been reluctant to expand the program, fearing long-run costs. Skeptics of expansion note that while the federal government funds 90% of the new enrollees, it still leaves state with a financial burden that will grow over time. They argue that the people covered by this expansion do not have disabilities or children to care for, so they should be seeking jobs that would have private health insurance.



Backers of expansion -- which included health groups, hospitals, and business interests in Missouri -- counter that Medicaid expansion is an effective way of helping those who cannot afford insurance. They say that it will save lives and reduce the use of emergency rooms. In some states where legislators refuse to vote in favor of expanding Medicaid, these advocates have gone directly to voters through ballot initiatives.


This is the second voter-approved Medicaid expansion in a Republican Midwest state this summer. In June, Oklahoma voters also voted in favor of a similar measure. There have also been successful citizen-initiated measures to add more enrollees to Medicaid in other GOP-controlled states. These include Idaho, Maine, Nebraska, and Utah. However, in both Missouri and Oklahoma, the initiative amends the state constitution; voters in the other states have only amended statutes. A constitutional amendment change prevents legislators from reversing the outcome or changing the program eligibility.


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