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Voters to decide on expanding Medicaid in state

On the Aug. 4 ballot, voters  will be asked to vote on whether to amend the Missouri Constitution to expand Medicaid as envisioned under the Affordable Care Act.

The Republican-led legislature has refused to expand Medicaid, claiming the state cannot afford to do so.

Some 350,000 Missourians signed petitions to put this measure on the ballot.

If the measure is approved by voters, this issue will bypass the legislature and our state Constitution will require Medicaid to be expanded to include people from 19 to 64 years old with an income level at or below 133 percent of the federal poverty level.

By some estimates, more than 250,000 low-income Missourians could be added to the Medicaid rolls. While federal dollars are expected to cover 90 percent of the cost of Medicaid, the state must fund the other 10 percent (“Editorial: We recommend a ‘yes’ vote on Amendment 2 to fix Missouri health care” by the Editorial Board, July 21, 2020,

State Reps. Kathy Swan and Holly Rehder said money to fund this expansion would have to come from somewhere else in the state budget. It would most likely mean cuts to education and mental health.

However, others claim expanding Medicaid could save the state money.

Missouri pays $3.245 billion annually for Medicaid and receives 65 percent reimbursement from the federal government.

If Medicaid is expanded, the federal government would pay for 90 percent of the cost of the expansion. Other states that have expanded Medicaid have offset the cost of the 10 percent increase in Medicaid rolls by synchronizing programs and matching initiatives.

A Washington University study claims if Medicaid expansion had occurred in 2020 and added 315,000 people, Missouri would have saved almost $40 million.

The study states that without expansion, Medicaid costs will still increase 20 percent  by 2024. With expansion, Missouri’s cost could decrease 2.8 percent over the next four years, the study claims.

Other studies claim expansion could save Missouri from $235 million to more than $1 billion a year.

On the other hand, the federal government is facing a deficit of $26 trillion. If it cuts Medicaid funding in the future to help reduce the deficit, Missouri will be Constitutionally on the hook to pay for all expansion costs (“Cost remains central concern in Missouri Medicaid expansion fight” by Cynthia Newsome,, June 22, 2020).

Gregory Dullum has worked for The Cash-Book Journal for more than 25 years. Prior to becoming the editor in May 2017, he was production manager, circulation manager and reporter. Before moving to Cape Girardeau in 1988, he was editor of the Saint Louis Park Sailor, a weekly community newspaper in suburban Minneapolis, MN. A native of Minnesota, he returned there after graduating with distinction in 1978 from Ambassador College in Pasadena, CA, with a degree in mass communications. His wife, Marie, whom he met in college, is a native of Zalma, a small town in southeast Missouri. They have two grown daughters and five grandchildren. Gregory may be reached at

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