Missouri becomes the 38th state to approve Medicaid expansion to more low-income adults

Missouri Gov. Mike Parson at the White House
In this July 7 file photo, Missouri Gov. Mike Parson speaks during an event at the White House in Washington.

Voters on Tuesday made Missouri the 38th state to approve expanding Medicaid healthcare coverage to thousands more low-income adults.

Support for the constitutional amendment means that as many as 250,000 more adults could choose to be covered by government health insurance beginning in July 2021, according to estimates from the state auditor.

“As Medicaid expansion is fully and expeditiously implemented so that Missourians are no longer forced to choose between putting food on the table and seeing a doctor, today’s victory will be a true turning point in the history of the Show Me State,” said A.J. Bockelman, the pro-Medicaid campaign manager.


The vote on healthcare, which was paired with Missouri’s primary elections, came as confirmed coronavirus cases have been rising in the state and the economy continues to suffer.

“I believe the economy is going to bounce back strongly but not anytime soon,” said 62-year-old Jim Roberts, an employee in the Clay County Prosecutor’s office in Liberty who voted to expand Medicaid. “Jesus said, ‘The poor will be with you always,’ but we still need to address the concerns of those who are less fortunate.”

Concerns about the virus appear to have driven a record number of people to cast absentee ballots in Missouri’s largest jurisdiction of St. Louis County, said county election director Eric Fey. Election officials said coronavirus concerns also led to a somewhat larger number of cancellations and no-shows among poll workers in the St. Louis and Kansas City areas, though substitutes were dispatched to fill the gaps.

Voters on Tuesday also picked the Republican and Democratic candidates for Congress, statewide offices and state legislative seats.

Cori Bush, a onetime homeless woman who led protests following a white police officer’s fatal shooting of a Black 18-year-old in Ferguson, ousted longtime Rep. William Lacy Clay in Missouri’s 1st District Democratic primary, ending a political dynasty that has spanned more than a half-century.

St. Louis Circuit Atty. Kim Gardner, whose job performance has been lauded by some civil rights activists and criticized by President Trump and other leading Republicans, also won a challenge from former homicide prosecutor Mary Pat Carl.


Missouri’s Republican-led Legislature has repeatedly rejected Medicaid expansion proposals over the last decade, prompting supporters to turn to the initiative process.

Idaho, Maine, Nebraska, Oklahoma and Utah have all expanded Medicaid through ballot questions following inaction by state lawmakers, according to the nonpartisan Kaiser Family Foundation. Oklahoma became the 37th state to expand eligibility for Medicaid under the federal law last month.

Missouri’s Medicaid program currently does not cover most adults without children, and its income eligibility threshold for parents is one of the lowest in the nation at about one-fifth of the poverty level.

The ballot proposal will expand eligibility under the terms of the 2010 federal healthcare law signed by President Obama. That law provides a higher-than-usual federal funding share for states that expand Medicaid coverage to adults earning up to 138% of the federal poverty level, about $17,600 for an individual or $30,000 for a family of three.

The office of Democratic Auditor Nicole Galloway, who won the Democratic primary for governor Tuesday, said the financial impact on the state was not clear. The office has estimated that expanding Medicaid could cost the state at least $200 million or save as much as $1 billion annually by 2026. Republican opponents cited the potential costs as reason to oppose the ballot initiative.

Bonnie Ciro, 73, a hairdresser in Liberty, said she voted against the proposal because she doesn’t trust politicians to use the money, and she doesn’t want to pay higher taxes.


“It’s too much money,” Ciro said. “I think it’s a scam, I don’t trust what they say. [Politicians] tell you one thing and then do another thing with these kinds of programs.”

By proposing a constitutional amendment instead of a new law, Missouri supporters have ensured that lawmakers will be unable to change it without going back to voters.

Republican Gov. Mike Parson, who opposes Medicaid expansion and won the Republican primary for a full term, moved up the vote on the proposal from the Nov. 3 general election to Tuesday’s primary. Parson said the earlier vote would give the state more time to financially prepare for Medicaid expansion, if it passes. He said his decision was not about politics.

Galloway’s campaign has said Parson switched the day of the vote on Medicaid because fewer people typically vote in August compared with November, possibly giving opponents a better chance of defeating the measure.

Voter turnout during the 2016 presidential general election in Missouri was almost three times higher than turnout for that year’s August primary. Even in 2018, a record year for turnout during a primary, roughly 1 million more voters turned up at the polls in November compared with August.

Local election authorities projected a statewide voter turnout of nearly 37% Tuesday.