Fix the Flat. Expand Medicaid.

Elections Healthcare Poverty

Fix the Flat. Expand Medicaid.

Note: Updated on July 8, 2020


Frankly, Medicaid expansion isn’t one of the most exciting things to talk about. Maybe this analogy will help:





The overall health of our state is riding on those four tires. The one that’s going flat? That one represents the 230,000 Missourians who aren’t able to get the kind of healthcare they need because of outdated Medicaid eligibility requirements. We’ve got to get that fixed. 


The 3 Ds of Medicaid Eligibility Requirements

It’s complicated, but under our current rules, Missourians typically can’t receive access to the healthcare they need unless they’re nearly dead broke, depleted, and destitute. For example:

Missouri seniors over the age of 65 must be nearly penniless before they qualify for Medicaid. For example, a widow or widower needing to be admitted into a nursing home can’t have more than $4000 in total assets. Plus, all available income they receive must be paid to the nursing home. 

Today, a child under the age of 18 who has a developmental disability can’t qualify for Medicaid if they earn more than $1311 per month and have no more than $3000 in resources available to them.

According to the Missouri Foundation for Health, parents in a family of four must earn less than $5,550 per year to qualify for Medicaid. With expansion, that same family of four could earn up to $18,000 per year and still receive the healthcare they need.


Oklahoma’s Journey to Medicaid Expansion

Voters in Oklahoma recently made the decision to expand Medicaid. It couldn’t have come at a better time for the tens of thousands who are struggling to make ends meet. It’s well known that those in poverty have more health problems than those who are better educated and have more money. With the COVID-19 crisis escalating in the Sooner state, Medicaid expansion was essential.  

Oklahomans in favor of expanding Medicaid touted the benefits of increased access to healthcare. They also said it would benefit rural areas of the state, which have suffered terribly from nine hospital and numerous other small health clinic closures between 2007-2019. In one of the few remaining rural hospitals, the eight nurses on staff at Haskell County Community Hospital are also responsible for the janitorial work. After caring for very sick patients, they literally mop the floors and scrub the toilets. 


Missouri Can Learn from Oklahoma

Missouri shares many similarities with its neighbor to the southwest. We’ve lost seven rural hospitals since 2014, mostly because when fewer people have health insurance they don’t go to the doctor. When they don’t go to the doctor they become more ill and may need hospitalization. If they don’t have insurance or enough money in the bank, they can’t pay those medical bills.

Over time, healthcare providers reach their limit as to how many losses they can absorb before they have to close the doors. Unless voters expand Medicaid, the number of rural hospital closures is likely to increase. With COVID-19 cases continuing to rise, poor and rural areas are starting to take a real hit. As these residents become sicker, we will see a ripple effect across the state. 


Amendment 2 on the Ballot August 4

Voters will decide the fate of more than 230,000 Missourians when they go to the polls on August 4 and consider Amendment 2. They will have to decide if they support expanding Medicaid eligibility requirements, or if they believe what we have in place today is working. As with all ballot measures, there are viewpoints on both sides. 


Oppose Expansion

One prominent individual who opposes expanding Medicaid is Republican Governor Mike Parson. To Parson, expansion isn’t financially feasible. At a recent briefing he commented, “The question is: Can we afford it or not? We don’t have the money.”  Parson had previously suggested that if Medicaid is expanded, cuts from other state services would have to be made. He called out mental health and public safety. Other Republican lawmakers have stated that the money would need to come from K-12 and higher education funds. 

Also opposing Amendment 2 are conservative groups, PACs, and nonprofits such as Americans for Prosperity and United for Missouri. Opponents have filed at least two lawsuits challenging the constitutionality of Medicaid expansion. 


Support Expansion

Democratic State Auditor Nicole Galloway is running for the state’s top spot against Parson. She supports Medicaid expansion. In a recent statement, Galloway explained, “I support Medicaid expansion because it will give roughly a quarter-million Missouri families access to insurance, create tens of thousands of jobs, save our rural hospitals and spur economic activity at a time when we need it most.”

Galloway isn’t alone in her support for the measure. Michael Neidorff, CEO of Centene Corporation supports Medicaid expansion. So does the Missouri Chamber of Commerce, AARP, first responders, and nearly 300 other organizations across the state.

Democratic Representative Crystal Quade (HD 132) believes the entire state would benefit if the measure passes in August. She stated, “Medicaid Expansion is long overdue in MO. We must pass Amendment 2 to bring healthcare to over 230,000 more Missourians. It will create over 16,000 new jobs and save Missouri $36 Million annually. We can’t afford to not do this.”

Supporters acknowledge the cost of providing more Missourians access to healthcare, but with the federal government picking up 90% of the tab for states that have chosen this path, they believe the long-term benefits will outweigh the cost. When residents are healthy they are able to work. When they’re able to work, they support local businesses and pay taxes. Residually, the overall health of the state will begin to improve.

Some think we can’t afford Medicaid expansion. Most understand that we’ve got more than a quarter million Missourians relying on us to do the right thing. In other words, we’ve got to fix that tire so the whole car can keep moving forward. 




OneMissouri is committed to research, education, advocacy, and policy development on behalf of all Missourians. 


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