Missouri voters approve Amendment 2 to expand Medicaid

Missouri voters approved Amendment 2 in a vote of 53% to 47% on Tuesday.

Amendment 2 was a citizen initiative to expand Medicaid eligibility in Missouri to adults that are between the ages of 19 and 65 whose income is 138% of the federal poverty level or below. In 2020, this amounted to an annual income of $17,608 for an individual and $36,156 for a household of four. The amendment prohibited any additional restrictions or requirements for the expanded population to qualify for Medicaid coverage than for other populations that qualify for Medicaid coverage.

Medicaid is a government program that provides medical insurance to groups of low-income people and individuals with disabilities. The Affordable Care Act (ACA), also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level. In 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that the federal government could not withhold funds from states that refused to expand Medicaid. The ruling had the practical effect of making Medicaid expansion optional for states. For 2020 and subsequent years, the federal government was set to cover 90% of the costs. As of 2020, a total of 37 states and Washington, D.C., had expanded or voted to expand Medicaid, while 13 states had not.

Yes on 2: Healthcare for Missouri led the campaign in support of Amendment 2. As of July 27, 2020, the committees registered in support of the amendment—Healthcare for Missouri and Missourians for Healthcare—had raised $10.1 million.

The support campaign argued that the coronavirus pandemic has shown the need for Medicaid expansion. Jack Cardetti, a spokesperson for the Yes on 2 campaign, said, “Now more than ever, Missourians need to be able to access care in their own communities and protect thousands of local frontline healthcare jobs. … Amendment 2 will help keep rural hospitals and urban clinics open by bringing $1 billion of our own tax dollars back from Washington, instead of going to the 37 other states that have expanded Medicaid.”

No on 2 in August led the campaign in opposition to Amendment 2. Opponents argued that expanding Medicaid would not be economically prudent. State Senator Bob Onder (R-2) said, “The money needed to expand Medicaid is going to come from somewhere. It either has to come from education, from roads or from massive tax increases. … I do think that Missourians, particularly in these challenging economic times, will realize that a massive expansion of the Medicaid program isn’t something that we can afford.”

Missouri was the sixth state to expand Medicaid through a ballot initiative.

In 2017, voters in Maine approved a ballot measure to expand Medicaid. The measure was the first citizen initiative to implement an optional provision of Obamacare.

In November 2018, voters in Idaho, Montana, Nebraska, and Utah decided ballot initiatives concerning Medicaid expansion and the funding of expanded Medicaid coverage. They were approved in Idaho, Nebraska, and Utah.

Oklahoma was the most recent state to approve Medicaid expansion in June 2020. Oklahoma State Question 802 passed with 50.49% of the vote.