Speeches & Writings

The case for Medicaid expansion in Missouri

Dear Washington University community,

Missouri is facing a health-care crisis. Far too many residents in our state cannot get needed medical care because they lack health insurance. This is why Washington University is backing the Healthcare for Missouri initiative – an effort to expand the state’s Medicaid program to cover more Missourians. The initiative is collecting signatures to put Medicaid expansion before Missouri voters in 2020.

The university has long supported efforts to make health care more affordable and accessible for all Missourians, especially vulnerable people who often must choose between buying groceries or paying for vital medications and health care. No one should have to make such agonizing choices.

For those dealing with serious illnesses, such as cancer, diabetes or heart disease, access to medical care is often a matter of life or death. Every day, we see patients at the Medical Campus who arrive with late-stage terminal illnesses that might have been prevented with earlier treatment.

Coverage gaps in Missouri

In Missouri, over a half million adults ages 18 to 64 are uninsured. Of them, 85% work in jobs that do not offer health insurance.[i] This creates a coverage gap, as these working adults also do not qualify for Medicaid or federal subsidies to purchase private insurance.

Missouri’s Medicaid program only covers children, pregnant women, those with disabilities, some seniors, and parents who earn less than $3,626 annually. Women typically lose Medicaid coverage soon after giving birth, and single adults without children are not eligible for Medicaid in our state, regardless of how little they earn.

This lack of coverage leaves many Missourians saddled with constant worries and what-ifs about maintaining their health and holding a job. Ironically, having access to health care would help them stay healthy, so they could continue to work and support their families.

Benefits of Medicaid expansion

Thirty-six states have chosen to bring home more of their federal tax dollars to expand Medicaid eligibility. This expansion allows Medicaid to cover those with annual incomes up to $18,000 or up to $30,000 for a family of three. If the Healthcare for Missouri ballot initiative passes, some 200,000 Missourians — including 35,000 in the St. Louis region — would be eligible for insurance coverage that already is available to residents in these other states.

Medicaid expansion would ensure that these individuals could see a doctor for basic and life-saving medical care. In those states that have expanded Medicaid, growing evidence shows associated benefits: more people are seeking medical care earlier — before health problems become more complicated and costly — and mortality rates are lower.

Expanding Medicaid isn’t just the right thing to do, it makes economic sense for all Missourians. Missouri taxpayers have been subsidizing Medicaid expansion in other states, without receiving a benefit in our own state. What’s more, Missouri budget estimates indicate that after five years, expansion would result in net savings to the state of $932 million annually, as the new Medicaid funds also would support many existing state expenditures.

Reinvesting in Missouri

Moreover, an expansion of the Missouri Medicaid program would bring more than $1 billion of taxpayer dollars back to the state from Washington every year. Additional federal funding would offset some of Missouri’s own Medicaid costs, enabling the state to redirect some of its current Medicaid spending to help support infrastructure or education needs, as has been done in other states.

The states that have expanded Medicaid also have experienced broad and deep economic benefits: the creation of thousands of new jobs within and outside the health-care sector and increased state revenues stemming from the employment boost. A 2017 analysis of Medicaid expansion in Michigan, for example, concluded that the economic benefits more than offset the state’s costs, and would continue to do so through 2021 and beyond.[ii]

Expansion also would help rural areas in Missouri, where the uninsured make up 12.3% of the population, compared with 10.1% in urban areas. Our rural counties have seen 14 hospitals close in the past few years,[iii]with the threat of further closures on the horizon. Medicaid expansion would provide new resources to help remaining hospitals stay open.

We hope that after careful and thoughtful consideration, Missouri voters will see why more hardworking residents of modest incomes need access to health care. If the ballot initiative is adopted, thousands of Missourians will lead healthier, more productive lives and, likewise, our state’s economic health will improve.

As a major health care provider and a top research institution dedicated to improving people’s lives, we strongly believe Medicaid expansion is right for Missouri. We’ll share more information as this effort moves forward.

Andrew D. Martin

David H. Perlmutter, MD
Executive Vice Chancellor for Medical Affairs
Dean, School of Medicine

[i] Distribution of the Nonelderly Uninsured by Family Work Status. Kaiser Family Foundation. 2017.

[ii] www.nejm.org/doi/full/10.1056/NEJMp1613981

[iii] According to the Missouri Hospital Association, October 2019