What’s the news: Missouri voters approved an amendment to their state constitution to expand Medicaid eligibility to 133% of the federal poverty level, which is about $16,970 for an individual and $34,846 for a household of four.

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An estimated 230,000 state residents—about 40% of those now uninsured in Missouri—will become eligible for Medicaid when enrollment begins next year.

Missouri had an uninsured rate of 9.4% in 2018, which tied it with Utah for the 17th-highest rate in the nation, according to the U.S. Census Bureau.

The approved ballot measure prohibits the state from imposing eligibility restrictions on the expansion population that are more burdensome than those imposed on other Medicaid-eligible populations.

The vote was 53.2% to 46.8%, with an 82,158-vote margin of victory. It made Missouri the 38th state to approve the Affordable Care Act’s provision for expanding Medicaid coverage, and the sixth state to do so via voter referendum, joining Idaho, Maine, Nebraska, Oklahoma and Utah.

As with Oklahoma, where expansion was approved June 30, the measure was approved as an amendment to the state constitution rather than as a statute.

Learn why Oklahoma voters put Medicaid expansion in their constitution.

The measure was supported by the Missouri State Medical Association (MSMA) “because physicians want their patients to have access to the best health care options possible.”

“Increased access to health care is linked to better health outcomes in patients of all ages,” the MSMA stated on its website. The medical society noted that access to preventive care “can help prevent or delay the onset of much more costly and devastating chronic health care problems for patients.”

The Kansas City Medical Society, which represents physicians in the two municipalities that bear that name in Missouri and Kansas, issued a statement thanking voters for passage of the amendment.

“Now, more than 230,000 hard-working Missourians will be able to access the health care they need to remain healthy, contributing members of society,” the statement reads. “This is especially welcome now as we face the challenges of COVID-19. We look forward to supporting the State of Missouri on a successful implementation of Medicaid expansion.”

The AMA supports Medicaid expansion and believes health system reform efforts must ensure that Medicaid is a viable and effective program to provide health insurance coverage to low-income individuals, seniors and the disabled.

The remaining twelve states that haven’t expanded their Medicaid program eligibility are: Alabama, Georgia, Florida, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

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Why it’s important: More than 14.7 million people gained coverage under Medicaid expansion since 2013, and this coverage has been linked to greater access to care, more preventive care and improved chronic disease management, wrote researchers from Columbia and Harvard universities in a recent JAMA “Viewpoints” column

Medicaid expansion states have seen significant declines in their uninsured population. The average uninsured rate for expansion states was 6.6% in 2018. In contrast, the average rate for non-expansion states was 12.4% and the national rate was 8.9%, according to the Missouri Foundation for Health.

Medicaid rolls are expected to grow as the nation’s unemployment rate remains high during the COVID-19 pandemic and people are at risk of losing their employer-based health insurance. Missouri’s Medicaid enrollment has already grown 8.8% from 848,048 in February to 923,048 at the end of June, according to the Georgetown University Health Policy Institute’s Center for Children and Families.

According to the Greater Kansas City Chamber of Commerce, which also represents the interests of businesses in both the Missouri and Kansas municipalities, economic benefits of Medicaid expansion will include:

  • The return of more than $1 billion of Missouri taxpayer dollars sent to Washington annually.
  • Creation of more than 16,000 jobs and an annual $2.5 billion boost to the state’s economy.
  • Assistance in keeping rural hospitals open.
  • More money for other priorities such as education and public safety.

In neighboring Nebraska, voters passed Medicaid expansion in 2018 and coverage begins Oct. 1. The Nebraska Department of Health and Human Services reported that it started taking new Medicaid expansion applications Aug. 1, with 1,135 residents applying over the weekend.

It’s estimated that 90,000 additional Nebraskans will gain coverage through Medicaid expansion.

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Learn more: The AMA continues to advocate for strengthening Medicaid. Steps to do so include:

  • Urging states that haven’t done so to expand Medicaid coverage.
  • To encourage states to expand Medicaid, allowing 100% federal matching funding for states that newly opt into Medicaid expansion for the first three years.
  • Increasing federal funding to state Medicaid departments to support the expected influx of enrollees.

To ensure that residents are covered during the COVID-19 pandemic, the AMA recommends that states take the following actions:

  • Expand Medicaid eligibility temporarily to any uninsured state resident with COVID-19 related diagnoses or symptoms.
  • Conduct outreach to uninsured populations, simplify enrollment and renewal processes, and expand 12-month continuous eligibility.
  • Suspend Medicaid work requirements and other barriers that disrupt coverage.
  • Seek enhanced federal matching funds for emergency coverage options.
  • Temporarily suspend disenrollment for the duration of the emergency.

The AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice and universal access for patients. Read more about the AMA’s vision for health care reform.

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