Another chapter in the long saga of Medicaid Expansion in Missouri

It’s Morning Edition on KRPS, I’m Fred Fletcher-Fierro.

Missouri Governor Mike Parson wrote another chapter in the long saga of Medicaid Expansion in the state on Thursday. After the Republican controlled State Legislature said they would not fund the initiative approved by voters last August, Governor Parson said Thursday, “Without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”

Photo by Karolina Grabowska on

So what’s next? On Thursday afternoon I spoke with the interim Executive Director of Missouri Healthcare for All, Sarah Wiley. The non-profit was instrumental in getting the initiative passed with 53% of the vote in 2020. I first asked Sarah, what’s next?

“So the administration went through its State Plan Amendment (SPA) which would expand the Medicaid population in Missouri, as it is in the majority of states across the nation. And it’s disappointing. He made a commitment to the residents of Missouri that he would uphold the constitution in this elected office. And he’s chosen to shriek that duty and ignore the will of Missouri voters. It’s shameful. Healthcare is a basic human right and there are 275,000 uninsured Missourians right now waiting to see if they’ll be given access to the life saying healthcare that is their right and that they need. So the next step right now appears to be a path to the courtroom. So it’s unfortunate that Missouians shouldn’t have to go to court and hold the people that they elect accountable for upholding the law. However, we’re confident that that the court will ultimately unhold what the Missouri voters passed in our constitution.”

Sarah Wiley

Last year, during his reelection campaign Parson said that he would support Medicaid Expansion if the voters passed the ballot. Here he is on October 9, 2020 during a candidate forum that was broadcast by Fox 2 in St. Louis.

“This is, the people state voted for this. We’re going to have to implement it. But it’s not going to be free. Anytime there is an expansion in state government it is never free. Trust me, I’ve been around long enough to realize that every program expands, it costs more money and so does Medicaid, even in its normal settings. It would engage $200 million dollars a year just under the old formula in the state of Missouri that we’d have to count for.”

Sarah Wiley

The Medicaid expansion in Missouri would provide healthcare access to individuals who earn less than $17,600 annually. Or for a family of four that makes roughly, $36,000 per year. The federal government already covers 90% of the cost of expansion in any of the 12 states that haven’t already done so. In March of this year, The American Rescue Plan Act of 2021 further encouraged non-expansion states to take up the expansion by providing an additional temporary fiscal incentive for states to newly implement the ACA Medicaid expansion. Sarah with Missouri Healthcare for All says how lawmakers define what’s covered by the federal government and what isn’t is up to interpretation.

“I think that there are different interpretations of existing research in terms of, what that additional ten percent cost and looks like for a state budget. And to what extent those costs might be recuperated. So the research that I have looked at and the research that I trust are really demonstrating that there’s an overall savings in the long-term to the money that you invest in a program like Medicaid. Because you end up with a healthier population. You are able to access preventative care, so instead of having more expensive medical care for things down the road you have less expensive upfront medical care. And you also have a population that’s more able to be productive to the local economy.”

Sarah Wiley

This announcement by Governor Parson the day after the State Legislature passed the first increase in Missouri’s gas tax in 25-years, something residents rejected by the same 53% of the vote that they approved Medicaid Expansion on in 2020.

It’s been frustrating, both on a professional and personal level for people like Sarah who worked on the grassroots campaign, gathering signatures to Medicaid expansion on the ballot, to watch it pass, only for Governor Parson to not follow-through.

“It’s frustrating, to put so much of your time as a professional, as well as a person, as an individual into engaging in the political process. I was out collecting signatures, literally asking folks to sign a piece of paper so that we could get Medicaid expansion on the ballot and I was involved in text and phone bank efforts so that we could get voters out to vote in August in the primary when this issue was on the ballot. And to feel like, man you can do all of that and amend the constitution and then the fight is still not over, but you still have to try to hold your elected officials accountable to upholding the literal law which is their job. It’s a very frustrating feeling.”

Sarah Wiley

Missouri resident, and interim Executive Director of Missouri Healthcare for All, Sarah Wiley

Advocates of expansion in Missouri expect the case to be heard by the State Supreme court, but as of Thursday no timetable has been announced for when that could happen.


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