Trust Missouri Voters on Medicaid Expansion — Even as They Elect Republicans Who Fight It

Missouri voters are suckers for conservative personalities but realists on the issues.
Missouri voters are suckers for conservative personalities but realists on the issues. FLICKR/PAUL SABLEMAN

It's time once again for Missouri voters to come to the rescue.

I realize that sounds a bit strange. This is, after all, the sixteenth Trumpiest state in the nation.

But there was actual cause for hope last week when statewide health advocates announced they were launching a campaign to place a Medicaid-expansion initiative on the 2020 ballot. It's at least a decent possibility that Missourians would have the common sense to provide health care for more than 200,000 working people in the state who cannot afford it. Not to mention saving some of their rural hospitals.

Why bet on an electorate that has made Missouri one of the reddest states in the land and has elected an overwhelming Republican legislature that has targeted Medicaid as an evil worth sacrificing literally billions in federal dollars to oppose for several years?

The answer is simple: Missouri voters are a lot smarter about issues than they are about electing politicians. In fact, if you look at 2018 statewide ballot items, the voters are on a four-game winning streak.

Last August, Missouri voters overwhelmingly rejected Republican Gov. Eric Greitens' top legislative priority of the prior year, a "right to work" measure designed to kill labor unions by allowing their members to opt out of paying dues. Using a state law that allows a public referendum to overturn new legislation, voters killed it by an astonishing 67-32 percent margin, a nut-sack kick to the state's Republican Party if ever there was one.

Three months later, the voters gave similarly huge victory margins to three more important measures: a constitutional amendment to legalize marijuana for medicinal use; an initiated statute to increase the state minimum wage incrementally to $12 per hour by 2023; and the Clean Missouri initiative to reform lobbying, campaign-finance and redistricting practices by politicians.

Taken together, you'd think conservative Missouri had been overtaken by Bernie Sanders' Democratic socialists with the four state-ballot votes. These weren't narrow defeats for Republican legislators. They were avalanches.

Funny thing, though. The same voters gave even larger victory margins to the same spurned Republicans in the same 2018 election. They actually increased Republican super majorities in both the state House and Senate, giving the GOP bulletproof, 71 percent ownership of both chambers. And they elected extremist Josh Hawley to the U.S. Senate — in a landslide over centrist Senator Claire McCaskill — despite the fact that Hawley fiercely supported "right to work," initially opposed medical marijuana and, at best, waffled on the other ballot measures favored by the voters.

Go figure.

In the context of Medicaid expansion, the statewide-voter disconnect between issues and politicians offers some promise in 2020. That's assuming, of course, that the health care advocacy coalition known as Healthcare For Missouri is able to gather the 172,000 signatures it says are needed to get an initiative on the ballot.

I think that's going to happen. This is not a wistful do-gooder dream, but rather a seriously funded enterprise that has big-money backing from the Missouri Hospital Association, BJC Healthcare, the Missouri Primary Care Association, the advocacy group Missouri Health Care For All and — get this — at least a couple of not-for-profits that take a play right out of the GOP/Greitens playbook by passing through donations from undisclosed donors.

"Dark money" is a noxious thing exploited by Greitens and presently shielded from reform in Congress by Sen. Moscow Mitch McConnell. It shouldn't exist. But look who's using it this time: Financial backing for the Medicaid measure includes undisclosed donations from groups with names like Fairness Project and Sixteen Thirty Fund.

Do I think the system needs reform so that groups like these should have to disclose donors? Absolutely. But unless and until that happens, it's deliciously ironic that some dark money is flowing in to challenge a major Republican priority. Hunting ain't fun when the rabbit's got the gun.

Whatever it takes to get Medicaid expansion to the ballot is fine with me. How fitting it would be for Missouri voters — who twice voted against President Barack Obama — to embrace this erstwhile pillar of Obamacare. I think they would, and not purely because of the aforementioned phenomenon of supporting politicians and opposing the issues those pols favor.

No, in the case, there's something more basic at play: Expanding Medicaid for the working poor is not merely a matter of decency and common sense — which it is — but it's also a cause that transcends the urban-rural divide that often splits Missouri so painfully. Republican talking points not withstanding, Medicaid is about health care, not handouts.

One of the most shameful legacies of political opposition to Obamacare has been that nine rural hospitals have closed since 2014 in Missouri. That should disgust people in St. Louis as much as it does outstate, where communities are devastated by the loss of their essential medical institutions.

Herb Kuhn, president of the Missouri Hospital Association, has been quoted in St. Louis and across the state in support of the Medicaid-expansion initiative, citing access to emergency care for rural residents as a key factor. But it's what Kuhn told the Becker's Hospital Review (not on my daily reading list) that most aptly captured the emotion that might buoy the initiative:

"Let me tell you, when you close one of these hospitals in a rural community, it really brings out a lot of grief and loss," Mr. Kuhn said. "Those five stages of grief — where there's denial, anger, bargaining, depression and then acceptance — you see all those things on full display when you close a rural hospital. It is remarkable. I don't think people fully understand and grasp how important they are in these communities."

I think that sort of sentiment will carry the day as much as the arguments more familiar to us in St. Louis. For my vote, the common-sense points you can find at are plenty persuasive:

"Right now, a single Missouri parent with one child cannot make more than a measly $381 a month and qualify for Medicaid coverage. More than 200,000 Missourians are uninsured and caught in the coverage gap — making too much money to get Medicaid, but not enough to get affordable health insurance. It is long past time for Missouri to join the 36 other states that have expanded Medicaid."

I'm plugging the group's website because it's where you can sign up — regardless of your politics — to get Medicaid expansion on the 2020 ballot. If it gets there, I'm pretty sure Missouri voters will do the right thing.

Even as they keep electing Republicans.

Ray Hartmann founded the Riverfront Times in 1977. Contact him at [email protected] or catch him on St. Louis In the Know With Ray Hartmann and Jay Kanzler from 9 to 11 p.m. Monday thru Friday on KTRS (550 AM).

Scroll to read more Hartmann articles (1)


Join Riverfront Times Newsletters

Subscribe now to get the latest news delivered right to your inbox.