Health Care

Kansas could be the next state to expand Medicaid. Missouri’s path isn’t so clear

Gary Peterson’s petition drive to get Medicaid expansion on the ballot in Missouri this year never really got off the ground.

But Peterson is not giving up, for one compelling reason: Pretty much everywhere it gets on the ballot, it passes.

“I really think that I’m going to have a good chance of getting it going this time,” Peterson said.

Voters in Idaho, Nebraska and Utah approved it this month, bringing the total number of expansion states to 37.

Elections of Democratic governors in Kansas and Wisconsin could add two more next year.

Medicaid expansion was a feature of the 2010 Affordable Care Act, commonly called Obamacare, to provide health care to more low-income residents. While the first states to embrace it were mostly run by Democrats, the latest election showed that it now has broad support even among red state voters. States that sign on pay only 10 percent of the cost, with a 90 percent federal match.

The Republican-led Missouri General Assembly has thus far resisted expansion, saying the program is too expensive and should not be available to able-bodied adults. Democratic legislators say they will push to bring it to the forefront again this spring, and try to gather a coalition for their own petition drive.

Peterson’s last drive didn’t have two key things ballot initiatives in other states had: money and organization.

All it had, basically, was Peterson, a retired trucker from Raytown with a zeal for progressive causes.

“I’ve been working off and on on this for about a year and a half now,” Peterson said.

But one man can only do so much when it comes to gathering about 100,000 signatures from all of the state’s congressional districts.

Peterson wouldn’t say how many signatures he got, except that the total was “very, very poor” and nowhere near the number needed.

“It takes money,” Peterson said.

The successful effort to get medical marijuana on the ballot in Missouri and get it passed this year had about $1.5 million behind it. So far, no one has stepped forward willing to pour that kind of money into a Medicaid expansion campaign.

Peterson said he expected organizing help from the state and local Democratic parties, but it never materialized.

Meanwhile, some people who said they reached out to help Peterson, including attorney and former Jackson County Executive Michael T. White, said he never got back to them.

Peterson said he didn’t remember getting an email from White. But he said the 2020 effort should be more organized, in part because of the work he put into this year’s petition.

“I’ve probably got over 2,000 contacts,” Peterson said. “A lot of these are religious leaders, some of them are people who have already worked on projects like this. Almost everyone on my list has had some contact with an organization that has worked on this.”

First he has to get his ballot initiative language approved by the Missouri secretary of state. That may not be a sure thing, because he’s added some sections to it this time around, including one requiring coverage of birth control in Missouri and another barring short-term health insurance plans that don’t have to cover pre-existing conditions or abide by other ACA guidelines.

The secretary of state’s office has already rejected his most recent submission, but Peterson said he’s going to revise it and resubmit it. He said he could go back to the same language that was approved for this year’s ballot, if need be.

Geoff Gerling, the executive director of the Jackson County Democrats, said he thinks Medicaid expansion “will be a significant part of our work as a party over the next year,” but it probably will be centered on another ballot initiative, not Peterson’s.

“(Missouri) Rep. Deb Lavender has already begun work on this,” Gerling said via email, “so the better method will likely be getting everyone on the same page with the ballot language and working together instead of potentially having competing petition drives.”

Lavender, a Democrat from St. Louis, said she plans to introduce legislation to put a Medicaid expansion question on the ballot. If majorities in both chambers voted for it, that would take the signature-gathering requirement out of the equation.

Lavender said there are also groups working behind the scenes to get a petition drive going, and she thinks expansion will end up on the 2020 ballot in Missouri one way or another.

“I think as we’re seeing states around us passing these things and people across the nation are saying this is what they want to do, it’s really time that Missouri gets it in place as well,” Lavender said. “I think there’s going to be a clamor from our population.”

Nationally, the only negative result for expansion supporters this year was in Montana, where voters denied a tobacco tax increase that would have continued to fund that state’s expansion after June 30. It will be up to state legislators to find another way to pay the state’s 10 percent share.

Medicaid expansion provides health care for residents with incomes up to 138 percent of the federal poverty level. For a family of four, that translates to $34,638 in annual income.

Kansas and Missouri currently have some of the tightest Medicaid eligibility limits in the nation, with their programs restricted mainly to low-income children, pregnant women, people in nursing homes and people with disabilities.

Laura Kelly, the new governor-to-be in Kansas, was elected in part on a vow to change that by accepting the federal expansion money. Kansas legislators voted for expansion last year, but then-Gov. Sam Brownback, a Republican, vetoed the bill. Brownback’s successor, Republican Jeff Colyer, also opposed it.

Once Kelly takes office in January Medicaid expansion will have a clearer path. But she will have to get a slightly more conservative legislature to sign off.

In Missouri, Peterson said Democratic legislators are welcome to try to get their own Medicaid expansion petition onto the 2020 ballot. But he’s going to keep pursuing his, because so far the state party hasn’t made much headway on the issue.

“I’m still going to go do it, OK?” Peterson said. “I have been working on my stuff and I’m going to have at least 1,000 emails and letters I’m going to send out here soon.”

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