Maine voted to expand Medicaid by referendum. Could Missouri be next?

Nov. 09--Raytown resident Gary Peterson was following Twitter closely last night as election results started rolling in from Maine's referendum to expand Medicaid.

Peterson is at the beginning of what could be a long fight to get the same question on the ballot in Missouri next year, and he got a jolt of energy when Mainers voted 59 percent to 41 percent in favor of it.

"That is a big margin," Peterson said.

Peterson's Medicaid expansion initiative is more of a long shot than the one in Maine. The Missouri Secretary of State's Office approved his referendum question last month, but now he needs about 100,000 signatures.

Missourians can put a legal change on the ballot if the language is certified by the Missouri Secretary of State's Office and then gets the signatures of at least 5 percent of the number of people who voted in the last governor's election in at least six of the state's congressional districts.

The effort in Maine was backed by a heavyweight coalition of groups, including those that represent the state's nurses, doctors and hospitals.

Peterson's effort doesn't have the backing of any of those groups in Missouri. The 76-year-old former long-haul trucker and caregiver for elderly and disabled Missourians is trying to gather the signatures mainly on his own right now.

He said he's sent about 500 letters and emails, mostly to health care facilities and churches, and he's reached out to the Missouri Democratic Party for help.

Sam Newton, a spokesman for the Missouri Democratic Party, said a party official talked to Peterson Wednesday. Newton said the party is "supportive of finding new ideas to expand healthcare and lower costs for working Missourians" but can't take an official position on Peterson's petition without a vote from its state committee.

Peterson said he's taken up a number of progressive causes since he retired, and getting Medicaid expansion on the ballot is just one of them.

"Nothing is getting done through the (Missouri General) Assembly," Peterson said. "I don't understand why somebody hasn't thought about doing this before."

Dave Dillon, the vice president of public and media relations for the Missouri Hospital Association, said that his organization is taking a different approach out of political necessity. Maine's state government is Republican-controlled, but more of the state's registered voters identify as Democrats. Missouri's party affiliation numbers lean solidly Republican.

"Maine and Missouri are both 'M' states, but that's where the similarities end," Dillon said via email.

Dillon said his group is focused on convincing the Republican-led Missouri Legislature to embrace an altered form of expansion that includes more flexibility in how states spend the money.

He said that's more likely to be approved under President Donald Trump than it would have been under President Barack Obama -- and would be more politically palatable in Missouri.

"If Missouri were to expand, this is the kind of environment that would be necessary," Dillon said.

Missouri Sen. Ryan Silvey of Kansas City, one of the few Republicans in the Missouri Legislature who have expressed openness to expansion, has tried that "block grant" approach in the past, but could not get enough colleagues on board.

Dillon said the hospital association doesn't have a position on Peterson's ballot measure. But he sees several obstacles to it.

"Even if there are enough signatures collected, it isn't clear that it would pass," Dillon said. "A statewide campaign would be expensive as well, and the effort could face opposition, driving up the cost."

Peterson said the results out of Maine, and Democratic victories Tuesday in Virginia, show the political tide is turning nationally on a number of issues, including Obamacare.

"People are getting together and trying to find out what they can do," Peterson said. "I think it's just a matter of time."

Maine is the 33rd state (including Washington, D.C.) to expand Medicaid, but the first to do it through a direct voter referendum.

That leaves 18 states, including Kansas and Missouri, that have declined expansion under the ACA, which is commonly called Obamacare. Those states are led by Republicans who have argued that the expansion increases dependence on government, is too expensive and the federal government might renege on its commitment to fund 90 percent of it.

There's a coverage gap in those states for people who make too much for Medicaid, but too little to be eligible for subsidies to buy private insurance on healthcare.gov.

According to the Kaiser Family Foundation, there were about 200,000 uninsured Missourians and about 80,000 uninsured Kansans in that gap that would gain coverage if their states expanded Medicaid.

Kansas almost did so last year. The Kansas Legislature passed an expansion bill, but Gov. Sam Brownback vetoed it and lawmakers fell a few votes short of overriding the veto.

Taking the issue straight to voters is not an option in Kansas, which doesn't allow state law to be changed through referendum.

Andy Marso: 816-234-4055, @andymarso

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