Missouri Gov. Parson moves Medicaid expansion amendment to August ballot

May 26--COLUMBIA -- Missouri Gov. Mike Parson is shifting a proposed constitutional amendment expanding Medicaid eligibility to the August ballot, a move his Democratic rival condemned as a bid to boost his own electoral chances.

Parson, a Republican, announced Tuesday that he decided to move the Medicaid expansion issue from the November general election ballot to the lower-turnout August primary to get an answer on the issue from voters as soon as possible.

"I want to be clear," Parson said, "this was about policy, not politics. At a time when our state is undergoing a major health, economic and budget crisis, we need to know where we stand when it comes to a massive spending initiative in Missouri."

State Auditor Nicole Galloway, the presumptive Democratic gubernatorial nominee, said Parson's true motivation is fear of having to defend his opposition to Medicaid expansion as a candidate on the fall ballot.

"He knows that Medicaid expansion is more popular than he is in a general election," said Chris Sloan, Galloway's campaign manager, later adding: "Gov. Parson is on the wrong side of the issues voters care about. He has to play political games with the democratic process to protect his own political prospects."

Random sampling

Thirty-six states have adopted Medicaid expansion, including several Republican-leaning states where voters approved ballot measures.

Proponents in Missouri gathered nearly 350,000 signatures for a constitutional amendment extending coverage to thousands of low-income adults.

It was widely expected that the time needed to verify those signatures meant the issue would appear on the November ballot alongside the president, governor and all but one statewide elected official.

But last week, Secretary of State Jay Ashcroft announced he had employed a rarely-used technique to expedite the signature verification process. By using random sampling instead of sending signatures to local election authorities for authentication -- the usual practice -- Ashcroft bought Parson time to move the issue to the August ballot.

Ashcroft said he used random sampling in order to avoid burdening local election authorities so close to a municipal election, which was moved from April to June 2 because of the COVID-19 outbreak.

It was the first time the method had been used in more than 20 years.

"We carefully considered whether to have local election officials conduct signature verification while they prepared for the June 2 election," Ashcroft said in an email Tuesday. "After visiting all 116 election officials in the state over the last two weeks, I know we made the right decision. It would have created a tremendous amount of work for them at the same time they prepare for, conduct and certify their local elections."

Parson, who has been outspoken in his opposition to expanding Medicaid coverage in Missouri, said the state would be on the hook for health care spending that would mean taking money away from education, workforce development, and roads and bridges.

That is especially dangerous, Parson said, during a time when COVID-19 has punched a massive hole in the state's budget.

"Pass or fail," he said, "it is important we understand the implications of what would be a new spending bill out of our already depleted general revenue."

But Galloway believes Parson is just hoping to take Medicaid expansion off the table as an issue in the fall campaign.

"Now more than ever Missouri needs healthcare, but Gov. Parson put his own political needs ahead of hundreds of thousands of working Missourians," Galloway said. "The governor and his special interest allies have already started to mislead voters, telling them that they must choose between funding our schools or access to healthcare."

Proponents of Medicaid expansion point to studies showing that it would not only provide health care to low-income Missourians, but it could also save money in the long run by drawing additional federal funding to cover a variety of health services currently paid for with state revenue.

According to one study by the Georgetown University Health Policy Institute, during the first year of expansion in Louisiana the state saved $199 million.

Right-to-work replay?

In Missouri, Republicans have blocked Medicaid expansion for years. That's created a coverage gap, where more than 200,000 Missourians earn too much to qualify for Medicaid but too little for subsidies to offset the cost of private insurance through the federal Affordable Care Act, more commonly known as Obamacare.

Missouri's Medicaid program does not cover most adults without children. Only the disabled, children and parents with incomes under 22 percent of federal poverty -- less than $5,800 a year for a family of four -- are eligible.

Proponents of expanded Medicaid coverage in Missouri gathered nearly 350,000 signatures to put a constitutional amendment on the statewide ballot raising the level for coverage to 138 percent of the federal poverty line -- about $36,000 for a family of four.

Moving the question to the August ballot is similar to what Republicans did in 2018 when faced with a campaign by labor unions to repeal the state's right-to-work law.

That year, after labor unions rallied to gather enough signatures to place a question on the November ballot seeking to repeal right-to-work, GOP lawmakers fast-tracked a bill moving it to August.

The move was seen as an effort to protect Republican candidates from an expected onslaught of union campaign spending and voter outreach.

In the end, labor unions spent more than $15 million to defeat right-to-work and rallied supporters across the state. They prevailed, with voters rejecting the GOP-backed law by a wide margin.

As of April 15, the political action committee supporting the Medicaid ballot measure reported having more than $400,000 cash on hand. And it has shown it can raise cash in a hurry, such as when last September it received $1.3 million in donations from two healthcare organizations in one day.

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