Missouri lawmakers have, for years, decided against the part of the Affordable Care Act that would expand Medicaid—the government health care program for low-income residents. So now, activists are trying to do it themselves—by collecting signatures to get the issue on the 2020 statewide ballot.

Activists say they added nearly 400 more signatures to their total at a Springfield parade earlier this month.

The expansion of Medicaid would mean Missourians aged 19 to 64 with an income below about 133% of the federal poverty level would be eligible for government health care coverage. Missouri’s Secretary of State has certified three initiative petitions on the topic of Medicaid expansion for circulation.

Missouri Jobs With Justice and Faith Voices of Southwest Missouri are two of the grassroots organizations collecting signatures. And Missouri Democratic House Rep. Crystal Quade is helping lead the charge.

“It’s very difficult to qualify as an adult under Medicaid,” said Quade. “For an example, a single parent of two – I’m looking at it right now, has to make - can make no more than $3,612 per year to qualify for Medicaid. We have a really huge gap of low-income adults who are working who don’t qualify for healthcare coverage right now.”

The Kaiser Family Foundation estimates that 200,000 Missourians could gain health care coverage if Missouri were to expand the program to include low-income adults. Missouri hospitals have been among the most vocal supporters of expanding Medicaid.

Heidi Lucas is the state director of the Missouri Nurses Association. She said the lack of Medicaid coverage is a major reason why so many rural hospitals have closed and why low-income residents can’t receive care.

“By bringing in those extra Medicaid dollars, hopefully more - either urgent care clinics or hospitals would be able to return to some of those communities,” Lucas said.

In a written statement, Kaitlyn McConnell, a spokeswoman for CoxHealth, said Missouri has lost out on $10 billion in potential federal funding since rejecting Medicaid expansion.

The Affordable Care Act says the federal government must pay the vast majority of the cost for states that choose to expand their Medicaid programs.

But the state would have to pick up part of the tab, too. And some Missouri Republicans, like Sen. Lincoln Hough of Springfield, don’t support Medicaid expansion, primarily because of that funding issue. He said an expansion of Medicaid would require cuts to other important programs.

“Our general revenue growth is hovering somewhere around the $98 million mark, actual new, hard dollars. So, if we have to spend $150 million, or more, on a program that is expanded and our economy grows at what it did last year, you’re talking about taking, at minimum, $50 million out of other programs. And, I mean, we all know what those are. Healthcare and education are the largest costs in our state budget,” Hough said.

Representative Steve Helms, chairman of the Subcommittee on Healthcare Reform, said the problem lies with Medicaid itself and its tendency toward waste.

“We already struggle, budgetarily speaking, to fund Medicaid and provide for children pregnant women and our seniors,” Helms said.

Helms and the director of Missouri HealthNet, Todd Richardson, are working on solutions to what they call systemic problems with Medicaid.

A report from the Washington University Center on Health Economics and Policy said if Missouri expanded its Medicaid program, it would likely pay for itself, depending on how many people enrolled.

The deadline to submit the signatures to the Secretary of State’s office is May 3, 2020.