Proponents of a Medicaid expansion in Missouri want to allow voters to override the state's Republican leaders, who have refused to extend coverage to more people.

The Healthcare for Missouri coalition is collecting signatures on a petition that would place a Medicaid expansion on the November 2020 ballot. If approved by voters, Missouri would expand the health insurance program to those who earn up to $18,000 a year. Missouri is one of 14 states that has not made the program available to more low-income people.

Campaign organizers say the expansion is necessary to extend health care coverage to people who have jobs but lack health insurance.

“These are hard-working individuals, they’re doing everything right, they’re getting up every day and going to work,” said Connie Farrow, a spokeswoman for Healthcare for Missouri. “Unfortunately, without employer-based insurance, they simply don’t have enough money on their own to afford the health care they need.”

An estimated 232,000 people would be eligible for coverage if Missouri expanded Medicaid, according to the Kaiser Family Foundation.

So far, 36 states and the District of Columbia have expanded their Medicaid programs. The Affordable Care Act lets states receive federal funds in exchange for making the program available to low-income people. States can expand Medicaid through acts of legislatures or through ballot initiatives.

Voters in several other Republican-controlled states including Nebraska and Idaho have recently passed Medicaid expansions through the ballot initiative process. Illinois expanded Medicaid in 2014.

The Healthcare for Missouri campaign includes individual doctors and patients, health care trade organizations and advocacy groups.

The Affordable Care Act took money away from other hospital payments such as Medicare to pay for the expansion, said Dave Dillon, spokesman for the Missouri Hospital Association, which backs the campaign.

“We have as a community of health care providers already been paying for this coverage for the better part of a decade without receiving it,” he said.

Uninsured uncompensated care means other people pay more in premiums and taxes, he said. Many Missouri residents are unaware of the limits on the current program, Dillon said.

“That coverage gap, when it’s explained, becomes a very compelling part of the explanation of why this is so important for Missouri.”

Educating people about what Medicaid is and who is eligible will be a big part of the signature-collecting process, Farrow said.

Republican Gov. Mike Parson has said he wants to cut down on people using the program who aren’t eligible before he considers a Medicaid expansion. Earlier this summer, Parson created a task force to look into the possibility of expanding Medicaid through a waiver.

That waiver would allow the state more flexibility in how to expand coverage and allow it to disregard some federal rules about who and what is covered by the program.

The federal government pays for 90% of costs for states that expand Medicaid through the Affordable Care Act.

Correction: An earlier version of this story misstated Connie Farrow's name.

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