This is one in a series of stories examining key issues addressed by the candidates for governor. Material for these stories comes from comments during the candidates’ only debate and follow-up interviews with Missourian reporters.

Today’s topic: Medicaid expansion

Candidates were asked how they would implement and cover the costs of Medicaid expansion in light of its passage by voters in the August primaries.

A proponent of Medicaid expansion, Democratic challenger Nicole Galloway said her health care plan will save money for Missouri residents.

“I know it can be implemented in a fiscally responsible way without raising taxes or cutting other accounts,” Galloway, the state auditor, said.

In a projection made by Galloway’s office in a fiscal review for the coming budget, the auditor’s office posited that expansion would cost $2 billion per year between the state and federal government. Missouri’s 10% cut would cost an additional $200 million.

During the debate, she cited independent studies and other states’ work in expanding Medicaid, stating that expansion will be “budget-neutral and in the long run, saves our state billions of dollars.”

Republican Gov. Mike Parson does not support Medicaid expansion. In May, the governor moved the amendment to the August ballot, citing uncertainty around COVID-19’s effect on the state budget.

He doesn’t believe the expansion will be budget neutral, echoing other lawmakers’ concerns that even the 10% share will burden the state’s budget. Opponents believe that expanding Medicaid will be expensive and might mean cuts to education spending and other programs.

“Anytime there’s an expansion in state government, it is never free,” Parson said.

The governor said he would implement Medicaid expansion regardless of his concerns.

“The people voted for it, we’re going to put it in place,” he said. “We’re just going to have to do that and balance the budget at the same time.”

Libertarian Party candidate Rik Combs said he understood how Missouri residents could see the personal benefits of Medicaid expansion, but the potential costs also worry him.

“When you start looking at the money that it’s going to cost the state of Missouri, that’s got to come out of somewhere,” Combs said.

Combs affirmed that he wouldn’t raise taxes to pay for the expansion and said he would instead look toward the “bloated” budgets of state programs and agencies to cover the cost.

Green Party candidate Jerome Bauer supported Medicaid expansion during the campaign for the August vote.

“I’m running on a platform stressing universal health care, disability and transportation accessibility and equity,” Bauer said. “My time spent without health care almost cost me my life three times in the last decade before I got disability and the salary blind pension with Medicaid.”

Bauer signed a petition to get Medicaid expansion, although he would prefer a single-payer system, also known as Medicare for All, that would cover all residents in the state.

Bauer contended a Wall Street transaction tax would provide enough funds for the health system.

In 2012, the Supreme Court gave states the choice to opt into expansion after the Affordable Care Act passed two years before, and up until Amendment 2’s passage, Missouri had been one of 14 states yet to extend health care to those in “coverage gap” limbo.

Missouri’s current Medicaid program, MO HealthNet, does not cover most adults without children and has a low-income eligibility threshold for parents — one of the lowest in the nation at about one-fifth of the poverty level.

Almost a quarter-million adults in Missouri earning less than $18,000 and families of three earning below $30,000 will be covered under the new expansion. Federal dollars currently cover two-thirds of the state’s program.

Under expanded Medicaid, the federal government picks up 90% of the program’s costs.

A fiscal analysis by the Center for Health Economics and Policy at Washington University in St. Louis projected up to $39 million in expansion savings after implementation costs. The study also concludes expansion will generate economic dividends over time “as investment in a healthy workforce has been shown in other settings to create.”

Reporter Adam Jackson wrote this story with contributions from Jose Luis Adriano, Ian Laird, Hannah Norton and Wicker Perlis.

  • State reporter, fall 2020. Studying print and digital news. Reach me at, or (573) 356-7458

  • State Government Reporter, Fall 2020 and Spring 2021. Reach me at, or in the newsroom at 573-882-5700

  • State reporter studying data journalism and interested in tech and new media. Reach me at, or in the newsroom at 882-5720. Follow me on Twitter: @adriano_dreamer

  • State Government Reporter, spring 2021. Studying print & digital journalism. Reach me at, on Twitter @HannahNorton89, or in the newsroom at 573-882-5700.

  • Mark Horvit is the state government editor. Call me at 817-726-1621 with story ideas, tips or complaints.

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