On your Aug. 4 ballot will be Amendment 2, a proposal to expand Medicaid to an additional swath of lower-income Missourians.

Here’s the deal: The Affordable Care Act, aka Obamacare, was a push to increase the role of government, particularly the federal government, in the medical industry. Using a carrot-and-stick approach, the act included a requirement that states expand Medicaid or else lose existing funding.

Subsequent legal challenges turned the requirement into an opt-in program, where the federal government promises to pick up most of the tab. Missouri has a right-leaning legislature, so we have not opted in. One compromise around this brick wall was to pair Medicaid expansion with reform measures, but that didn’t go anywhere either. So moaning left-leaning advocates, as has been a trend with several issues in recent years, resorted to the initial petition process to put the matter before voters, and here we are.

Proponents are talking this up as if it’s a no-brainer: Get health insurance for poor folks without coverage and use free money from Washington. But there are several flaws in these talking points.

First, is this the direction we want to go with medical insurance in our state? This is clearly a step toward getting more people into a standard socialized medicine program.

Medicaid and the like are bureaucratic and impersonal systems. They detach the patient from the doctor, who has to consider not just what is best for a patient but what the bureaucracy allows. The process is mechanical, and the patient is left with limited choices.

Medical providers over the years are more and more bogged down with medical coding and billing, along with lower reimbursement rates from Medicare and Medicaid. Some mature providers have called it quits, retiring prematurely from a profession they used to love.

Second, are we sure about the significant financial commitment we are making as a state? Medicaid expansion is said to be free money, that we’re just prudently reclaiming tax dollars we previously paid to Washington. As if.

This assumes the federal reimbursement rate is set in stone, but political winds tend to shift. If, like other states, we make this commitment and more people sign up, and the funding later dries up, our state budget will be greatly affected.

Medicaid has already taken a growing share of our state’s discretionary budget; the other two big allocations are education and prisons.

Our state requires a balanced budget, and it has a low appetite for tax increases. So Medicare expansion would be a long-term risk to school and prison funding.

This is also not money we have paid to Washington. The feds chronically deficit-spend in general, so the appropriation of Medicaid funds to Missouri would be at least partially borrowed. Through a process commonly calling “printing money,” new dollars are created for Washington to borrow and spend. Such monetary inflation tends to cause higher consumer prices, which regressively hurt the very working poor folks the Medicaid advocates aim to help.

Third, is this the way we want to legislate? Left-wing activists are frustrated with elected officials in our capital, so they are doing an end run around the legislative process.

We can be cynical about how things work in Jefferson City, but the legislative process is a strength of our political system. With committees of subject-matter specialists, ideas are brought to the table, along with discussion, hearings and, yes, horse-trading to get votes. But bad or inconsistent measures tend to get pared down with other ideas included.

When an advocacy group writes law the way it wants and then puts it to us as a binary, up-or-down vote, we lose the chance for debate and compromise.

The measure on your August ballot is pretty short, but it marries our state Constitution to a chunk of a 900-plus page piece of federal legislation. I openly admit that I have not read the Medicaid expansion portion of the Affordable Care Act, and I bet very few voters have either.

Amending our Constitution should be a big deal. It should be reserved for basic, fundamental structures of government, like the balance of powers, how judges are selected and who qualifies to vote.

I was personally in a quandary two years ago with the medical marijuana amendment on the ballot. It was an issue I supported and wanted to move forward, but it had very specific provisions that should have been left to the legislative process to work out, not details to be hard-coded into our Constitution.

But, frankly, either readers care about these counterpoints or they don’t. In fact, it’s likely a pretty hollow debate on this one, as those who like the idea of moving toward socialized medicine are automatically voting “yes” and those opposed to Obamacare are an automatic “no.” It’s pretty predictable.

Steve Spellman hosts “The Mid-Missouri Freedom Forum” at 5 p.m. every Tuesday on KOPN/89.5 FM.


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