ARI SHAPIRO, HOST:
Tomorrow, voters in Missouri will decide whether to expand Medicaid insurance to cover more low-income adults. This has been adopted in 37 other states. And now the coronavirus has raised the stakes for people who have lost jobs and insurance coverage. From member station KCUR, Alex Smith reports.
ALEX SMITH, BYLINE: At the start of the year, Nika Cotton of Kansas City, Mo., had a full-time job in social work. Today, she's running her own tea and coffee shop.
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SMITH: Cotton opened the shop, Soulcentritea, just three weeks ago. After public schools shut down in the spring, Cotton had no one to watch her young children, who are 8 and 10. So she quit her job in social work and went into business for herself.
NIKA COTTON: It's kind of like I didn't have a lot of other options. At this point, it's either get another job or, like, use this opportunity.
SMITH: While she makes drinks, her kids play at a table. Cotton lost her insurance when she left her job. And while her children are now on Medicaid, her income is too high for her to qualify. She can't afford to buy insurance on her own, and so she's been urging friends to vote to expand the Medicaid program.
COTTON: Like, I would qualify right now. I'd be able to get Medicaid while I start my business. Like, that would be amazing.
SMITH: Expansion would extend Medicaid eligibility to many more uninsured adults, including families of three like hers that make up to about $30,000 a year. It's estimated a yes vote would save Missouri around $39 million a year because it would reduce the need for other spending, like on mental health programs or health care for prisoners. And Medicaid expansion stimulates the economy, bringing new jobs as well. One study shows Missouri's would increase by $2.5 billion. So it seemed like a win-win for the state budget - until the pandemic.
Rachel Nuzum is a health care policy expert with the Commonwealth Fund.
RACHEL NUZUM: We're expecting - and we're starting to see already in some states - increased Medicaid enrollment at a very time that state budgets are really being pinched.
SMITH: Medicaid enrollment in Missouri jumped up nearly 9% this spring. Meanwhile, the state budget is already suffering this year. Worries about how much expansion will cost are the main reason behind opposition from conservatives like Missouri's Gov. Mike Parson. He says that if too many people enroll, it could end up costing the state hundreds of millions of dollars. Parson says that's why he moved the vote from November to the August primary.
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MIKE PARSON: 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 exactly where we stand when it comes to a massive spending initiative for Missouri.
SMITH: That angered health care advocates who fear that having the vote in August will depress turnout. They also point out that 90% of the cost of expansion is paid for by the federal government. The state covers just 10%. They say that expanding Medicaid is now more important than ever in tough economic times to help people like Nika Cotton. For Cotton, who's Black, expansion is also a way to address racial inequities in health care. And she says the spread of the virus shows how when it comes to health, we're all in it together.
COTTON: Kind of the silver lining in this really dark cloud for the pandemic is how much it has globally brought people together. Like, these dividing lines are kind of arbitrary, really. At least coronavirus decided they were arbitrary (laughter).
SMITH: But the idea of expanding Medicaid hasn't yet won over everyone. A recent poll showed only 49% of likely voters support it.
For NPR News, I'm Alex Smith in Kansas City, Mo.
SHAPIRO: And this story is part of a partnership between NPR, KCUR and Kaiser Health News.
(SOUNDBITE OF AESOP ROCK SONG, "NO CITY") Transcript provided by NPR, Copyright NPR.
