Missouri Becomes Sixth State to Expand Medicaid at the Ballot Box

Despite the justified fear that COVID-19 would render the newly energized ballot initiative strategy moot, progressives secured a big win in red state Missouri on Tuesday, overriding the legislature’s and the governor’s persistent refusal to expand Medicaid. It is the sixth state to do so.

The Missouri vote, 53 percent “yes” to 47 percent “no,” followed a now-familiar pattern with urban voters overwhelmingly supporting Medicaid expansion and rural voters decisively rejecting it. But observers think COVID-19 has diluted this pattern—a bit—with “surprising” rural support in some precincts:

“The biggest visibility piece we have here in the rural areas is, people drive by a hospital and see a ‘Closed’ sign on it,” says Erich Arvidson, a campaign leader, banker, and former congressional candidate. “The COVID-19 crisis resonated with people on a basic level.”

Indeed, 10 rural hospitals have closed in Missouri in the past five years, and the state has faced one of the sharpest increases in daily COVID cases in the past weeks, almost three times more than a month ago. Although the state has one of the most restrictive Medicaid programs in the country, its program enrollment has risen nearly nine percent between February and May—among the largest increases in the nation.

How did this ballot initiative succeed in COVID-era Missouri?