Missouri‌ ‌to‌ ‌expand‌ ‌Medicaid‌ ‌under‌ ‌the‌ ‌ACA;‌ ‌what‌ ‌does‌ ‌it‌ ‌mean‌ ‌for‌ ‌the‌ ‌rest‌ ‌of‌ ‌the‌ ‌country?‌

Ingrid Stiver Senior Manager, Health Research Institute, PwC US August 27, 2020

This month, Missouri voters approved a constitutional amendment to expand Medicaid, broadening eligibility for the program to an additional 250,000 Missouri adults aged 19 to 64 with incomes at or below 133% of the federal poverty level. The expansion is expected to take effect on July 1, 2021, though the state must first submit a Medicaid expansion plan amendment to the federal government by March 1

After Oklahoma, Missouri is the second state to expand Medicaid during the pandemic. Idaho, Maine, Nebraska, Oklahoma and Utah have all expanded Medicaid through ballot initiatives as an alternative to doing so in the state legislature. 

Texas, Florida and Mississippi—three COVID-19 hotspots over the summer—are among the 12 states that have not adopted Medicaid expansion, though in 2019 each state’s legislature considered proposals to do so. 

HRI impact analysis

Thirty-eight states and the District of Columbia have expanded Medicaid since the Affordable Care Act became law in 2010, mounting pressure on the remaining 12 states to follow suit as the country grapples with historic job and health insurance losses, a provider liquidity crisis, and concerns about uncompensated care created by the pandemic. 

Providers and patients benefit from Medicaid expansion. Providers face less uncompensated care—as much as $6.2 billion less across all expansion states (2013-15)—and patients may experience better access to care.

Medicaid expansion could also provide relief to hospitals facing a liquidity crisis in the midst of the pandemic and possibly help some keep their doors open. A January 2018 study of 2008-16 data by researchers from the Colorado School of Public Health concluded that Medicaid expansion is associated with significant reductions in hospital closures, especially in rural areas. The study found that after rural hospital closures, patients may experience worse health outcomes and skilled labor may leave the area. Rural providers in particular stand to benefit from Missouri’s Medicaid expansion: 45% of the state’s hospitals are in rural areas. 

Payers that administer managed Medicaid plans benefit from Medicaid expansion, as they cover more people. Pharmaceutical and life sciences companies also benefit, because expansion increases the number of people with prescription drug coverage.   

States that expand Medicaid are better positioned to address the pandemic’s health effects and its economic consequences, according to a July paper by the Center on Budget and Policy Priorities (CBPP). Medicaid expansion also improves rates of early cancer diagnoses, clinically appropriate surgical care and routine checkups. By one estimate, Medicaid expansion saved over 19,000 lives between 2014 and 2017. Based on available Census Bureau data, the CBPP estimated before the Missouri vote that 4 million uninsured adults would become eligible for Medicaid coverage if the remaining states expanded Medicaid.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Ingrid Stiver

Senior Manager, Health Research Institute, PwC US

Erin McCallister

Senior Manager, Health Research Institute, PwC US

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