Medicaid serves as a lifeline and should be expanded in Missouri

We are in the depths of an unprecedented global pandemic that has had a devastating impact on our social, emotional, and physical health. In times of crisis, we often search for reassurance that things can and will get better. We need a reassurance that if we get sick, there will be treatments available to help us heal and, ultimately, survive.

The unfortunate reality is that there are thousands of Missourians navigating this pandemic isolated, fearful, and without the assurance of accessible healthcare. They grapple with the uncertainty of what will happen if, or when, they get sick. As clinicians at a federally qualified health center, we see first-hand the constant struggle that our patients face in an effort to stay alive in a system without insurance. For many, it means limited medical visits and restricted access to medications. It means choosing between medication for high blood pressure or diabetes but not being able to afford both. It often means no access to critical preventative screenings, such as a mammogram and colonoscopy.

The other staggering impact of the COVID-19 global pandemic is the effect that it has had and will continue to have on the mental health of our community. As we confront coping with the new normal of social isolation and distancing, feelings of depression and anxiety rise. Irrespective of a pandemic, one in five Missourians will experience a mental health disorder annually. Unfortunately, their income will dictate whether or not they have access to mental health services.

Healthcare coverage opens the door to critical interventions, such as therapy, medication coverage, and hospital care when necessary. Medicaid serves as a lifeline for much of the nation's mental health and substance use disorder services, providing coverage to more than one in four of adults with a serious mental illness in our country. 

Along with mental health, drug and alcohol use disorders are treatable health conditions, when given access to proper care. Every year since 2010, drug-related deaths have exceeded traffic fatalities in Missouri. The number of African-American males dying from an opioid overdose in Missouri has risen for two consecutive years, while Caucasian male deaths have decreased. The lack of Medicaid expansion to date continues to shine a light onto the systemic racism that plagues our healthcare system.

Health outcomes analyzed by race show an unacceptable story: In St. Louis, African Americans account for 1972 of the cases of COVID-19 and 108 deaths, compared to 934 cases and 49 deaths for Caucasians (as of 7/23). The infant mortality rate for African Americans in Missouri is more than double the rate for all Missourians. While African Americans have similar rates of opioid misuse, they have experienced the greatest increase in fatal overdoses. An entire community of individuals has been left behind with limited to no connection to evidence-based, life-saving treatments, and a basic human right to access healthcare. Expanding Medicaid is absolutely essential to move toward more equitable healthcare in Missouri.  

On June 30, Oklahoma passed Medicaid expansion by ballot initiative, becoming the 37th state to expand Medicaid. Missouri has the possibility of becoming the 38th. We have learned from watching other states that Medicaid expansion has had a profound impact on access to both physical and mental health care within those states. Medicaid expansion removes the daunting task of having to prove a health disability in order to qualify for coverage, rather allowing people to become eligible based on income.

Expanding Medicaid in Missouri will open up healthcare to Missourians earning less than $18,000 a year. An estimated 230,000 Missourians currently work in jobs that do not provide them health insurance. Medicaid expansion would remedy that, while bringing over $1 billion of our tax dollars back to Missouri and create 26,000 jobs in the first 5 years after its passage.

During this pandemic we have seen people rise to the occasion in many inspiring ways, from donating food and supplies, to making masks, to placing a sign in their yard letting the world know they support front-line workers. Compassion drives so many to ask the question, “how can I help?” 

It is simple, and it is clear: it is decision time for our state. We have the opportunity to finally get it right. We have been shown by other states the benefits that come with Medicaid expansion, so now it’s time for Missourians to come together to raise their voices in shaping a more compassionate, resilient, and equitable state through Medicaid expansion. Your voice, and your vote, WILL. SAVE. LIVES. Join us by voting Yes on 2.

Dr. Kelly Gable ( / 314-353-5190) is a professor of Pharmacy Practice at SIUE School of Pharmacy and a board-certified psychiatric pharmacist and Joel Sjerven ( / 314-531-5444x4403) is a recovery specialist and licensed master social worker, both providing behavioral healthcare at family care health centers in St. Louis.

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