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Opinion: The conservative case for Medicaid expansion in Missouri


As a rural conservative, lifelong Republican, and former state lawmaker, I want to share a conclusion that’s become increasingly apparent not just to me but also to my friends, family, and neighbors back home in southeast Missouri.

With a statewide initiative headed for inclusion on the November general election ballot, it’s past time for Missouri to expand its income eligibility rules and allow more working Missourians to receive Medicaid. 

Tila Hubrecht

It is not a decision I have come to lightly.   

As a two-term state representative from Dexter, I worked on many issues vital to the needs of my fellow rural Republicans, sponsoring bills that were strongly pro-life and pro-family. In 2017, my final year in the General Assembly, the American Conservative Union honored me with its Award for Conservative Achievement.  

But after working for decades as a registered nurse, and after watching members of my own family continue to struggle to get the basic medical care they need, I’ve come to a decision that may sound odd coming from a rural Republican like me — but which also makes fiscal as well as moral sense. 

Across our state, hundreds of thousands of hardworking Missourians with jobs that don’t provide health insurance find themselves trapped in the coverage gap. These workers earn too much to qualify for Medicaid but can’t possibly make enough to be able to purchase private health insurance. 

For the typical rural Missouri family, the premiums are simply out of reach.

Expanding Medicaid will provide health care coverage to more than 230,000 Missourians. Many of these people are self-employed or work for small farms and businesses that can’t provide group health insurance.

But people still get sick, still need treatments and therapies, and still need care. Expanding eligibility gives working people who earn less than $18,000 a year access to lifesaving medical care.

Rather than cost the state money, Medicaid expansion could save Missouri more than $1 billion annually, according to both a state summary and academic research, by bringing our tax dollars home. 

Right now, we’re shipping our money off to Washington instead of investing it in our state. It’s getting spent in places like California to pay for their healthcare and help their economy.

That just doesn’t make any sense – especially at a time when Missourians desperately need healthcare and jobs.

Thirty-six other states have already expanded Medicaid, including Arkansas. Officials there reported using savings of more than $400 million from the expansion to cut state income taxes and reduce payments previously allocated to the uninsured. The Missouri border states of Illinois, Kentucky, Nebraska, and Iowa have also opted for Medicaid expansion.

Another part of this crisis involves the disappearing rural hospital. It’s hard to believe, but 10 rural hospitals in our state have closed in the last six years! 

In southeast Missouri alone, Butler, Dunklin, Reynolds, Ripley, and St. Francois counties have all lost their hospitals, forcing patients to drive to communities up to one hour away and turning routine ambulance calls into possible life-or-death situations. Emergency departments, outpatient clinics, and operating rooms are now even farther away for thousands of rural Missouri families.

Dozens more rural hospitals face a similar threat of financial ruin that has only grown in recent months, with plummeting revenues due to the elimination of elective surgeries and patients staying home for fear of possible contagion.

Thanks to the submission of nearly 350,000 petition signatures earlier this month, Missourians will be asked to approve the expansion of Medicaid eligibility on Nov. 3. 

Medicaid expansion will boost our economy, keep rural hospitals open, and ensure all Missourians have access to healthcare regardless of where they live. Missourians cannot afford to wait any longer.