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FILE – In the April 26, 2017 file photo, supporters of single-payer health care march to the Capitol in Sacramento, Calif. Large majorities of young Americans want to see an expansion of government services, including a single-payer health care program, according to a new poll by The Associated Press-NORC Center for Public Affairs Research and MTV. (AP Photo/Rich Pedroncelli)

Tomorrow, Missourians will vote on whether or not to expand the state’s Medicaid program through a long-awaited ballot initiative. If it passes, the referendum would vastly expand eligibility for the Show-Me State’s Medicaid program under the Affordable Care Act’s Medicaid expansion provision.

Missouri Amendment 2, the Medicaid Expansion Initiative, would expand Medicaid eligibility in Missouri to adults aged 19 to 65 whose income is up to 133 percent of the federal poverty level. It would also prohibit any additional restrictions or requirements for the expanded population to qualify for Medicaid coverage. Finally, the initiative would require the state to seek maximum federal funding when it comes to Medicaid.

This ballot initiative could not come a more hectic time. As a historically red state, one would initially assume that an expansion of a large government-run program would fail in Missouri. However, COVID-19 and the economic calamity is has wrought makes political prognosticating as useless as a screen-doored submarine.

Many Americans are feeling unprecedented pressure to lean more into the government for assistance due to the financial and medical hardships the coronavirus pandemic (and terrible public policy decisions) has brought upon the nation.

This could not be a worse idea. From the inception of the Affordable Care Act in 2010, the primary focus of many state legislators has been to significantly expand enrollment in Medicaid. Because of this, the federal government has handed out hundreds of billions to subsidize woe begotten state Medicaid programs. And let’s not forget that the vast majority of Americans experience sub-par medical coverage while on Medicaid.

Historically, Medicaid scores zero out of 10 in terms of transparency and effectiveness. We know that hundreds of billions have been poured into Medicaid over the years. We also know that the program is shoddy, full of corruption, and offers substandard care and treatment options. Do we really want to double-down on this failure?

A significant number of Americans are reeling from economic uncertainty amidst the coronavirus-related-recession. Put another way, this is possibly the worst time to make commitments to increase failing government programs. Major budget deficits are plaguing all states, now is not the time to expand costly and ineffective programs.

Even worse, Missouri could be swimming into unchartered waters. For example, what if the federal government pulls back its matching funds for state Medicaid programs? This alone would thrust the burden of Medicaid’s skyrocketing costs onto hard-working Missourians, who are already feeling amplified financial pressure from the COVID-19-related shutdowns.

As Medicaid has expanded over the past decade, it takes up more and more of a state’s budget. This is unsustainable, especially as many states are already facing huge financial burdens. Furthermore, massive state program expansions, at their very core, do little to actually help and protect the most vulnerable residents.

There are serious and viable alternatives to a big-government sponsored Medicaid expansion.

Since the coronavirus pandemic, we have seen a rise in telehealth services and the development of new trends in health care delivery. We do not have to rely on Medicaid and federal programs for our health care needs.

Containing Medicaid expansion and targeting those truly in need could lead to long-lasting innovations in health care via the free-market. A focus on growing direct primary care and telehealth are reforms that would not leave the people of Missouri stuck with an expanded Medicaid program.

Samantha Fillmore ([email protected]) is government relations coordinator at The Heartland Institute.