Missouri's Supreme Court last week declined to address the issue of whether a ballot initiative to expand Medicaid is unconstitutional.
But opponents of the initiative, who argued that it would force the spending of state money in violation of the state constitution, are not finished despite the deadline passing to keep the question on the ballot.
United for Missouri, the conservative activist group that took the case, may try and ask the Supreme Court to review, either prior to or after it takes place, whether the vote is null and void.
"We are still pursuing the case because it should not be voted on as it does violate the state constitution," said Carl Bearden, chief executive of United for Missouri.
Healthcare for Missouri, which announced May 1 the collection of close to 350,000 signatures — more than twice needed - had been submitted.
After the initiative was certified for a vote, Gov. Mike Parson immediately announced that it would be on the ballot on August 4 instead of November, prompting critics to claim it was a move to take advantage of lower primary turn out. The governor is an opponent of Medicaid expansion.
The government said it was because time would be needed to work out the fiscal implications, particularly due to the heavy hit the state has taken during the COVID-19 outbreak.
Bearden told the St. Louis Record that proponents of Medicaid expansion were overly optimistic in their projections for savings.
"There is going to be an Increased cost demand on general revenue, and the campaign (against) is going to refer to unrealistic cost savings," Bearden said. "There will be an effort to increase awareness of the negative fiscal impact "
Auditor Nicole Galloway estimates ranges from an annual cost of at least $200 million by 2026 to an annual savings of $1 billion depending on take up, movement from other state programs and increased preventative health.
In its fiscal report, Washington University concluded expansion will be largely revenue neutral with a best estimate of savings of $39 million a year, though that is based on a 4.5 percent growth rate, and a worst case scenario of a cost of $42 million.
The initiative would expand Medicaid coverage for parents with family incomes of 138 percent of the federal poverty level, and to single individuals living in or close to poverty, most of whom do not currently qualify.
Most children are covered either by Medicaid or the state CHIP program, but their parents only qualify if the family income is 22 percent of the federal poverty level, or $480 a month for a family of four.
Under the Affordable Care Act, federal funding will cover 90 percent of the cost of the expanded coverage.
Prior to the Supreme Court declining review, a three-judge appeals panel in the Western District affirmed a lower court decision stating that the ballot initiative does not require the appropriation of state money nor say how much is allotted.