Chancellor Andrew Martin and Washington University School of Medicine Dean David Perlmutter jointly endorsed a potential 2020 state ballot initiative which would expand Medicaid coverage in a University-wide email.

“Missouri is facing a healthcare crisis,” the email began. It goes on to discuss the over 500,000 uninsured adults in Missouri who are often “saddled with constant worries and what-ifs about maintaining their health and holding a job,” and must make choices between medical care and basic necessities. “No one should have to make such agonizing choices,” the email said.

The email then extolls the potential economic benefits of the initiative. If adopted, the amendment would make any individual aged 19-64 who earns below 133% of the federal poverty line eligible to join the Medicaid rolls. According to the email, this would expand coverage to roughly 35,000 new St. Louisans.

To reach the 2020 ballot, the amendment must receive 160,199 signatures in support and must be submitted by May 3, 2020.

Tim McBride, a Brown School professor and leading expert on the topic of healthcare access, said the initiative would provide Medicaid access to around 230,000 new Missourians and roughly 40,000 Missouri children. McBride estimates that initiative could save the state $40 million in the first year alone. McBride, who is not involved with the initiative, said based on his conversations with those involved in the process, the initiative has a good chance to make the ballot.

In an interview with Student Life, Perlmutter said “there could not be a more powerful thing for the state of Missouri and its community” than Medicaid expansion. According to Perlmutter, leading the way in reducing the cost of healthcare to society is “the number one priority” of the School of Medicine, and described how there are “literally dozens” of projects underway at the School of Medicine to curb the cost of healthcare. He pointed to the School of Medicine’s Personalized Medicine Initiative, which aims to treat patients more efficiently and cheaply through targeted therapy.

According to Perlmutter, the School of Medicine has one of the lowest costs per patient in the state.

According to the email, closing the coverage gap would reduce the number of people who are forced to choose between “buying groceries or paying for vital medications and health care.”

Dr. Timothy Eberlein, Director of the University’s Siteman Cancer Center, recalled a recent patient who delayed getting a mammogram because she could not afford it. When she was finally checked, she was diagnosed with a late stage of cancer requiring costly intervention. “She would NOT be in that position if we had Medicaid expansion,” Eberlein wrote in a statement to Student Life.

Although the extent to which the amendment would benefit the School of Medicine is unclear, McBride said passage of the initiative would help WUSM’s bottom line. The School of Medicine is a major safety net provider in the region, which means it provides care to many who could not otherwise afford treatment. That means it spends vast sums on uncompensated care, services that a healthcare provider is never reimbursed for, which often arise from treating the uninsured and those who can’t afford the treatment.

According to Joni Westerhouse, Associate Vice Chancellor and Associate Dean for Medical Public Affairs, around four percent of patients seen at the School of Medicine are uninsured.

“An analysis of the impact on the School of Medicine has not been done because this really wasn’t the reason to back the initiative. Our interest was the impact of this on our community,” Westerhouse wrote in an email to Student Life.

The amount of uncompensated care provided by Washington University physicians has ballooned in recent years, from $84.5 million in the 2016 fiscal year to $144.3 million in 2019. According to McBride, that trend is not isolated to the University; rural hospitals are closing in scores across the country. McBride says areas with large populations of uninsured people, such as rural locations and urban centers, are hit the hardest. “Basically it’s any place other than suburban areas,” McBride said.

According to Perlmutter, the University may contribute to covering some of the costs associated with getting the initiative on the ballot. To reach the ballot box, a potential constitutional amendment must reach a certain threshold of statewide signatures. This process, which involves staging digital campaigns and hiring a network of signature collectors, often incurs costs upwards of a half million dollars.

According to Joni Westerhouse, the University has offered financial support to past ballot initiatives that “[had] a major impact on the University’s core mission of teaching, research, and clinical care,” or that directly affected members of the University community.

This is far from the first ballot initiative, either state or local, that the University has weighed in on. In 2008, Chancellor Wrighton endorsed a sales tax increase that would help raise funds for the Metrolink; in 2016, the University voiced its opposition to a cigarette sales-tax that included language barring the revenues from funding stem-cell research or abortions.

The email marks a rare instance of political signalling from the University. The University has typically erred on the side of political neutrality; recent notable exceptions include Chancellor Wrighton’s open letter in favor of DACA, and his denouncement of President Trump’s 2017 travel ban.

Last year, in an interview with Student Life, then chancellor-elect Martin said he would be scaling back communications from the University, citing practicality concerns. In August, Martin approved a new set of guidelines that would govern when the University communicates on public policy. Among them was whether an issue affects the University’s “core mission,” and if the issue directly affects the University community.

According to McBride, any Washington University student who is not listed as a dependent and fulfils the amendment’s income requirements, would be eligible under the proposed amendment.

Despite the potential windfall for the Medical School, McBride views its support of the initiative as a “social justice mission.”

“I feel like we have an obligation to give back to the community that we live around and we have a lot of resources,” McBride said. “This is important.”