Executive Vice Chancellor for Medical Affairs Dr. David Perlmutter and medical student Hannah Truong stand beside a van that was used to campaign for Medicaid expansion in Missouri last year. (Matt Miller | WUSTL Photos)

Washington University administrators and faculty members are maintaining their support for Medicaid expansion—one of the University’s top political priorities in recent years—as state legislators consider restricting funds for the voter-approved expansion.

In last August’s primary election, Missouri voters passed Amendment 2, which expanded Medicaid eligibility criteria, with 53% of the vote, but Republican state representatives did not allocate the necessary $128 million to fund the program in their March budget. While advocates of Amendment 2 hope the Senate will reverse course, Senate leaders say that it is “too early” to determine the fate of funding for Medicaid expansion.

“[Access to healthcare] is a public good, and at a time when we have seen our society impacted by health dangers in such a profound way… this is the most proximate major thing that could happen that benefits St. Louis and Missouri,” Executive Vice Chancellor for Medical Affairs Dr. David Perlmutter told Student Life this month. “There are many other things to do, but this is the one that’s closest and it’s one that makes so much sense financially.”

The University donated $250,000 in the fall of 2019 to Healthcare for Missouri, a campaign committee promoting Medicaid expansion. In June 2020 Perlmutter and Chancellor Andrew Martin continued this advocacy by endorsing the specific amendment, citing how it would insure an additional 230,000 Missourians, create jobs and increase economic output in the state by $2.5 billion. They also argued in their endorsement that Medicaid expansion was a “first step” in combating racial inequality.

“Racism is, to be sure, a public health problem and Medicaid expansion is an important first step in righting the unconscionable disparities that disproportionately harm communities of color,” Perlmutter and Martin wrote in a June 23 email to the University community.

The Affordable Care Act guaranteed federal funding for nation-wide medical expansion in 2012, and all but 13 states have since expanded it. Other states that expanded Medicaid saw increased utilization of medical and preventative services, fewer hospital closures and fewer home evictions. Because low-income communities and communities of color are more likely to be uninsured, Medicaid expansion also led to reductions in race-based economic inequality.

Various faculty members have been outspoken advocates in support of the state funding for Medicaid expansion, citing the responsibility to care for Missourians in need. Dr. John DiPersio, deputy director of the Siteman Cancer Center at the School of Medicine, told Student Life that Medicaid expansion would have “a profound impact on the healthcare system.”

“We want to take care of people, even people who don’t have sufficient means,” DiPersio said. “We want to take care of everybody equally. There can’t be anything more important than saving the life of a poor person in Missouri.”

According to co-director of the University’s Center for Health Economics and Policy Dr. Karen Joynt Maddox, expanding Medicaid is especially beneficial in Missouri, where health outcomes have remained stagnant relative to other states where outcomes have risen over the last decade.

Maddox spoke about the benefits for the state at an April 7 webinar discussing Medicaid expansion. She emphasized how at least seven rural hospitals in the state have shut down since 2014, and Missouri’s existing cutoff for Medicaid is one of the lowest in the country. In addition, families who make more than 22% of the poverty level, or $10,000-12,000, cannot qualify for coverage. Even with this lack of coverage for many individuals, Missouri spends more on healthcare than other states because Missouri opts to utilize fewer available federal dollars, she said.

Many Washington University doctors and faculty members have also tried to communicate the importance of expansion to state representatives and senators via emails, advertising and campaigning.

“Many of my colleagues had yard signs, and we were advocating for it on social media,” Associate Professor of Psychiatry Dr. Cynthia Rogers said. “It was a really exciting moment when it passed. I think many of us, however, were aware that we might run into the current challenges. We were cautiously optimistic that it would be implemented.”

Of the more than 230,000 individuals who would gain coverage under the amendment, two out of three are currently uninsured and one in three are on private plans they cannot sustain, Maddox added.

The main obstacle that Democratic lawmakers faced was resistance from Republicans who pointed to fiscal responsibility when blocking the amendment. However, according to Maddox and other experts, expansion would not require revenue spending and would instead generate millions of dollars for Missouri’s economy.

Martin and Perlmutter’s June statement noted that the state would have extra funds to distribute to social services because the expansion would boost the economy.

“Just imagine what could happen if the state were to use its additional resources to improve early education, which we know will be a critical determinant of improving the chances of Black and poor families to participate in the American dream,” they wrote. “Wouldn’t more jobs and more tax revenue make it possible for the state to increase its investment in education, infrastructure and innovation?”

Perlmutter recalled how, when he told his government relations representative at the University that he wanted to campaign for Medicaid expansion about two years ago, his colleagues were “very skeptical.” They told him they had already tried and failed to get it passed in 2014 and 2016.

Advocates proposed the constitutional amendment after Republican majorities in the state legislature repeatedly voted down past attempts to expand Medicaid through legislation, and the University signed on soon after. “There could not be a more powerful thing for the state of Missouri and its community,” Perlmutter told Student Life in November 2019, when the University first endorsed the potential 2020 ballot initiative.

Because the amendment is projected to generate financial gains for the state, some of the University’s faculty advocates believe that Republicans are blocking funding for the amendment for political reasons. According to Maddox, several state officials represent counties whose constituents would benefit from expansion, but nevertheless voted against it.

“There are political issues, there are financial issues and there are ethical issues,” DiPersio said. “Those three should be aligned, meaning that we should do what [is] ethically right, in a way that’s economically sustainable, and in a way that benefits our patients and our constituents of the state, rich and poor.”