The three Democrats who want to be the next state senator from Missouri's 6th District agree state lawmakers should expand Medicaid to serve more people.
The subject has been an issue since 2010, when Congress passed the "Patient Protection and Affordable Care Act" and included a plan to make more people in each state eligible for coverage under the Medicaid program that's paid for with state and federal dollars.
However, Missouri's Republican-controlled Legislature has rejected the idea.
Bryan Struebig, of Eldon, sounded the most cautious about possible expansion of the assistance program.
"I am in favor of Medicaid expansion," he said, "but with the uncertainty in Washington and the large deficit we are facing in Missouri, I fear we cannot afford to expand Medicaid in Missouri."
Struebig's businesses include a tax and accounting service. He said during a recent candidate forum: "What we were able to find was a very large majority of our tax clients - especially in rural areas - would have qualified for Medicaid expansion. There are a lot of people who have a variety of medical problems, and they don't get them addressed because going to the doctor is unaffordable."
Nicole Thompson, of Jefferson City, said failing to expand Medicaid is "federal money that we're just saying no to."
While she also supports looking at other ways to improve health care and reduce costs in Missouri, she said: "The first and primary step is we need to expand Medicaid in our state."
Mollie Freebairn, of Jefferson City, said the Legislature's refusal to expand Medicaid eligibility to 133 percent of the federal poverty level also has cost the state an opportunity to create more jobs, even as people are getting less healthy.
However, some of that also is related to the economy, she said: "We see people falling prey to unhealthy lifestyles, infant mortality, substance abuse (and) rising crime rates, with the decline in economy."
Freebairn and Thompson noted rural hospitals have suffered because of the lack of Medicaid expansion.
"Hospitals have been forced to close," Freebairn said.
Thompson added, "That funding is necessary for our rural hospitals, where we have a lot of patients already on Medicaid, and an additional group that could be supported by that additional funding. Without it, our rural hospitals are struggling and closing."
Struebig said the issue is larger than hospitals, which aren't always close to where people in rural areas live.
"It would be best if we had some more urgent cares that would be available in a lot of our rural areas," he said, noting a trip to a hospital emergency room could take a couple of hours.
All three candidates acknowledged passing Medicaid expansion if Republicans continue to control a majority of the Legislature will be an uphill battle.
The 6th Senate District covers seven Missouri counties - Cole, Moniteau, Morgan, Miller, Maries, Osage and Gasconade.
Until this summer, when he resigned after being named Missouri's new lieutenant governor, Mike Kehoe, R-Jefferson City, represented the district.
Voters will choose one of the three Democrats to face Republican Mike Bernskoetter and Libertarian Steven Wilson, both of Jefferson City, in the Nov. 6 general election.