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story.lead_photo.caption Gov. Mike Parson waves to the upper gallery Wednesday before making his way to the podium to give the annual State of the State address at the Missouri state Capitol. Parson covered several topics, including a plan to reduce violent crime across the state. Photo by Liv Paggiarino, News Tribune

Missouri Gov. Mike Parson said Thursday that he plans to fight efforts to expand the number of people eligible for government health care, as a ballot initiative to do so gains momentum.

Advocates are collecting signatures to put the issue on November's ballot. The proposed constitutional amendment would allow adults earning up to 138 percent of the federal poverty level to access Medicaid starting in July 2021.

Parson warned the Republican-led Legislature during his State of the State address Wednesday that Medicaid expansion is "a massive tax increase that Missourians cannot afford."

On Thursday, he told the Associated Press that expanding Medicaid eligibility would mean taking money away from education, workforce development, and roads and bridges to pay for health care for more people.

The ballot initiative includes no dedicated funding source, meaning the state's share of the additional costs would come from existing revenues.

"I will be out there making sure people are aware of the facts, of what I believe the facts to be, and let them make a decision at the ballot box," Parson told the AP. "I think that's really important, that everybody hears both sides of this issue."

States had the option to extend eligibility under former President Barack Obama's federal health insurance program. However, many Republican-led legislatures, including Missouri's, have long fought such efforts.

"We're hurting Missouri's children and families by not pursuing expansion of Medicaid," Senate Democratic Minority Leader Gina Walsh said Thursday.

Absent action by Missouri lawmakers, advocates for greater access to government health care now are trying to put the issue to a public vote.

A campaign raising money for the effort brought in more than $3 million as of the end of 2019 and spent $1.9 million in recent months. Top donors include the Missouri Hospital Association, which gave $500,000, and Washington University, which donated $250,000. Most of the spending went to pay workers to collect enough signatures to get the measure on the ballot.

Healthcare for Missouri's campaign manager, A.J. Bockelman, said Thursday that the campaign had gathered roughly 90,000 petition signatures so far, which is more than half of roughly 172,000 needed to qualify the measure for the November ballot.

"The response when we've had people going out has been incredible," Bockelman said. "We know that there is a strong desire for this."

Bockelman declined to respond to Parson's suggestion the expansion initiative amounted to a tax increase but instead pointed to a Washington University study suggesting Medicaid expansion could produce savings for the state.

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