MARSHALL, MO (KCTV) -- Missouri voters face an important choice in healthcare on Tuesday.

One of the issues on the ballot is Amendment 2, which would expand federally funded Medicaid to individuals earning just above the poverty line of around $18,000.

Critics fear it could strain taxpayer funds, but one group pushing for it to pass is rural hospitals. In a town like Marshall, a local hospital plays a larger role than ever.

Angy Littrel is the President and CEO of Fitzgibbon Hospital. It's one of the only healthcare providers in Saline County and was a major center of COVID-19 testing earlier this summer. However, like many hospitals in rural Missouri, it's struggled to meet the rising costs of unreimbursed visits that stem from a lack of insurance coverage in the surrounding community.

“Rural hospitals end up bearing the burden of that,” she said. “We spend millions in uncompensated care every year.”

“Rural hospitals have thin margins,” she added.

According to the Missouri Hospital Association, the state has lost nine rural hospitals in the last six years. That's why Fitzgibbon and other rural providers are pushing to expand Medicaid in a statewide vote.

“The population that will be impacted by Amendment 2, that's a component of rural areas,” Littrel said.

The idea behind Medicaid expansion is that there's a gap between people who already qualify and people who can afford insurance or get it through work. Expanding Medicaid would extend coverage to around 300,000 Missourians to shrink that gap.

“These are the working folks who don't have insurance because they can't afford it,” Littrel said.

However, critics fear the expansion could burden Missouri taxpayers.

Senator Denny Hoskins represents the state district that includes Marshall. He said state lawmakers might need to cut other programs like education funding to supplement the expansion.

“Even though the federal government covers 90% of the cost, the state would have to cover 10% of the cost,” Hoskins said. “Supporting our rural hospitals at the expense of our schools isn't a winnable choice for anyone.”

Advocates believe the expansion could actually save the state money in the long run and point out that taxpayers fund Medicaid whether Missouri votes to expand it or not.

“These dollars are dollars going away from our state,” Littrel said.

For some, it comes down to costs.

“Medicaid wasn't intended for able-bodied adults that can go out and find employment for their own health insurance,” Hoskins said.

For others, it's about expanding care.

“It comes down to what we want for the people of our state,” Littrel said. “We want them to be healthy and this helps us do that.”

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