On Tuesday, voters across Kansas and Missouri sent a clear message by rejecting measures that would have harmed health outcomes and civic engagement. More importantly, these were not slim victories – they were clear and substantial. REACH Healthcare Foundation applauds advocates and partners involved in all aspects of educating people across both states about the damage these measures would have done to the health of our region.
In Kansas, voters rejected a measure that would have allowed for the direct election of justices to the state Supreme Court. This ballot measure was passed out of the Kansas legislature in 2025, which is the only way Kansans can vote on issues directly by ballot. If it had passed, it would have threatened essential components of public health and civic infrastructure, especially for reproductive health equity and public-school funding.
Voters overwhelmingly denied passage to two deeply unpopular ballot measures placed on the ballot by the Missouri General Assembly in a 2025 special session – that cost Missouri taxpayers over $173,000 – and the 2026 regular legislative session. Both of these measures failed to win a single county in Missouri. The first was Amendment 5, which – if passed – would have given the legislature the power to eliminate the state income tax and replace it with costly sales taxes, including those on services never taxed before, and raised taxes on most Missourians – especially those paid lower wages. The other ballot measure that Missouri voters said ‘no’ to was Amendment 4. This measure would have made it nearly impossible to adopt statewide, citizen-led initiatives voted on directly by allowing as few as 5% of voters in the state complete veto power over the rest of the state. If this had been in place in 2020, Medicaid expansion would not have passed, meaning more than 364,000 hard-working Missourians would not have had access to quality health coverage.
REACH consistently opposed these ballot measures as they worked their way through the legislature. We are heartened to know that the vast majority of voters in our service area understood the stakes and acted accordingly. Additionally, we are so proud of our partners who work in this space. They knocked doors, made calls, and invited neighbors into their homes to talk about the importance of these issues. The power of consistent messaging and collective action was on full display last night.
As with any policy victory, it is never permanent and much work remains.
Kansas still hasn’t expanded Medicaid, which would cover more than 150,000 people. Missouri is facing a $2 billion budget shortfall due to recently adopted tax cuts that will impact health and human services statewide. In the interim, we join our Kansas and Missouri advocacy partners and everyday citizens in celebrating these wins and will return ready and refreshed to advance our shared vision of a healthier, more civically engaged region.
Work requirements may sound reasonable on the surface, but in practice, they create significant barriers that make it harder for eligible people to access Medicaid and food assistance.
Our policy explainer examines how work requirements in H.R. 1 are used to reduce access to Medicaid and SNAP, what additional state proposals could mean for Kansas and Missouri families, and why these policies are often impractical to implement.
With the expiration of enhanced premium tax credits, many Kansas and Missouri residents are facing higher health insurance costs and difficult coverage decisions.
This policy explainer breaks down what these changes mean, what early data is showing, and what to watch in the months ahead as the full impact on the ACA marketplace becomes clearer.
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