Missouri Gov. Jay Nixon was in Chillicothe Wednesday afternoon to discuss the expanded Medicaid program now being considered by the state legislature.

In all, around 100 people crowded into the bays of the Chillicothe Fire Department to hear the governor's comments. The state legislature is expected to vote next month whether to opt in to the health care program.

The governor, standing in front of a Chillicothe ambulance, was flanked by leaders in health care, education, business, and law enforcement — those who heal the sick, protect the vulnerable, and keep the streets safe.

"The people standing here with me today understand that bringing billions of our Missouri tax dollars back to Missouri to strengthen Medicaid will have a profound and positive impact not only on our health and safety, but also on the local economy here, in Chillicothe, and in communities in every corner of the Show Me State," the governor stated.

Nixon said that, as governor, he has the opportunity and obligation to keep Missouri's economy moving forward. He noted that the state's unemployment rate has stayed below the national average for four years, and that the number of jobs increased last year.

"We're making solid economic progress," he said. "And, making sure that we continue to build in this progress has everything to do with how we move forward on health care."

Nixon's proposal of expanding Medicaid would bring $5.7 billion to Missouri and provide heath coverage to an additional 300,000 Missourians over the next three years, at no cost to the state.

"The question before us is a narrow one," the governor stated. "Will we bring the tax dollars we send to Washington back home to strengthen our Medicaid system here in Missouri, or will we let our tax dollars that we send to Washington be spent in other states instead? Other states would get the benefits, we get the bill. The answer is clear."

Nixon's budget for fiscal year 2014 includes federal funding to provide basic health coverage for an estimated 300,000 more Missourians who currently have no health insurance.

He said it is the smart and the right thing to do, explaining that for the first three years, 100 percent of the cost for providing health insurance for those additional people will be covered by federal funds.

"That first year alone, that's $1.8 billion coming back here to the state of Missouri," he said. "Make no mistake, that's tax dollars you're sending to Washington — that's us getting them back to use them right here. That 100 percent is only available for three years, starting on Jan. 1."

After the first three years, the state share than phases up to 10 percent by Jan. 2020.

"As a business decision for our state, it is incredibly clear that this would be a big win for our economy," he said.

The program has been endorsed by a broad coalition of business groups across our state. Among those who have endorsed the governor's recommendation to join the Medicaid expansion are: the Missouri Chamber of Commerce and Industry, Associated Industries of Missouri, the Chambers of Commerce for Kansas City, Independence, Kirksville, Hannibal and Sedalia, the Kirksville Regional Economic Development and others.

"For those business leaders, this was not a political decision," Nixon said. "It was an economical one. And, we shouldn't let last year's politics get in the way of next year's economic growth."

The Chillicothe Area Chamber of Commerce is slated to consider endorsement next week.

"Moving forward with this plan will bring a total of $5.7 billion of your tax dollars to Missouri, to the first three calendar years, at no additional cost to the state," the governor said.

He stated that a study by the University of Missouri last fall found that bringing these dollars back to Missouri to strengthen Medicaid would create 24,000 new jobs in Missouri alone. The jobs would include nurses, doctors, pharmacists, therapists, and medical technicians.

"Strengthening Medicaid will strengthen our economy," Nixon said.

The governor also explained how the expanded program, which is now offered for those at 20 percent of the federal poverty level, would reach more people once it is expanded so that those who are at 138 percent of the poverty level could get health care.

Under the proposed expansion, low-income Missourians who can't afford health insurance and earn less than 138 percent of the federal poverty level — or $32,500 a year for a family of four — would be eligible for coverage.

"They are people who work hard, but just can't afford to go to the doctor for preventative or even necessary treatment and, as a result, they often end up in our hospital emergency rooms," Nixon said. "That's a terrible way to deliver health care. That puts a heavy burden on our doctors, nurses and hospitals, it drives up premiums for individuals and businesses."

Just as there are clear benefits for seizing this opportunity, the governor said, there are also high costs for inaction.

"For our economy, inaction means fewer jobs," he said. The Missouri Hospital Association estimates that passing up expanded Medicaid will cost the state 9,000 jobs and increase health insurance premiums for families and businesses by more than $1 billion."

"For family and businesses, inaction means crowded emergency rooms and higher insurance premiums," he said.

Inaction, he said, also means fewer mental health services for those who need it most. The Department of Mental Health estimates that hundreds of in-patient psychiatric beds will be cut from the system already struggling to meet current needs.

"Law enforcement folks with us... they understand the mental health aspect," Nixon said.

Of the 300,000 people that will be covered with an expanded program, independent analysis shows that 50,000 of those are in dire need of mental health services.

"They understand that mental health psychiatric services have been dropping," Nixon said. "We all have seen what happens when folks in dire need don't get the treatment they need in the mental health system. We saw it in Aurora, Colo.; we saw it in Newtown; and, unfortunately, across this country, far too often, folks are in deep mental need."

The governor stated that the expanded Medicaid program transcends politics.

"Across the country, we are seeing governors and legislatures put politics aside and do what is undeniably best for their states," Nixon said. "Republican governors across the country are supporting this plan. They are doing this not because it is the easiest thing for them to do politically, but because it is a smart thing for them to do economically."

Standing still and doing nothing will not leave Missouri in the same place it started, the governor warned.

"If we don't move forward, we slip farther behind. Fewer jobs, higher costs, less safety," he said. "That's not the right direction for our great state."

The governor acknowledged that the crowd gathered in front of him most likely had some form of health insurance.

"There's a whole bunch of working Missourians who don't have that," he said. "We need to make sure they have it so they can work harder, be healthier, and have the preventative care that gives them a much better lifestyle than otherwise."

In addition to the federal tax dollars paying for coverage that is currently being paid for with state dollars, the economic benefit of the expansion would generate additional state revenue. These savings and revenue are conservatively estimated to have a positive impact of $46 million in 2014, $125 million in 2015, and $139.6 million in 2016, the governor said.