ST. LOUIS, July 7, 2021 – At one of our most recent patient advisory board meetings, the agenda included an update on Medicaid expansion. One of the representatives said, and I quote, “Yes, we need to talk about that. I’m mad.” Those words resonated with the other members of the board, as well as those of us who are receiving daily updates on the advocacy efforts for Medicaid expansion implementation. The St. Louis Regional Health Commission’s patient advisory board is comprised of individuals who have no insurance or who have coverage through Gateway to Better Health or Medicaid; many of whom have health care issues that require routine doctor visits. After the historic vote in August 2020, to approve Medicaid expansion in our state, our advisory board representatives were hopeful for a chance to have new or expanded access to health care coverage. Instead, our legislature failed to appropriate funds for expansion, and our Governor withdrew necessary documentation to implement expansion.

The fate of Medicaid expansion implementation is now in the hands of the courts, when it should have stayed in the hands of Missourians. As I continue to watch this political exercise unfold, I find myself asking, “How are we centering and responding to the voices of people most impacted in our work?” A clear majority of voters (53%) approved expansion. However, a small number of legislators insist they know what is best for the community, though it stands in direct opposition to how Missourians voted. This fight for expansion follows an all too familiar pattern, where institutions fail to actively listen and respond to the needs of our community. It should come as no surprise then, as a result of this fractured trust, the community is “mad.”

How can we prevent a similar outcome for other policy measures and health care improvements? We have seen a new way of leadership from St. Louis Mayor Tishaura Jones. When her team did not receive adequate input from North City residents regarding how to spend American Rescue Plan Act relief dollars, they canvassed at a neighborhood-level. They did not assume how to spend millions of aid; they went directly to St. Louis residents who were disproportionality harmed by COVID, asked for their guidance, and listened. We need similar models of accountability at all levels of governance – institutional, local, state, and federal.

At the St. Louis Regional Health Commission, we are committed to leaning into this charge of centering those most impacted in our decision-making. If we really want to see justice in our lifetime, we need more leaders who are willing to engage in radical listening and power sharing with community. We hope that the Missouri Supreme Court will honor the will of Missourians and implement Medicaid expansion in response to the hearing on July 13. 

For more information about the St. Louis Regional Health Commission, please visit or contact Angela Brown at (314) 446-6452.

Angela F. Brown, MPH, is CEO of the St. Louis Regional Health Commission. The St. Louis Regional Health Commission is a non-profit organization with a mission to increase access to health care for people who are medically uninsured and underinsured; reduce health disparities among populations in the St. Louis City and County region; and improve health outcomes among populations in the St. Louis City and County region, especially among those most at risk. The Commission comprises an appointed body of government, health care and community leadership, and serves as a key regional health planning body for the St. Louis region.

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