When Heidi Miller’s patient, a 49-year-old waitress, got lung cancer, treatment had to wait until the patient became physically disabled.

That disability qualified her for Medicaid, Miller said. Otherwise, the woman made too much money to qualify and not enough to buy health insurance.

She also didn’t have breast or cervical cancer, which would have qualified her for Medicaid, while lung cancer doesn’t.

"The strong lady survived" after getting treatment, Miller said. "She was disabled. She couldn’t work anymore. She wanted to continue to work."

Amendment 2, on the Aug. 4 ballot, would expand Medicaid in Missouri. It would provide health coverage to individuals who earn less than $18,000, covering around 230,000 Missourians it doesn’t now cover.

It would benefit many of Miller’s patients, she said. She is a primary care doctor at Family Care Health Centers, a federally qualified health center in St. Louis. She’s also medical director for Gateway to Better Health, which serves 20,000 uninsured patients in St. Louis.

Her education began when her primary care practice began 17 years ago, she said. She has many patients with congestive heart failure, epilepsy and other health issues who can’t afford health insurance and can’t qualify for Medicaid.

"I feel like my hands are tied," Miller said.

Many employers don’t offer health insurance, and low-wage workers often hold jobs that are labor-intensive and hard on their bodies, she said.

The federal government would pay 90 percent of the cost of Medicaid, with the state paying 10 percent.

"In Illinois and 37 other states, their residents are able to access Medicaid, and we in Missouri are paying for it," Miller said.

Health care for inmates, currently paid 100 percent by the state, could be shifted to Medicaid, paid with 90 percent federal funds, she said.

Missouri is among the final 13 states to expand Medicaid and among the states with the lowest health outcomes Miller said.

"I think we can do better," Miller said. "I think we want to do better."

Medicaid expansion also would improved the general well-being of people in the state, she said.

"Improving health also improves the social, cultural and economic well-being of our communities," MIller said.

The need also is apparent at Namaste Health Care, a primary care practice in Ashland, said Dr. Bridget Early and family nurse practitioner Kate Branham.

"There’s a desperate need for Medicaid expansion," Branham said. "It’s just heartbreaking for people who have medical needs and can’t afford it."

Many of its patients don’t pay, Early said.

"There’s a lot of poor people out there with jobs that don’t provide any benefits," Early said, adding most would qualify for Medicaid if it’s expanded.

Missouri’s Republican-led legislature has repeatedly rejected Medicaid expansion proposals over the past decade, which prompted supporters to turn to the initiative process. By proposing a constitutional amendment instead of a new law, supporters have ensured that lawmakers will be unable to change it without going back to voters.

Gov. Mike Parson is opposed to Medicaid expansion, citing its potential costs. Nicole Galloway, his Democratic opponent, favors it.

Other opposition is from Missouri Right to Life. No one with the organization or its political action committee would agree to a phone interview. In Missouri, under what is known as the Hyde Amendment, federal Medicaid funds can only be spent on abortions in the case of rape, incest or a threat to the life of the mother.

In its literature, Missouri Right to Life states that the Hyde Amendment is under attack, and it doesn’t protect against spending for abortifacient contraceptives and "morning after" pills.

"Abortion is not health care," the Missouri Right to Life literature reads. "It is wrong to ask the people to pay for more abortions as the price for expanding Medicaid coverage in Missouri, as Amendment 2 does."

Among the proposal’s notable endorsements is from the Missouri Chamber of Commerce and Industry, which said the initiative is a "pro-jobs measure that will help fuel economic growth throughout our state."

The endorsement cited a report from the Missouri Foundation for Health on the economic impact of Medicaid expansion. The report found that it would create more than 16,000 new jobs annually over its first five years, expand the state’s economic output by $2.5 billion a year and increase personal income by more than $1 billion annually.

Kara Clovis, a master of public health student at the University of Missouri, said she was a skeptic before she researched Medicaid expansion. She has worked on Medicaid projects for an internship, reluctantly at first.

"I didn’t really support Medicaid expansion," Clovis said. "My first outlook was everybody should be paying for their own insurance."

Researching the issue opened her eyes, she said. Now, a family of four has to have a salary of $5,500 annually to qualify for Medicaid. With expansion, individuals making up to $18,000 annually would qualify.

"We’re already paying for it," Clovis said. "We’re just not getting the benefit. The rural hospitals especially are financially struggling because they’re not getting reimbursed."

The Yes on 2 campaign states that 10 rural hospitals in Missouri have closed since 2014, and that Medicaid expansion could help keep them open.