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Luke Barber enjoys his work.

He bags groceries at . He also has a second job, advising disabled people on independent living decisions, like how to navigate various government programs, and prepare for a job interview.

Barber, who is 26 and lives in Des Peres, knows these things firsthand. He was diagnosed as having autism spectrum disorder when he was 7. He struggles, sometimes, with communication. He takes medication and receives mental health services that help him maintain an ability to function in the community.

Barber was looking forward to qualifying for Medicaid under the expansion voters approved last November. He voted for the expansion and even campaigned for it. He ran a long-shot statehouse campaign against Rep. Dean Plocher, R-Des Peres, who may well be the next speaker of the House. It’s because of Plocher and his fellow Republicans that Barber’s plans of qualifying for Medicaid later this summer have been put on hold.

Republicans refused to budget the money needed for the expansion that is now called for in the Missouri Constitution. Most of the money for the expansion would come from the federal government. Expansion in other states has improved their economies because of the influx of federal dollars, as well as the coverage of people who otherwise would not seek services until they ended up in an emergency room.

Barber’s case represents a bit of an anomaly, but it contradicts the Republican philosophy in Missouri that Medicaid expansion is intended only to cover lazy, “able-bodied� people who ought to be working for a living. Many of the 275,000 people estimated to be covered by the expansion already work, but they don’t qualify for Medicaid under the state’s guidelines, some of the most stringent in the nation.

Missouri is one of only 13 states that withholds Medicaid from adults living in poverty who don’t have children, whether or not they have jobs. Barber has two jobs. He has Medicaid now because of his disability. But because of a second job he started last year, he’ll be making about $16,000 a year, or about $3,000 too much to qualify for the Medicaid he currently has.

During the coronavirus pandemic, the federal government has granted waivers to keep people like Barber on Medicaid through the end of the year. But if the program doesn’t expand, he’s going to face a tough choice:

Quit one of his jobs or take the private insurance he could get through his union. With the private insurance, he would give up some of the specialized disability services he receives. They are covered only under the state program. Barber is grateful that his grocery-bagging job provides him union benefits, but he recognizes that there are a lot of people in his situation — working 30 hours a week or more in part-time jobs — who don’t have access to private health coverage.

“I want to work,� Barber says. “It makes my life better.�

Inaction from Missouri Republicans, and Gov. Mike Parson, will cause a massive disruption in Barber’s life, unless a lawsuit against the state’s inaction forces a Medicaid expansion by the end of the year. Such a lawsuit was filed Thursday by three single mothers who are in similar circumstances as Barber. Two of those women, Autumn Stultz and Stephanie Doyle, work part-time jobs. Another, Melinda Hille, can’t work because of underlying medical conditions. All three, like Barber, have medical conditions that need the sort of health care provided by Medicaid coverage.

This is not the first time the state has gotten in the way of Barber and his health coverage. In 2019, he was one of more than 100,000 people — children, disabled people and senior citizens — who lost their Medicaid during a purge caused in part by a failed computer system.

At the time, Parson and his fellow Republicans turned a blind eye to the damage caused in the lives of people who lost their insurance, blaming the purge on an improved economy.

Now Barber might lose his insurance again, unless he quits one of his jobs. He is hardly alone.

“Having Medicaid allows me to see my psychiatrist, to get the medications I need, to have a higher quality of living. My mental health is better when I am working, and when I have access to health care,� he says. “Do they want people living in the community or do they want people institutionalized?�