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SCOTT JAGOW: So what's the Real Agenda this midterm election? If you look at the polls, health care is way up there on the list. And some states are doing something about it. Missouri wants to raise the tobacco tax to pay for more health insurance for low-income people. The problem, in Missouri, is that Medicaid is very sick. Hillary Wicai has more.

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HILLARY WICAI: A helper puts one of 13 afternoon pills into Wayne Fry's mouth. The 46-year-old was a middle class carpenter before he broke his neck and became a quadriplegic about a decade ago. A bedsore almost cost Fry his life. So Medicaid provided him with a special air mattress that prevents the nasty sores. But then, last winter . . .

WAYNE FRY: "I got a phone call that they were going to come pick this mattress up the next day."

Fry struggles with speech after a stroke. A local charity pleaded to delay the pick up until it could locate a donated mattress.

FRY: "They wanted their mattress back and they got it."

Fry says he got lucky because there aren't enough charities out there to help everyone. Like many other states, Missouri was caught in the wind shear of rising Medicaid costs and dipping state revenue. So it made some of the most dramatic cuts in the country.

In the last year, at least 116,000 Missourians, and perhaps more, have fallen off Medicaid's rolls, including children and the disabled. But by far the hardest hit are working parents.

As is stands now, a working parent with two children can make more than $292 a month to qualify for Medicaid.

MICHAEL GIBBONS: "No one liked doing that."

That's Republican and Missouri Senate Majority leader Michael Gibbons. He says the program went from costing $400 million state dollars in 1992 to more than a billion in 2005. So Missouri took the emergency step of slashing eligibility. But the ultimate goal? Overhaul the whole system.

GIBBONS: "I offered the amendment, I honestly didn't think it would pass, but I offered the amendment to end our state Medicaid system June 30. 2008. No other state has done that."

The state doesn't have a plan to share yet. The governor's office declined an interview. But a state commission made dozens of recommendations on how to fix Medicaid. Among them is an emphasis on personal responsibility, tiered co-pays, and encouraging long term care insurance for younger consumers.

Advocate Amy Blouin with the Missouri Budget Project fears even more people will be hurt in the process.

AMY BLOUIN: "We're kind of like the crash-test dummy of the nation."

Blouin says a cigarette tax would go a long way to fixing Medicaid. But Gibbons says taxes alone aren't the answer.

Meantime, Celeste Webster, a divorced mom of two, lost her Medicaid last summer. She waitresses in a health food restaurant with the hope the food she eats there will help prevent cancer. Other than that her backup plan is simple.

CELESTE WEBSTER: "I pray that I beat my family's odds and I don't get breast cancer."

In St. Louis, I'm Hillary Wicai for Marketplace.