Missouri ‘Voted for This Lie,’ Says State Rep Trying to Block Medicaid Expansion

ISTOCK.COM/benkrut

 

Connecting state and local government leaders

Even with extra federal dollars and a flush budget, Show Me State Republicans are putting up roadblocks to the voter-approved constitutional amendment that would give 275,000 people health insurance.

It is hard to qualify for Medicaid as an adult in Missouri. Single adults aren’t eligible for coverage through the state’s program — dubbed MO HealthNet — at all, and parents can’t make more than 21% of the federal poverty level: $5,400 in 2021 for a family of three.

That was all set to change on July 1 because of a constitutional amendment voters approved last summer, which made Missouri the 38th state to expand Medicaid coverage through the Affordable Care Act. Single adults would be covered if they made under around $17,770.

As many as 275,000 additional Missourians could get coverage — if there’s funding for the program. But in the deep-red state, which voted for former President Donald Trump by more than 15 percentage points in 2020, lawmakers are looking to undo the voters’ decision.

As it crafts the budget for the next fiscal year, the state legislature has moved to strip funding for Medicaid expansion. Rep. Cody Smith, the Republican chair of the House budget committee, separated the money for expansion into its own bill, which the GOP-controlled committee voted down in March. On the floor of the House last week, Smith said, “Medicaid expansion is wrong for Missouri, I think it’s wrong for the state budget.”

Smith argued spending on expansion is irresponsible, even though the federal government covers 90% of the costs for those covered under expansion. Compare that with the 60% of costs Washington covers for current Medicaid recipients.

Nevertheless, Smith contended that “the federal government has no money — there is only taxpayer dollars. They are federal-deficit-spending at a rate that is unprecedented at this point.”

Complicating that argument is the state’s current budget surplus, which Missouri’s Republican governor estimated at nearly $1.1 billion for the 2021 fiscal year. In addition to an influx in federal aid money, the state saw higher-than-expected revenues and, because it delayed tax collection in 2020, that money rolled over into the current fiscal year, which began in July 2020.

Some Republicans contend the rural districts they represent voted against the measure; others claim voters were misled. For example, during floor debate on the budget last week, Republican Rep. Justin Hill said, “Even though my constituents voted for this lie, I am going to protect them from this lie.”

Democrats argue Republicans are pushing ideology over the will of the people — who voted by more than 6 percentage points to expand the program. They also contend the legislature is now required to fund expansion because it’s in the constitution.

“Even if we didn’t have a surplus right now of dollars, we’ve seen in every other state that’s expanded they’ve actually had cost savings in states and revenue increases,” said Rep. Peter Merideth, the ranking Democrat on the House budget committee.

A large body of research has found a range of budget benefits associated with Medicaid expansion, and opponents’ predictions that paying for expansion comes at a cost for other priorities such as education or transportation have not proved true for other states.

Additionally, the American Rescue Plan Act, which President Joe Biden signed into law last month, compels the federal government to pitch in an extra 5% of costs for new expansion states.

In Missouri, that could amount to $1 billion over the next two years, according to the Centers for Medicare & Medicaid Services. That incentive has pushed other GOP-controlled states to consider expanding Medicaid as well, and Missouri Republican Gov. Mike Parson included expansion funding in his proposed budget. While Parson opposed expansion in the run-up to the vote, he has since argued he has to carry out the will of the voters. “If it’s not funded, there’ll be challenges to that,” Parson said at a recent press briefing.

There are a number of ways those legal challenges could play out. Thomas Bennett, an associate professor at the University of Missouri School of Law, said it will depend on what the state Department of Social Services does with the money it is budgeted.

If the state denied coverage to someone eligible under expansion, Bennett said, that would be grounds for a lawsuit. On the other hand, Missouri “could just try to muddle through with the money that it already has and try to provide as much coverage as it could to everybody who is made eligible.” That, Bennett said, could result in another set of problems, because there are minimum standards the state must meet to participate in Medicaid.

James Layton, a former solicitor general for Missouri, points to more trouble the legislature could run into with the Missouri Constitution. The ballot measure was a constitutional amendment, Layton explained. “The legislature can’t actually change eligibility for MO HealthNet in an appropriations bill,” Layton said. “This particular aspect of Medicaid eligibility — of MO HealthNet eligibility — it’s in the constitution, so the legislature can’t change it at all.”

The big legal question of what happens if the legislature defies the constitutional amendment could still be rendered moot. The budget will now head to the state Senate, where Republicans are split over what to do. While some have said they support including expansion funding, others are still speaking out against it. The deadline for those disputes to be resolved is July 1, the date the constitution states eligibility will expand, regardless of funding.

Subscribe to KHN's free Morning Briefing.

This story is part of a partnership that includes KBIANPR and KHN. It can be republished for free.

Sebastián Martínez Valdivia is a health reporter at KBIA.

NEXT STORY: Arkansas Gov. Asa Hutchinson Vetoes Anti-transgender Bill

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.