Last week, Missouri Gov. Mike Parson dropped plans to expand the state’s Medicaid program to thousands of low-income families after the GOP-led legislature refused to fund the voter-approved expansion.
The approved ballot measure stated people ages 19 to 65 earning up to 138% of the federal poverty level — less than $17,774 annually for an individual or $37,570 for a family of four — “shall be eligible” and “shall receive coverage” for Medicaid benefits starting July 1. The amendment did not change existing eligibility standards for children and seniors or say how to pay for the expansion to cover about 275,000 people.
“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said Thursday, May 13. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”
Prior to the vote, the Missouri Court of Appeals Western District issued an opinion in June 2020 explicitly stating that the MO HealthNet expansion ballot initiative did not create a revenue source or direct the General Assembly to appropriate funds. The court noted the General Assembly retained discretionary authority to fund or not fund expansion.
House Budget Chair Cody Smith removed Parson’s request for funding early on. The decision may trigger a lawsuit from supporters of Medicaid expansion.
“This is going to end up in court — the governor knows it’s going to end up in court,” said Richard von Glahn, policy director for Missouri Jobs With Justice, one of the organizations supporting Medicaid expansion.
Emily Kalmer, spokeswoman for the American Cancer Society Action Network, said cancer patients cannot wait for legal battles to access coverage Medicaid expansion would provide.
“Earlier this year, during his state of the state address, Governor Parson committed to upholding the will of Missouri voters by funding Medicaid expansion. The legislature has ignored the governor’s budget recommendations,” she said.
“By backtracking on implementation of Medicaid expansion, Governor Parson is breaking his promise to the people of this state and violating his oath to uphold the Missouri Constitution,” said House Minority Leader Crystal Quade, D-Springfield. “Whatever reputation he once had for respecting the law is gone forever, and he is just another politician whose word can’t be trusted. Medicaid expansion will still happen as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it.”
Republican House leaders remain confident the legislative process would stand against a lawsuit.
“I’m not an attorney, (I) won’t really speak to all of the dynamics around potential litigation without knowing who might file suit against whom,” Smith, R-Carthage, told reporters last week. “I would only assume that we would hire counsel to defend us if we were a party in some lawsuit. I don’t know why that would be the case as it relates to Medicaid expansion.”
and senator responses
Rep. Josh Hurlbert, the Republican representative who serves Smithville, Kearney and part of Kansas City North in House District 12, said he voted as his constituents did.
“The district said ‘No’ during the initial vote,” he explained. “There are a couple factors here. Take New York in particular, as one of the states that expanded Medicaid greatly, it exceeded costs from when they first passed it. I believe there needs to be serious reforms and get Medicaid costs under control.”
Hurlbert said there has been an increase to Medicaid this year of 11%.
“We have a lot of extra bodies that are on Medicaid due to the pandemic,” he said. “We had to budget for that increase. I do believe the path forward will include conversations to be had. For example, I don’t want people to have a lapse in coverage if they are unemployed. However, I don’t think we can do a carte blanche expansion to the budget.”
Hurlbert said he knows this is not the final word and expects the courts to make the final decision.
Mark Ellebracht, a Democrat, represents parts of Liberty, Pleasant Valley, Kansas City and Claycomo as the District 17 House representative,. He called the lack of funding as a tactic that goes against the political ideology of a few people on the budget committee.
“I support the expansion and I want to see what the voters told us to do,” he explained. “It’s the democratic will of the people. Unfortunately, there are fights. Those fights are with Democrats and Republicans. It’s more about political activism versus legislators representing the will of the people.”
Ellebracht believes federal funds may diminish before Missouri complies with the constitutional effort.
“We are refusing those federal dollars,” he said.
Rep. Maggie Nurrenbern of District 15, which covers Gladstone and part of Kansas City North, is among Democrats on the budget committee.
“I saw the sort of slow-motion train wreck happen,” she said. “When I heard the State of the State address, the governor spoke about Medicaid. I was grateful to hear about funding for Medicaid.”
In the governor’s address, Parson said, “Like I have said many times, I will always uphold the will of the voters, and we will move forward with expanding Medicaid coverage to approximately 275,000 Missourians. However, it is important to remember that the costs of this expansion will be significant – hundreds of millions of dollars, in fact. This will have a major impact on other areas of our budget, and we must plan accordingly, ... which means staying vigilant in maintaining the program’s integrity by protecting against fraud and waste.”
Nurrenbern said the budget cost for expansion would be around $130 million from the state while $1.5 billion, would come from federal dollars.
“We have been told that the federal dollars are 90% and the state 10%,” she explained. “It’s absolutely maddening. The leadership has turned their backs on the voters of the state. Now we are going to see Missouri taxpayer dollars taken to battle the will of the voters in court.”
Nurrenbern said this decision has snubbed the working poor.
“We have families who are the working poor who are living barely paycheck to paycheck,” she said. “If they aren’t healthy, they can’t be productive members of society.”
Prior to her service in the statehouse, Nurrenbern collected signatures to get Medicaid expansion on the ballot.
“I heard personal stories that broke my heart,” she said. “Now, the issue goes to the courts while we have federal money sitting there for us. Plus, the state is flush with funds to the tune of $7 billion in reserves. And, I know the Republicans set aside a pot called the Medicaid stabilization fund, around $500 million. I believe, despite all the rhetoric, the courts will make the state fund it.”
Sen. Lauren Arthur of District 17, which covers the bulk of Clay County including Gladstone and Liberty, agrees with her Democratic counterparts in the House.
“Essentially, my colleagues who decided against funding the Medicaid expansion are going against the oath of office they swore to uphold,” she said. “It’s an example of politicians kicking the can down the road. The legislature failed to do their duty after the voters approved it by 53%.”
Arthur said Medicaid sign-ups were initially slated for July.
“It just leaves so many people in limbo,” she said. “They already have years without health care, but are looking for some clarity. The Missouri General Assembly has a responsibility. If things do change and the courts pass it, we will hear about activist judges. So many people are being used as pawns. It harms our state and undermines our democracy.”
Arthur said she wants to see the Medicaid issue resolved before the 2022 assembly session.
“It’s time to put away the political theater when real lives are at stake,” she said.