Abortion amendment puts bill to finance Missouri Medicaid program in limbo
Senate studying whether provision against contraceptives violates federal rules for basic coverage
A view of the Missouri Senate chamber from the visitors gallery (photo courtesy of the Missouri Senate).
Missouri Senate leadership pulled a bill vital for funding the state’s Medicaid program from floor debate Tuesday after adopting an amendment barring the use of public money for common contraceptive treatments.
The amendment, sponsored by Republican Sen. Paul Wieland, could endanger the state’s entire Medicaid program by eliminating a health care service required by federal law, said Senate Minority Leader John Rizzo, D-Independence.
“I would say on its face that is why the bill got laid over immediately and the panic button was hit because it put us out of compliance in those regards,” Rizzo said.
Wieland said in an interview that he doesn’t intend to dismantle the Medicaid program. But he wants to extend a current ban on using public funds for abortions.
“My intent was not to deny Medicaid recipients birth control,” Wieland said. “My intent was to prevent the state of Missouri from paying for abortions.”
Missouri uses a tax on hospitals, nursing homes, pharmacies and other medical providers to support the medical program for lower-income residents. Called a reimbursement allowance, the taxes are the major reason general revenue paid only 18.2 percent of the program’s $10.8 billion cost in fiscal 2020.
The bill before the Senate, sponsored by Senate Appropriations Committee Chairman Dan Hegeman, R-Cosby, would extend the expiration date of the taxes for one year. The bill is must-pass legislation for balancing the state budget.
Wieland’s amendment would bar the use of Medicaid funds for any FDA-approved medication or device that would cause “destruction of, or prevent the implantation of” a fertilized ovum. Those products include levonorgestrel, commonly called the “morning after” pill and some intrauterine devices, or IUDs.
Levonorgestrel can prevent fertilization if used soon after intercourse. IUDs are designed to prevent fertilization as well either through spermicidal action or hormonal treatments.
When Wieland offered his amendment, Hegeman said he didn’t like it but wouldn’t fight it.
“I would like to keep this bill as clean as possible but I respect your passion for what you are interested in here,” Hegeman said during floor debate. “I would like for this not to be on the bill.”
There was little other discussion and the amendment passed on a 21-12 vote, with Hegeman and Sen. Lincoln Hough, R-Springfield, joining all 10 Democrats in opposition. The bill was immediately set aside after the vote.
The impact of Wieland’s amendment was being studied Wednesday afternoon, Hegeman said. He added that he doesn’t know if keeping it in the bill would put the Medicaid program in danger.
“That’s what we are pondering,” he said. “We need to figure out the implications of the amendment and we have not completed that analysis.”
Wieland said he was surprised his amendment passed with no supporters of abortion rights challenging it.
“I think that people were caught off guard that it went on as easily as it did,” he said.
The Affordable Care Act passed in 2010 made birth control an essential health benefit that all insurance plans must provide. Every state Medicaid program must provide the same set of health benefits and failure to do so puts the state out of compliance with federal law.
But federal law also bars the use of federal Medicaid funds to pay for abortions and Missouri law mirrors that limitation. Wieland said his amendment just emphasizes that the prohibition also covers any method that prevents implantation of a fertilized egg in the uterus, which he said is a human life deserving of protection.
“If a device that’s been approved by the FDA kills a human life, that is an abortion,” Wieland said. “I don’t know why the rest of the world doesn’t see it that way.”
A lobbyist who helped work on the language, Sam Lee of Campaign Life Missouri, said he doesn’t think the impact of the amendment on the state’s Medicaid program will be as dire as feared. If the amendment, or some version, is approved, it will likely end up in court, Lee said.
With strong anti-abortion sentiment dominating the legislature for decades, every significant step taken to limit access or funding has been challenged in court. In June, for example, the Missouri Supreme Court ruled that lawmakers could not bar Planned Parenthood from being a Medicaid provider just because some of its clinics offer abortions.
Arguing that Missouri would lose federal support for all Medicaid services because of a law banning the program from paying for a particular class of products is extreme, Lee said.
“I don’t see it as a choice of one or the other, either you have the program as it is or you don’t have it at all,” Lee said.
The reimbursement allowance bill is not the place to have the debate, Rizzo said.
“There is a reason why when we pass an FRA bill, we try to do it as clean as possible,” he said. “We need to stay tight to the boundaries to make sure we are not compromising that funding.”
The fight over contraceptive care is not new for Wieland. In 2016, he won a lawsuit arguing that he did not have to accept or pay for contraceptive coverage in the state’s health insurance plan for employees.
The amendment approved Tuesday was not a surprise, Wieland noted. It was distributed to other Senators three weeks ago in anticipation of the debate.
And, he said, there is time to consider the implications of his amendment and draft language that will keep the state in compliance while achieving his goal.
The budget must be passed by May 7 and extending the reimbursement taxes is part of that process.
“It is a false choice to me to say we are going to sacrifice unborn children to provide health care to other people,” Wieland said.
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