With the Missouri Senate poised for what promises to be a lengthy debate over Medicaid expansion, legislative Democrats said Tuesday that the fight over funding will move to the courts if lawmakers don’t approve money for the new coverage.
During a rally on the Capitol Building lawn, Senate Democrats promised to push for adding the $1.9 billion expected cost to the state budget. During debate in the Senate Appropriations Committee, a proposal from Sen. Lincoln Hough, R-Springfield, to include Medicaid expansion funding in the budget failed on a tie vote, with Hough and two other Republicans voting with Democrats in favor of the spending.
The Senate on Wednesday will debate the 13 spending bills that fund state operations in the year beginning July 1. The House-passed version did not include funding for Medicaid expansion to cover approximately 2750,000 people.
Sen. Barbara Washington, D-Kansas City, asked the approximately 100 people at the rally to visit Senate offices to lobby for votes. Democrats hold 10 seats in the 34-member Senate. If the three Republicans don’t change their votes, five more GOP Senators would be needed to give expansion an 18-vote majority in the Senate.
Four more votes would put the decision in the hands of Lt. Gov. Mike Kehoe, who only votes to break ties. Kehoe declined to say how he would vote when asked by the St. Louis Post-Dispatch.
“We just need 18 votes to say fund Medicaid expansion and do what the people who sent you here told you to do,” Washington said.
In his budget plan, Gov. Mike Parson proposed using $130 million in general revenue, and spending $1.9 billion overall, to cover expansion costs. Asked on Tuesday whether he expects the final budget proposal to include that money, Parson said he didn’t know.
Parson, who opposed Medicaid expansion prior to the August passage of Amendment 2, has not lobbied lawmakers in favor of his budget proposal.
“In the last two weeks of the session a lot of things happen, so we will just have to wait and see what happens,” Parson said.
Medicaid is a shared obligation of the state and federal government, and Missouri’s current program, called MoHealthNet, offers few services that are not required to participate in the program.
Adults with children and no other qualifying conditions such as a disability are covered only if their income is less than the family would receive in cash welfare benefits, $292 a month for a single-parent household with two children. No working age adults without children are covered unless they qualify for another reason.
Almost 1 million people are currently covered by the program.
Under the 2010 Affordable Care Act, states that expand Medicaid coverage to people earning less than 138 percent of the federal poverty guideline pay only 10 percent of the cost. Missouri pays 34 percent of the cost of the traditional Medicaid program.
Expansion would cover working-age adults who earn up to $17,774 a year, the equal of working about 33 hours a week at the state minimum wage of $10.30 per hour. For a single parent with a child, the limit rises to $24,039 a year, or the equivalent of working full time for $11.55 per hour.
“We are not talking about giving free health care to millionaires here,” House Minority Leader Crystal Quade, D-Springfield, said. “We are talking about the person working two part-time jobs, 40 hours a week, pulling in under $18,000 a year.”
Before the August vote, Republicans contended passage would force the state to increase taxes or cut programs such as public schools to cover the cost.
But rather than settling the debate that has raged in the state since passage of the Affordable Care Act, Amendment 2 instead added a new layer of disagreement.
Opponents cited the relatively close vote – 53 percent of voters supported Medicaid expansion – and the lack of a funding source for the state’s share. Proponents said that by approving the constitutional amendment, lawmakers were obligated by their oath of office to fund it.
There is no question that the state has the money needed for its share – the general revenue fund will end this year with a $1 billion surplus, according to Parson’s budget projection. In addition to that money, the state is sitting on almost $500 million from an increased federal share of Medicaid due to the COVID-19 pandemic and would receive a 5 percent cut in its share of traditional Medicaid – equal to about $1.2 billion over two years – by expanding Medicaid coverage.
“The false narrative being sold that Missouri cannot afford to invest in the health of its residents and afford to invest in our children’s education is a lie,” Quade said.
The rally, small and socially distanced because of the COVID-19 pandemic, drew people from both the large urban areas that supported expansion and smaller communities that did not.
Susan Drummond of Boonville lives in the 19th Senate District, represented by Senate Majority Leader Caleb Rowden, R-Columbia. While Cooper County, where Drummond lives, voted against Amendment 2 by almost a 2-1 vote, it received an equally strong vote in favor in Boone County, where Rowden lives.
The district as a whole voted for Medicaid expansion, with 63 percent in favor.
One argument being made by Republicans opposed to expansion is that because Amendment 2 did not include new revenue, lawmakers are not obligated to appropriate funds for it.
Drummond said Pinnacle Regional Hospital in Boonville closed in early 2020 in part because of a financial crunch created by the state’s refusal to expand Medicaid.
“I think Missouri voters have already said yes to this and I don’t see why the assembly wants to ignore us,” Drummond said. “I would say to Caleb Rowden we need to get our hospital up and running again in Cooper County.”
Amendment 2 directs the executive branch to change eligibility standards and did not direct the legislature to spend any money. If legislators refuse to pay for it, the next step is the courts, state Rep. Barbara Phifer, D-St. Louis, said.
“The fight has not ended,” she said. “This fight is going to go all the way to the Supreme Court of Missouri if we need it to and the people will win.”