Abortion amendment imperils bill crucial to Missouri Medicaid finances

Over the past 30 years, as Missouri legislative majorities shifted from Democratic to Republican and party control of the executive changed five times, one piece of recurring legislation has retained strong bipartisan support.

On 16 occasions, lawmakers have renewed a set of taxes on medical providers essential to funding the Medicaid program. Usually, the votes coincide with passage of the budget bills that fund state government as a whole.

But not this year.

Lawmakers will take their final budget votes Friday but the Senate bill that would extend the taxes until Sept. 30, 2023, is stalled in the upper chamber. There is an amendment pending that would bar Planned Parenthood from providing Medicaid-funded family planning services.

The amendment’s sponsor, Sen. Bob Onder, R-Lake St. Louis, wants to use the must-pass legislation to write the ban into state statutes because the Missouri Supreme Court ruled last year that writing it into a spending bill is unconstitutional.

Onder is confident he can get his amendment approved as part of passing the bill.

“As you say, it is must-pass legislation, as is the budget, and those who would oppose a ban on funding of abortion providers have stood down and repeatedly allowed budget bills to pass,” Onder said. “I think that is what would happen this time.”

If no resolution is found by next Friday, when lawmakers adjourn their regular session, the provider taxes, called reimbursement allowances in legislative jargon, would have to be renewed in a special session before they expire on Sept. 30.

“I am not there yet. I am not advocating that,” Senate Appropriations Committee Chairman Dan Hegeman, R-Cosby said of the idea of a special session. “If we end up there we end up there but that is not a strategy for me right now.”

The reason the bill is must-pass legislation is the enormous share of state Medicaid costs it represents. In fiscal 2020, the taxes on hospitals, nursing homes, pharmacies and ambulance services raised $2.3 billion to support Medicaid. 

The general revenue fund provided $1.9 billion for Medicaid, which cost a total of $10.8 billion in the year that ended June 30, 2020.

The tax is given a short sunset each time it is renewed in part to give lawmakers flexibility to react to changes in federal law. The taxes on providers are used to match federal funds that support Medicaid and there has, on several occasions, been an attempt to limit the taxes to lower national Medicaid costs.

Hegeman’s renewal bill, was already delayed by one abortion-related amendment. 

In late March, Sen. Paul Wieland, R-Imperial, added language that bars using public funds to pay for some contraceptive treatments that also prevent implantation of a fertilized ovum. That amendment, many argued, put the state out of compliance with national Medicaid rules and jeopardized the whole program.

Medicaid requires states to provide family planning services and contraceptive treatments, Michelle Trupiano, executive director of the Missouri Family Health Council wrote to lawmakers on April 19.

“If Missouri Medicaid recipients select an IUD as their chosen method of contraception, (Wieland’s amendment) prevents them from accessing that method, which is a violation of federal Medicaid law,” Trupiano wrote.

Hegeman and Wieland resolved that issue by adding language that would have preserved the provider taxes if the limit on contraceptive services was found to be unenforceable. That is when Onder offered his amendment and the bill was again pulled from debate.

There is a House bill awaiting a vote in the House Budget Committee that would also extend the taxes. It could be brought forward quickly, if necessary, but committee Chairman Cody Smith, R-Carthage, said it would meet the same issues that have stymied Hegeman’s bill once it reached the Senate floor.

“Until some of the concerns are addressed over on the other side, I don’t see a path to get that done,” Smith said.

There is little enthusiasm for delaying action until a special session. While Gov. Mike Parson could try to limit the agenda to only renewing the tax, it is questionable whether he could limit it so tightly that Onder’s amendment wouldn’t be allowed.

Lawmakers can only address issues specified by the governor during a special session.

“I would rather get it done now,” said Senate Minority Leader John Rizzo, D-Independence.

If there is a special session, Parson should try to write the agenda to limit the types of amendments that could be offered, Rizzo said.

“I would highly encourage him to do so,” he said. “That is so we can get it done in a way we know it fits with federal law.”

Smith also said he does not want to wait for a special session.

“I think while we are here we should take care of it,” Smith said. “That would be preferable, to address a major piece of legislation inside the regular session while we are here.”

Onder, however, said he doesn’t think opponents gain any leverage by waiting for a special session. Parson’s power is not so great that he would be barred from offering the same amendment during a special session, he said.

“The governor could call us into session but the governor can’t exclude amendments that are germane to the subject matter,” Onder said. “The governor can’t write the bill for us.”