Missouri lawmakers appear to be headed into a special session next week to renew medical provider taxes vital to sustaining the state’s Medicaid program.
Gov. Mike Parson met Tuesday with the state Senate Republican caucus. The group discussed language that would bar the state from paying for some contraceptive medications and devices and extend the taxes set to expire on Sept. 30 for up to five years.
Sources told The Independent that Parson is expected to issue the special session call soon.
The proposed language, however, does not include provisions sought by some anti-abortion senators that would prevent Planned Parenthood from being a Medicaid provider.
“A few folks wanted more added to it,” Senate Appropriations Committee Chairman Dan Hegeman, R-Cosby, said Wednesday. “A lot of folks didn’t.”
Sen. Bob Onder, R-Lake St. Louis, on Wednesday afternoon said he would continue to push for the ban on Planned Parenthood and would not be satisfied with a bill that did not include it.
“I think that there has been some narrative that somehow a grand compromise and deal has been reached and everything is great, but that is not the case,” Onder said.
Parson “cannot micromanage or write the bill,” Onder said. While he would like to see the session start with a bill that unifies Republicans, he added, he’s willing to debate it on the Senate floor.
“There is no reason not to do it right now in this particular bill,” Onder said.
The taxes on hospitals, nursing homes, pharmacies and ambulances are called the federal reimbursement allowance and have been in place since 1992. In that time, they have been renewed 16 times and this year’s legislative session was the first time that abortion politics intruded.
It was also the first time an extension has not passed during a regular session.
The debate over what to include in the renewal aggravated existing splits in the Senate Republican caucus.
Last month, Sen. Paul Wieland, R-Imperial, wrote a letter to each of his Senate GOP colleagues excoriating Senate Majority Leader Caleb Rowden and Senate President Pro Tem David Schatz over how the issue was handled during the final days of the legislative session. Wieland asked his colleagues to replace Schatz and Rowden.
Wieland derailed the first attempt to pass the tax renewal when he added an amendment limiting Medicaid payments for contraceptive care. He could not be reached Wednesday for comment on the version discussed by the GOP caucus.
Without a renewal by July 1, Parson has said he will be forced to restrict spending in the new fiscal year to sustain the Medicaid program. The taxes are budgeted to provide $2.6 billion in the coming fiscal year for the $12 billion Medicaid program.
Parson wants a quick special session that will allow him to sign appropriations bills without imposing spending restrictions to begin the fiscal year. The quickest a bill can be passed is five days, but the Missouri Constitution allows up to 60 days for sessions called by the governor.
The state’s interim Medicaid director, Kirk Matthews, said recently that if the tax isn’t extended the “existence of the (Medicaid) program will be threatened by the end of the year.”
The liberal Missouri Budget Project has been working on an analysis of how the taxes work to make general revenue tax funding available for other programs in state government like education.
“The state Medicaid provider tax is a critical component of Missouri’s revenue structure and serves as a building block upon which all public services, including health and education, are funded,” budget project president and CEO Amy Blouin said. “The loss of this revenue source would create a domino effect, destabilizing the entire state budget. The consequences of failing to renew Missouri’s provider taxes would be dire, affecting services far beyond Medicaid, and they would be felt by Missourians in every community across our state.”
News that Senate Republicans may have broken the impasse that prevented the taxes from being renewed in the regular session is welcome, House Budget Committee Chairman Cody Smith wrote in a text message.
The House passed several versions of an extension, including one that did not have any provisions sought by anti-abortion lawmakers.
“I am still gathering information at this time but I’m encouraged to hear that we are moving forward with a special session,” Smith said.
The news that the deal targets contraceptive care wasn’t so welcome among advocates for family planning and abortion rights. The provisions being circulated bar several medications, some that end pregnancy and some that prevent fertilization, as well as intrauterine devices, or IUDs.
Michelle Trupiano, executive director of the Missouri Family Health Council, representing more than 80 clinics, including health departments and federally qualified health centers, providing family planning services, said the language being discussed would put Missouri out of compliance with federal Medicaid regulations.
“Because of it being non-compliant, it is sure to have legal implications, with lawsuits, etc., which would create uncertainty and destabilize the entire budget,” Trupiano said.
The language is also an attack on family planning, she said.
“It is purposefully and irresponsibly conflating abortion and birth control,” Trupiano said.
Of the women seeking contraception, Trupiano said, 16 percent of those visiting member clinics choose an IUD over pharmaceutical-based methods.
“This amendment is trying to suggest that emergency contraception, IUDs and other forms of birth control are abortion,” she said. “IUDs are the most effective form of birth control to prevent pregnancy.”
M’Evie Mead, director of Planned Parenthood Advocates in Missouri, issued a statement accusing anti-abortion lawmakers of deliberately trying to confuse Missourians about the medications and devices the contraceptives provisions seek to ban.
“These politicians are holding hostage a must-pass bill so they can block patients’ access to common forms of birth control — and they’re willing to risk funding for the entire Medicaid program to do it,” Mead said. “Hundreds of thousands of patients rely on Medicaid to access essential health care, including birth control. Decisions about birth control belong to a patient and their provider — not state legislators.”
House Democrats reacted strongly to the reports of an internal Republican deal. State Rep. Peter Merideth, D-St. Louis and chairman of the House Democratic Campaign Committee, said the GOP has taken a non-controversial bill usually passed with bipartisan support and made it a vehicle for extremist views about birth control.
“This year, extreme right-wing Republicans are threatening the very existence of Missouri’s Medicaid system, holding the third largest source of state revenue hostage over new partisan language that will have devastating, real-world consequences,” Merideth said.
Senate Democrats are studying the language they have been provided before deciding on a strategy, said Senate Minority Leader John Rizzo of Independence.
“My staff is working through it and how it is applied in real life,” Rizzo said. “At first glance, it does seem problematic. It seems that they are appeasing the extremists in their caucus and trying to take away birth control for women.”
Democrats will caucus after Parson issues the call to decide a strategy. One path would be to leave it to President Joe Biden’s administration to determine if Missouri can limit the medications and devices that are primarily used to prevent pregnancy.
“Any sort of tinkering with that language places it in jeopardy,” Rizzo said, “and it especially places it in jeopardy with a House, Senate and White House in the hands of Democrats who are very pro-reproductive rights.”
This story has been updated since it was originally published.