Divide among Missouri Republicans threatens to upend special session on Medicaid tax

Missouri Gov. Mike Parson and GOP legislative leaders were gathered on a conference call Tuesday morning, with little time to spare. 

The governor had set a noon deadline for lawmakers to strike a deal on a tax that provides $2 billion for Missouri’s Medicaid program. If they didn’t, he vowed deep cuts across the board to the state budget. 

The mood was testy, with the governor venting frustration at how the process had played out. 

Then suddenly, Parson was gone. He’d hung up on his fellow Republicans, leaving lawmakers unclear whether there would be a special session after all. 

Not long after, though, cooler heads seemed to prevail. Parson announced he was convening the legislature the following day. 

It wasn’t the most auspicious start to a special session with such high stakes. 

The struggle to renew a tax crucial to Medicaid’s funding, known as the federal reimbursement allowance (FRA), is the highest profile example of a divide that has plagued Missouri Republicans all year. 

From Parson’s scolding letter in January to House leadership complaining about the venue of his State of the State speech to a demand last month from one Senate Republican for a change in the chamber’s leadership, infighting bedeviled the Republican super majority and often left the impression that the state had three political parties. 

On Wednesday, as state senators gathered to work towards a resolution of the FRA, the tension — and lack of trust — was on full display. 

Sen. Paul Wieland, a Republican from Imperial whose attempt to ban certain contraceptives from being paid for by Medicaid originally derailed the FRA extension, rose to question why Senate leadership had decided to introduce three bills instead of only one. 

“The last time we discussed this, I was under the impression we were going to do one bill,” Wieland said, adding no one had notified him of the “11th hour surprise.” 

Then came Sen. Bob Onder, R-Lake St. Louis, who has demanded any FRA extension include language preventing Planned Parenthood from being a Medicaid provider.

During a speech on the Senate floor, Onder said he’d tried to work with the governor’s office during the final weeks of the legislative session to strike a deal on the FRA. 

“I pleaded with the governor’s office to intervene with House and Senate leadership so we could get something done in the regular session,” Onder said, later adding: “By the way, neither he nor his chief of staff ever returned my call.”

Earlier in the day in an interview with KCUR, Onder even suggested Parson was doing the bidding of Democrats by keeping “the money flowing to Planned Parenthood.”

Kelli Jones, the governor’s spokeswoman, did not respond to a request for comment. 

Onder’s critique came just two days after Parson called a press conference to publicly criticize his fellow Republicans in the legislature for moving the goalposts during FRA negotiations. 

“I am pro-life. I have supported pro-life measures my whole career and always will,” Parson told the media on Monday. “However, narrow political interests cannot be allowed to hold hostage vital health care funding and the success of our economy.”

At stake is a tax on hospitals, nursing homes and other health-care providers that expires in September and is expected to provide more than $2 billion for the state’s $12 billion Medicaid program. 

The FRA has been extended without controversy 16 times since it was first implemented in 1992.

Parson’s proclamation convening a special session calls for the FRA to be extended fo five years. 

As a concession to Senate conservatives, Parson called for limits on the purchase of several contraceptives through Medicaid and a prohibition on Planned Parenthood providing care under a state-funded family planning program for uninsured women.

But Planned Parenthood says its Missouri affiliates don’t receive “any state-funded reimbursements under the uninsured women’s health program,” a revelation that immediately drew the ire of Onder.

Sen. Denny Hoskins, R-Warrensburg, said he was under the impression during the regular legislative session that Republicans were on the same page about approving an FRA extension with contraception and Planned Parenthood language. 

But then, Hoskins said, it appeared GOP leaders struck a deal with Democrats on the session’s final day in an attempt to extend the FRA without those provisions. 

That deal blew up, leaving both Republicans and Democrats feeling betrayed. Senate Minority Leader John Rizzo, D-Independence, retaliated by leading a daylong filibuster that eventually forced the chamber to adjourn four hours early.

On Wednesday, Rizzo and his fellow Democrats urged the Senate to follow three decades of precedent and approve the FRA without any amendments. 

With only 10 seats in the 34 member Senate, Rizzo expressed hope enough Republicans would join in the effort. 

“If there are eight Republicans who would decide to join us and pass a clean FRA and continue this program for the next five years,” Rizzo said, “we’ll be more than happy to have those conversations.”