Missouri Capitol in Jefferson City (Creative Commons photo by Lee Harkness/Flikr).
A bipartisan coalition handed anti-abortion activists a rare defeat in the Missouri Senate Friday night, rejecting a push to ban Planned Parenthood as a Medicaid provider as it passed a bill to secure billions for the state’s Medicaid program.
And only a restatement of the state’s already existing ban on using public funds to pay for abortions remained of the effort to use the regular renewal of medical provider taxes as a vehicle to limit when the state will pay for several contraceptive drugs and devices by redefining their function as abortion.
On the key vote, 11 of the 23 Republicans present voted with all 10 Democrats to defeat an amendment targeting Planned Parenthood from Sen. Bob Onder, R-Lake St. Louis. The vote signaled that many Republicans were unwilling to risk the funding provided by the bill to please Missouri Right to Life, which is making the bill a test of fidelity to the anti-abortion cause.
When the final vote came after 12:30 a.m. Saturday, the vote was even stronger. The bill passed 28-5, sending it to the Missouri House for action next week.
Lawmakers are in special session called by Gov. Mike Parson because they failed to pass a bill extending the taxes in their regular session. With the beginning of the new fiscal year coming on Thursday and a limited time to pass a bill that will take effect before the taxes expire, Parson called lawmakers to work despite deep divisions with his fellow Republicans in the days leading up to the call.
On Monday, Parson warned of $722 million in budget cuts, heavily directed at promised rate increases for nursing homes and other providers, during a news conference that set a noon Tuesday deadline for lawmakers to present him an agreement on the bill.
A frustrated Parson hung up on legislative leaders during a conference call as the deadline approached.
During the news conference Parson said, he will be forced to put the cuts into effect on Thursday if he does not have a bill by Wednesday.
Now that the Senate has passed a bill, Parson will expect the House to pass it as is.
“There will be no back and forth after that, so there will be no changes,” Parson told reporters.
Susan Klein, executive director of Missouri Right to Life, said late in the evening, after the defeat was clear, that her organization will press the large Republican majority in the House to restore the provisions cut out by the Senate.
Planned Parenthood Advocates, in a statement celebrating the victory, said it will work to preserve the bill as-is.
“While access to birth control and Planned Parenthood health centers were protected tonight, the fight for a clean FRA funding bill is not over,” the statement read.
Call to intervene
The taxes on hospitals, nursing homes, pharmacies and ambulances are called the federal reimbursement allowance, or FRA. They brought $2.3 billion to the state in fiscal 2020 to support the $10.8 billion Medicaid program. In 2020, Medicaid cost the state $1.9 billion in general revenue, which also pays for public schools, higher education, prisons and hundreds of other programs.
First enacted in 1992, the taxes have been extended 16 times in the past, often for a single year. The bill sent to the House extends it for three years.
Because Medicaid is an entitlement for those who qualify, the state must pay for required services if it participates in the program. A loss of the provider tax revenue would mean replacing every dollar or cutting payments to providers. Most nursing homes are dependent on Medicaid to stay in operation and the program pays for almost 40 percent of births in the state, according to the March of Dimes.
Sen. Mike Cierpiot, R-Lee’s Summit, said he was not willing to risk that funding if the state was found to be out of compliance with federal regulations and lost a portion of its federal funding.
“It assures that these funds for women on Medicaid who need neonatal care are still available,” Cierpiot said. “It assures there are funds for 23,000 Missourians in nursing homes who depend on Medicaid funding for the last few weeks or months of life.”
Over the course of the Senate’s 14-hour day, which lasted from about a little after 10 a.m. Friday until after 12:30 a.m. Saturday, three versions of the bill were brought to the floor by Senate Appropriations Committee Chairman Dan Hegeman.
Each successive version included less of the language sought by abortion foes.
The first version mirrored the provisions that Parson included in his call for the special session. It denied payment for specific medications and devices by Medicaid, including commonly used contraceptives, if the use was to induce an abortion.
It also denied participation in the $11 million Uninsured Women’s Health Care program to any organization that provides abortions and its affiliate organizations, which in Missouri means only Planned Parenthood.
When Onder tried to expand that prohibition to the $11 billion Medicaid program, Senate Minority Leader John Rizzo, D-Independence, objected. The proclamation bringing them into session didn’t allow it, he said.
At that, the Senate went into recess for eight hours. Republicans met repeatedly in caucus to find an agreement.
About four hours into the recess, Rizzo said Parson should intervene.
“I have a lot of respect for the governor in the last few days in really trying to make his case,” Rizzo said. “I think it is time for him now to narrow the call and take the guesswork out of the Senate.”
During the day, lobbyists with interest at stake and lawmakers from both parties pointed to Onder as the obstacle to an agreement. His demands kept changing, they said.
Rizzo referred to that as he talked to reporters during the recess.
“This is a crisis, period,” Rizzo said. “And for one person to hold all of that up and also to be appeased by the rest of their caucus…because I don’t think the rest of the caucus feels that way.”
As the hours passed, a bipartisan group of women senators also met.
The Senate has 11 women, the most in the state’s history, with five Democrats and six Republicans, and three Republicans joined in the majority on the key vote.
As a group, Republican women had been relatively quiet while their male counterparts pushed for banning Medicaid payments for contraceptives and to chastise Planned Parenthood. But Sen. Jeanie Riddle, R-Mokane, made her views clear during the Senate Appropriations Committee meeting.
“Women in the state of Missouri need, want and deserve contraceptives and I really don’t want contraceptives to be part of this,” she said.
During floor debate, Sen. Jill Schupp, D-Creve Couer, said the men who were taking the leading part on the Republican side didn’t understand the health care needs of women or the consequences of failure to renew the FRA.
“If we let this get tied up in an argument over birth control, we are telling our hospitals, especially our rural hospitals, we don’t care if you get reimbursed,” Schupp said. “These drugs are about prevention of pregnancy.”
When the chamber resumed work about 9:30 p.m., the second version delivered by Hegeman included a requirement that Missouri seek a waiver from federal regulators to stop Planned Parenthood from providing Medicaid-paid family planning services.
Onder said that expecting approval from President Joe Biden’s administration was unrealistic.
“It might as well say we are defunding abortion providers if the sun doesn’t rise tomorrow and the moon turns purple,” Onder said.
When the crucial vote came, Onder’s amendment removed the language requiring a waiver and put a ban on Planned Parenthood into the Medicaid statutes.
After it was defeated, Hegeman delivered the third version, which retained only a portion of the language added to a renewal bill March 23 by Sen. Paul Wieland, R-Imperial.
Only Onder spoke before the vote. He said only two sentences.
“This bill is an embarrassment,” he said. “It is a betrayal of our pro-life principles.”
Senate President Pro Tem Dave Schatz and Senate Majority Leader Caleb Rowden didn’t portray it that way in a statement issued after adjournment.
Parson intends to use state administrative processes to remove Planned Parenthood as a Medicaid provider, the statement read.
“Senate Republicans have been, and will continue to be, pro-life champions,” they said.
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