‘Who do they work for’: On day Medicaid expansion would have started, Missourians protest

Protesters had a special delivery for Gov. Mike Parson on Thursday, but they couldn’t reach him.

On the day more than 275,000 Missourians would have been eligible to enroll in Medicaid if the voter-approved expansion had gone into effect, a dozen clergy members stood in the entrance to the Missouri Department of Transportation offices with a box in hand.

In it were transcripts from more than 150 Missourians who had called to leave Parson a message. There was Susan from Joplin, Phillip from St. Louis, Elizabeth from Wentworth.

“I know people who died because they could not get Medicaid…” a message from Phillip read. “Please fund what the public voted for.”

Parson was scheduled to attend an announcement Thursday afternoon in the MoDOT headquarters, and more than a hundred protesters gathered outside — blocked from attending but vowing to stay until their voices were heard.

“Clergy only work on Sundays,” one joked as they noted they had nowhere else they needed to be.

The protesters want Parson to reverse course and implement Medicaid expansion, just two weeks before the Missouri Supreme Court will hear arguments over the constitutionality of the voter-approved health care initiative

Under the terms Amendment 2, approved in August 2020, adults aged 19 to 64 would become eligible for Medicaid if their household incomes are 138 percent of the federal poverty guideline or less.

That is $17,774 a year for a single person, equal to working about 33 hours a week at the state minimum wage of $10.30 per hour. For a household of four, the limit is $36,570, the income of one person working full at $17.58 an hour or two people working a combined 68 hours a week at minimum wage.

In his January budget proposal, Parson asked for $130 million in general revenue and $1.9 billion overall to pay the costs of covering the expansion group. Lawmakers did not approve the funding. Lawsuits quickly followed.

“That was the legislative process. It’s fine to protest and be out there,” Parson said Thursday, according to the St. Louis Post-Dispatch. “But the reality of it is there is nothing to be done until next year.”

The court case turns on whether voters can set policy that requires the state to spend money through the initiative process. But for Missourians protesting Thursday, it’s a matter of essential healthcare.

As a person with autism, St. Louis resident Luke Barber receives targeted case management, community support services and job coaching. But if Medicaid expansion is not approved by December, he will be forced to quit one of his two jobs in order to keep his income low enough to keep his health insurance, he said.

Karen Brickey of Columbia knows what it’s like to live without health insurance. It’s something she did for decades until she qualified under the Affordable Care Act.

And she’s seen Medicaid and Medicare’s impact firsthand in both her work as a care attendant for a client in their early 50s who has multiple sclerosis and through her own 26-year-old daughter’s experience, who is on the autism spectrum and has significant cognitive impairment.

“It’s tremendous,” Brickey said of the programs. “That’s all they have.”

Brickey worked on the expansion campaign last summer, making calls to voters across the state. She pushed back on lawmakers’ assertion that voters didn’t fully understand the ballot measure and said lawmakers were the ones who didn’t understand.

“They’re out of touch with reality,” Brickey said of lawmakers.

For the members of Service Employees International Union Local 1, many of whom earn just above minimum wage working in warehouses and other jobs, Medicaid expansion would help them make ends meet, said Wesley Reed, a union organizer who traveled from Kansas City.

“This means a lot to them. Because this is another thing that they could take off their table that they don’t have to worry about, along with paying the bills, babysitters, and covering for other things..” Reed said. “Being able to know that they have a healthcare system that works for them, is going to truly make their lives better.”

Heidi Miller, a primary care doctor at Family Care Health Centers in St. Louis and medical director for the St. Louis Regional Health Commission, said sickness perpetuates poverty — a state many of her patients who are essential workers find themselves in.

“In Missouri, the medically underserved are indeed serving us,” Miller said.

The appeal

On Wednesday, plaintiffs seeking to force the state to implement expansion filed a brief with the Supreme Court arguing it should reverse the Cole County Circuit Court ruling because it went farther than the law allows.

Attorneys Chuck Hatfield and Lowell Pearson, who represent three clients who would be eligible for coverage, wrote that when Judge Jon Beetem decided that the initiative was unconstitutional he answered a question he was not asked.

“The Circuit Court should have considered the issues presented, rather than take up a constitutional question not advanced by the parties,” Hatfield and Pearson wrote.

The filing is the first of many in advance of the July 13 oral arguments before the high court. So far, two friend-of-the-court briefs have also been filed, with the state’s main reply brief due next Thursday.

In his decision, Beetem ruled that a provision written into the Missouri Constitution during work on the document approved by voters in 1945 makes the Medicaid expansion amendment invalid. The provision prohibits initiatives that appropriate existing state revenues and was cited by lawmakers repeatedly during work on the fiscal 2022 budget as the reason they had no obligation to appropriate funds to cover the newly eligible group.

Hatfield and Pearson are arguing that coverage did not require an appropriation specific to the expansion group. Instead, other appropriations, for the services needed by Medicaid clients, should be interpreted as funding the needs of the expansion population.

“The General Assembly may choose to fund the MO HealthNet (Missouri’s name for Medicaid) program robustly, partially, or not at all, but it may not use appropriations bills to change the substantive laws governing eligibility,”  they wrote.

Setting eligibility requires either a statutory change or a constitutional amendment, they wrote. And the prohibition on appropriations by initiative was intended by the authors to block specific appropriations of money, not policy directives that may involve a cost, they wrote.

“More fundamentally, the relevant inquiry…is whether the legislature retains discretion over appropriations, not whether full implementation of the initiative would involve any expenditures,” Hatfield and Pearson wrote.

In an interview Thursday, Hatfield said Attorney General Eric Schmitt’s office could have filed a counterclaim asking Beetem to make the decision he delivered or the plaintiffs who sued to block Amendment 2 from the ballot could have intervened.

“If nobody asks you to find something unconstitutional, you should not rule on it,” Hatfield said.

The friend-of-the-court briefs, one from Greater St. Louis and four other business and civic groups and the other from a group of health providers and researchers, so far support a ruling that the state must expand Medicaid coverage.

The Greater St. Louis filing backs the legal arguments made by Hatfield and Pearson and urges the judges to consider the economic impact of Medicaid expansion. The extra spending on health care is expected to create more than 16,000 new jobs and add $2.5 billion annually to the state’s economic output.

“Medicaid expansion’s positive economic impact compels this court to reverse the decision of the court below and order the implementation of the adjusted Medicaid program enrollment contemplated by Amendment 2,” the brief states.

The economic benefits aren’t the biggest factor for the high court to consider but if the case is a close call, it could make the difference, attorney Booker Shaw said. Shaw, a retired appeals court judge who is a partner at Thompson Coburn, wrote the brief along with J. Bennett Clark of Bryan Cave Leighton Paisner.

“Certainly the legal arguments that Judge Beetem raised in making his decision are going to be pivotal,” Shaw said. “But because the trial court was concerned with the availability of funds to pay for Medicaid, the positive economic benefits of Medicaid expansion should play a greater role in the court’s decision.”

‘Who do they work for?’

Protesters’ fury was primarily directed at Parson, who many said they felt went back on his word.

To Tori Jameson, the pastor of Lot’s Wife Trans and Queer Chaplaincy in St. Louis, following the will of the voters is simple.

“And instead, he’s pulling us into legal battles. It’s costing money and time and lives,” Jameson said of Parson. “People will die, because they’re being denied care that they should have been having starting today.”

For the Rev. Emmet Baker, the fight has been long and years in the making.

Seven years ago he was one of 23 clergy members arrested after shutting down the state Senate. Dubbed the “Medicaid 23,” they were among hundreds of protesters who refused to leave the Senate gallery as they chanted, prayed and sang hymns in an effort to urge lawmakers to expand Medicaid under the Affordable Care Act. 

Baker said his daughter died of a brain aneurysm nine years ago and lacked health insurance without Medicaid expansion.

“God is god and he will always reign true. And no matter what you do, just like they have, you’ve got to understand, it’s going to rain soon,” Baker said in a message to Parson. “And it’s going to rain because the people of Missouri are sick and tired of being sick and tired.”

Rev. Teresa Danieley, an organizer with Missouri Jobs With Justice, said it was necessary to set up a toll-free hotline and gather voicemails from Missourians because Parson’s office does not accept voicemail messages after 5 p.m.

The cardboard box full of papers that contained their pleas eventually made its way to the governor’s office Thursday.

Rep. Peter Merideth, a St. Louis Democrat, attempted to deliver the box to Parson himself in the MoDOT building. But by the time he was let in, Parson had already left.

“I went in the building, but the governor had already snuck out a different door,” Merideth told demonstrators. “The governor is afraid to see the faces out here. He’s afraid to take your questions. He’s afraid to show his face as he denies the vote of the people, the will of the people and the Constitution of our state.”

An attempt to deliver the messages at the governor’s mansion was also fruitless. It wasn’t until shortly before 1:30 p.m. — more than two hours after the rally had started — that Merideth and a few of the last remaining protesters dropped the box off at the governor’s office in the Capitol.

Parson wasn’t there, a receptionist at the office said.

“Who do they work for? I think it’s pretty clear. They ignored what people voted for. They ignored what people want, because they don’t actually think they work for the people,” Merideth said. “If they thought they worked for the people, they would have let us in and accepted the message. Instead the governor’s hiding from the people and I think that’s a damn shame.”