JEFFERSON CITY — Funding for a voter-approved expansion of Medicaid for about 275,000 low-income Missourians appears to hinge on the state Senate after House members clearly signaled Tuesday they would block the money from the state budget.
The first of several Democratic-sponsored measures to fund expanded eligibility for the health care program failed to clear the House floor by a vote of 52 in favor and 100 against.
Six Republicans voted along with 47 House Democrats — all but one — to support funding, including Kansas City Rep. Chris Brown. Ten lawmakers were absent.
The vote concerned only a fraction of the $130 million of state money for Medicaid expansion that the House Budget Committee rejected along party lines last week. But in more than an hour of floor debate, Republicans vowed to do the same for the rest of the funding
. A second expansion funding measure later in the afternoon failed with only 46 supportive votes.
Under the Affordable Care Act, expansion would come with $1.4 billion in federal funds for Medicaid. The most recent federal aid bill also would give the state $1.1 billion specifically for the expansion.
Voters approved expanding Medicaid eligibility in a constitutional amendment on last August's ballot, with 53% in favor. Republicans, who long have opposed expansion, have repeatedly stated they are not obligated to pay for the amendment.
Gov. Mike Parson, who opposed the ballot measure, has said he would uphold the voters' will and move ahead with implementing the expansion, including money for it in his budget request.
It has since become the most contentious issue in the Missouri House this year, with many of the issues raised during the ballot initiative campaign being re-debated.
The Missouri Hospital Association last week circulated to lawmakers an independent survey it commissioned in January showing 18% of those who voted against the expansion now support its implementation. The Missouri chapter of Americans for Prosperity, a conservative Koch brothers-funded group, has launched a campaign urging legislators not to vote for the funding.
"This is the fight of the session," said Rep. Rasheen Aldridge, a St. Louis Democrat.
Republicans insisted that paying for Medicaid expansion, which they called welfare for able-bodied adults, would take money away from services for the elderly and disabled. Democrats have slammed the argument as a "false choice" and said expansion would be an economic boon to the health care sector while providing life-saving care for the working poor.
"People in your districts will die based on the actions you take here today," said Springfield Democrat Betsy Fogle.
If expansion is not funded, House Budget Chair Cody Smith, a Carthage Republican, said he expects the Department of Social Services to deny coverage to Missourians who will become eligible in July under the constitutional amendment.
That would almost certainly lead the state to court.
"We're not debating today whether or not to expand Medicaid," said House Minority Leader Crystal Quade, a Springfield Democrat. "That's already been done....Today we're discussing how much money to simply put into Medicaid."
Echoing last week's debate in the budget committee, Republicans opposed to expansion denied they had a mandate to fund it despite the constitutional amendment.
Rep. Justin Hill, a Lake St. Louis Republican, called the promise of "affordable care" a "great lie from the left." Voters in his county, St. Charles County, approved the expansion last year.
"Even though my constituents voted for this lie, I'm going to protect them from this lie," Hill said of his vote against the expansion funding, adding, "So I'm proud to stand against the will of the people who were lied to."
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