May 15—With 53% of Missouri voters approving Medicaid expansion last year, many of them say they feel like their voices aren't being heard after the Republican-led Legislature refused to provide funding for the measure this week.
Gov. Mike Parson dropped plans Thursday to expand the state's Medicaid health care program. It would've allowed people ages 19 to 65 earning up to 138% of the federal poverty level — less than $17,774 annually for an individual or $37,570 for a family of four — to be eligible and receive Medicaid benefits starting July 1.
Medicaid funds doctor visits, hospital stays, long-term medical care and other health-related costs. The expansion was projected to cover an additional 275,000 low-income residents by expanding eligibility under the terms of the 2010 federal health care law signed by President Barack Obama.
Parson said the state's $35 billion budget approved by lawmakers last week didn't provide the funding he had requested for an expansion of Medicaid, which is known as MO HealthNet.
"Without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri's existing MO HealthNet program remains solvent," Parson said Thursday.
The federal government pays for most of the cost to expand Medicaid, anywhere from 90 to 95%, but Missouri still would need to chip in some state dollars. Missouri will get nearly $2.7 billion of flexible federal aid under a coronavirus relief law.
Budgeters estimated the expansion would cost $1.9 billion, with the state chipping in about $120 million and the federal government paying for the rest. However, some GOP lawmakers said the state cannot afford the long-term costs.
The Missouri Constitution prohibits ballot initiatives from appropriating funds without creating a revenue source, according to House Budget Committee Chairman Cody Smith, R-Carthage.
"The Missouri Constitution is clear," he said. "The ballot proposition process cannot create new benefits without providing a source for the revenue required to fund them. Supporters of Medicaid expansion want the Legislature to ignore one provision of the Constitution in favor of another."
Smith said that it was a simple decision not to appropriate funding for Medicaid expansion because not only does the budget need to be balanced every year, but two-thirds of Jasper County voters opposed expansion.
He said that the people who wrote Amendment 2 were aware of the revenue requirement in Article 3, Section 51, of the constitution and purposefully misled voters in an attempt to expand Medicaid without the necessary tax increase to pay for it.
"Expansion would cost $120 million in state funds in the first year alone," said Smith. "It would cost $200 million or more every year thereafter. Combined with federal funding, the cost would exceed $2 billion each year. Without a funding mechanism, the impact of Medicaid expansion on the state budget would be devastating."
Parson's office did not respond to the Globe's request for comment by press time.
Defend and demand
The state's rejection sparked outrage among hundreds of Missourians where organizations held day of action rallies across the state Friday to "Defend and Demand" that Medicaid expansion be fully funded and implemented.
Missouri Health Care for All — a nonpartisan, grassroots effort aimed at providing access to health care for everyone — held a small rally on Friday of about 10 people on the corner of Seventh Street and Range Line Road in Joplin to demonstrate that the fight for Medicaid expansion is far from over.
"Lots of folks across the state are rallying together in solidarity to make our voices heard," said K.J. McDonald, senior organizer for Missouri Health Care for All. "We really want to raise the issue for our communities and for Gov. Parson to let them know that we voted for this, and we expect it to be implemented. Not only has our Legislature chosen not to listen to us, but our governor, as well."
Missouri's Republican-led Legislature has repeatedly rejected Medicaid expansion proposals over the past decade, prompting supporters to turn to the initiative process in which they collected over 350,000 initiative petition signatures to place the proposal on the ballot. That's about twice as many valid signatures as needed.
"It was passed as a constitutional amendment, and I think our people are just disappointed that our government continues to look at our votes and decide that they're good enough to get them elected but not good enough to elect something like Medicaid expansion and get health care to our neighbors," said McDonald.
Medicaid expansion supporters believe this will trigger court battles. Krista Stark, executive director of the Southwest Missouri Democrats, participated in the Joplin rally and said she has faith in the Missouri courts to give voters justice. Stark has worked on Medicaid expansion throughout three careers, including during the Obama For America campaign.
"This is hard to digest because we won," she said, "and we put it in the constitution, so this idea that they can say 'No. We're not going to fund it.' It's making people say, 'Well, our vote doesn't matter.' and I can't imagine any worse thing for a public servant to do to voters than to make them feel like that."
Hugh Shields, 75, of Joplin, attended the local rally and has previously marched at the state capital to demand Medicaid expansion.
"We legally passed this, so let's put it in place," he said. "I think legally, they'll have to."
Although some Republicans said the state cannot afford the long-term costs of expanding Medicaid, Democrats noted that the state is flush with cash from federal coronavirus relief laws and would get even more federal money if it expanded Medicaid eligibility under the terms of a health care law signed by Obama.
Stephanie Clarke, 62, of Joplin, who formerly worked as a patient care specialist at St. John's Regional Medical Center, collected petition signatures last year and also participated in the local rally. Clarke said she's seen too many people have to put their basic needs aside because of lack of money.
"Our neighbor's daughter, who was 50, died because she was scared of going to the emergency room because she couldn't afford it," said Clarke. "I've watched families including my own feel devastated because they thought they'd be bankrupt. It's really holding off on getting care because they don't have insurance. and of course, these people don't have money."
Stark said she hasn't lost hope yet and is using this as an opportunity to spread more awareness about the need for Medicaid expansion throughout the state.
"We're going to have to work really hard from the other side of the aisle to reinforce the opinion that yes, our votes do matter," she said. "And one of the ways we can do that is by reminding people that when elections come around, we need to vote for people who do listen to our vote, even if they disagree with the issue."
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