Proposed constitutional amendment would reverse Labor-endorsed, voter-approved Medicaid expansion

By TIM ROWDEN
Managing Editor

Jefferson City — Missouri Republicans just hate voters telling them what to do.

A proposed constitutional amendment working its way through the Missouri House has the potential to gut Missouri’s Medicaid expansion, reversing what voters approved in 2020 by giving legislators annual discretion over whether to fund the program.

Introduced by House Budget Committee Chair Cody Smith (R-Carthage), HJR 117 would amend the state’s constitution to allow the Medicaid expansion program to be subject to annual funding appropriations made by the Missouri General Assembly. In other words, it would allow the General Assembly to appropriate funds to the program as legislators see fit.

Missouri voters approved a constitutional amendment requiring Medicaid expansion through a ballot initiative in August 2020.

Those covered by the joint state and federal health care program include children, the elderly, pregnant women, people with disabilities and low-income adults. After Missouri voters approved Medicaid expansion in August 2020, Medicaid eligibility extended to working-age adults making up to 138 percent of the federal poverty level. For a family of three, that is $31,781.

COVERAGE DEPENDENT ON LAWMAKERS’ WHIMS
Under Smith’s proposal, annual funding for the expanded program would depend entirely on the whims of the General Assembly.

The House gave preliminary approval to the measure on Feb. 15. Another vote is needed to send it to the Senate. If approved by the legislature, the resolution would be placed on the statewide ballot for consideration by voters.

Missouri Republicans have long resisted providing Medicaid to all but the most desperately poor Missourians. Prior to expansion, Missouri had some of the strictest Medicaid eligibility requirements in the nation for working-age adults, according to a study by the Kaiser Family Foundation.

Non-disabled childless adults, regardless of how low their income was, were not eligible. Only those who were elderly, severely disabled or had children qualified. Parents had to make less than 21 percent of the federal poverty level to qualify, which for a family of three in today’s dollars is the equivalent of $4,836 a year, leaving an estimated 250,000 Missourians who didn’t qualify for Medicaid but also didn’t make enough to buy private insurance without any coverage at all.

With expansion, those Missourians were able to apply for coverage, with 90 percent of the program’s costs covered by the federal government, and the state making up the other 10 percent.

REPUBLICAN RESISTANCE
Conservative Republicans have maneuvered to avoid expanding Medicaid coverage ever since voters approved it.

Last year, the Republican majority in the legislature blocked efforts to fund Medicaid expansion, and Gov. Mike Parson decided not to implement the program because of the lack of funding.

The issue wound up before the Missouri Supreme Court, which ruled that because the ballot initiative made Medicaid expansion a part of the Missouri constitution, a lack of appropriated money did not mean the program could be halted.

For Smith’s amendment to become law, it would have to go on the ballot for a statewide vote. However, if it were to pass, it would cancel out the court’s decision and allow a potential lack of appropriations to leave many Missourians without health care coverage – again.

To make matters worse, Republicans also are pursuing measures this year that would make it harder for voters to use the initiative petition process to place constitutional amendments on the ballot.

‘FIGHTING AGAINST THE PEOPLE’
Rep. Peter Merideth (D-St. Louis) said the amendment is yet another attempt by conservative Republicans in the Missouri Legislature to reverse the will of voters.

“It makes me angry, and it makes me tired,” Merideth said. “Every step of the way, (Republicans are) just trying to fight against the people and against everybody, against common sense.”

Last year, conservative Republicans blocked efforts to fund Medicaid expansion, and Gov. Mike Parson decided not to implement the program because of the lack of funding.

The deceptively worded proposed amendment does not directly say it reverses Medicaid expansion or would that it would give the legislature the power to do so, but that is the intent.

“The way they word it, you can’t even tell it’s about expansion,” Merideth said. “It’s just this wonky legal language about, ‘Shall eligibility be determined by the legislature during the appropriation process?’ Well, I don’t think people even know from that language that they’re saying, ‘Can the legislature undo expansion?’ Because that’s a question that they already voted on.”

REJECTION ECONOMIC GROWTH
Amy Blouin, president of the nonprofit Missouri Budget Project said that HJR 117 would not only undermine the will of Missouri voters but also stamp out economic growth that Medicaid expansion will deliver when fully implemented.

Independent research on behalf of the Missouri Foundation for Health suggests that Medicaid expansion will create an average of more than 16,000 new jobs statewide in its first five years, thanks to the influx of new federal tax dollars at a higher reimbursement rate – a 900 percent return on the state’s investment.

That infusion of federal money could actually save the state more than $1 billion annually, research shows, and free up state money for priorities such as education, transportation, and public safety.

All of that makes little difference to Republicans in the Missouri Legislature who have long resisted expanding Medicaid coverage. That’s why voters had to do it for them.

(Some information for this story  from the Missouri Independent and the Columbia Missourian)