Missouri House votes against funding Medicaid expansion

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JEFFERSON CITY, MO. — Voters approved expanding Medicaid in Missouri last year, but Republican lawmakers spent Tuesday blocking ways to fund the expansion. 

Back in August, 53% of Missouri voters approved to expand Medicaid, allowing an additional 275,000 Missourians to become eligible. 

Republicans on the House Budget Committee voted down the funding for the expansion during a hearing last week, but Democrats have made it clear they aren’t giving up the fight. 

“People in this state will die if we do not expand Medicaid,” Rep. Betsy Fogle, D-Springfield, said while offering an amendment to reinstate the funding in the state’s budget Tuesday. 

The voter-approved measure was in limbo for hours Tuesday as the House debated the state’s $34.6 billion budget. 

“Government programs, expansion programs, they can’t just start by fiat,” Rep. Dirk Deaton, R-Noel, said in response. “Money can’t just leak out of the treasury to start expansion of government programs.”

But House Budget Committee Chairman Cody Smith, R-Carthage, said on the floor Tuesday that Medicaid expansion is wrong for the state. 

“People say the federal government provides 90 percent of the amount for the program, in fact, the federal government does not have any money,” Smith said. “Those are only taxpayer dollars. I think [Medicaid expansion] is wrong for the state budget.”

Democrats tried to add the funding back in for the expansion multiple times during debate, each time it failed, but they reminded their colleagues across the aisle, the expansion will happen whether the state funds it or not. 

“We are not discussing how much money to simply put into Medicaid as a whole,” House Minority Leader Crystal Quade, D-Springfield, said. “Today, we are discussing how much money to simply put into Medicaid as a whole.”

Originally, the budget committee said it would cost $1.6 billion to fund the expansion, with less than $130 million of that coming from the state. 

“What does people in poverty is us failing to expand Medicaid,” Rep. Peter Merideth, D-St. Louis, said. “This is not a game and I’m not joking right now. We are playing games with peoples’ lives and our state economy.”

Republicans that spoke on the floor Tuesday blamed the amendment on the ballot because it did not indicate how and where the money should be spent. 

“The language that passed in August that’s related to Medicaid expansion does not include a mechanism of which to pay for it so in the short-term we are forced to try and shoe-horn a two-to-three-billion-dollar program,” Smith said. 

“If it provided a funding mechanism for which to pay for it, but it didn’t,” Deaton said. “Spend money on this expansion means we’re not spending money on other things.”

Rep. Justin Hill, R-Lake St. Louis, said voters were lied to. 

“I am proud to stand against the will of the people who were lied to,” Hill said. 

Gov. Mike Parson has recommended to fund expansion in his budget, saying it wouldn’t currently cause a tax increase or a cut. 

Quade stated multiple times on the floor, the expansion is happening no matter what lawmakers want to do about it. 

“These people are covered, the question is whether we are going to pay our bill and listen to the will of voters and uphold the constitution that we all swore to,” Quade said. 

The Missouri Hospital Association is one of the organizations that spoke in favor of expansion. In a statement Tuesday, Communications Director for MHA Dave Dillon said: 

“We support expansion and were disappointed to see that members of the House refused to advance it in committee. Missourians made their feelings on this issue clear in August of 2020.

“There is hope that the Senate will support including expansion in their budget, but it is too early to tell. 

“At the same time, Parson has been as good as his word. He signaled that he would follow the will of the people before the election and has been taking the necessary steps to implement it on the timeline included in the Missouri Constitution.

“The actions this week and last must be a stinging blow for the low-income workers — nursing home caregivers, grocery clerks and others in essential jobs — who sustained the rest of us through the early days of the pandemic. They were called “heroes” at the time.  Lawmakers are essentially leaving them out in the cold.

“At the same time, these actions are an affront to the voters. I’d say the Show-Me state’s voters sent a pretty strong signal, but apparently lawmakers didn’t get the message.”

The Missouri Chamber of Commerce has also previously spoke in favor of the expansion, saying it will bring hundreds of jobs to the state. 

After Republicans on the budget committee failed to pass the legislation to fund the expansion Thursday, Smith filed another bill Friday, House Bill 21, to use the money for expansion and put it towards seniors in nursing homes, add public defenders to the criminal justice system and help K-12 school transportation.

“In short, this bill will support the most vulnerable Missourians,” Smith said.

Expanded eligibility goes into effect July 1 for those earning less than $17,600 for an individual or $30,000 for a family of three. Missouri became the 37th state to expand Medicaid.

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