(The Center Square) – Missouri’s Medicaid expansion goes into effect July 1 but House Republicans have thrown a wrench into implementing the voter-approved plan to extend health care coverage to 275,000 uninsured adults.
The House Budget Committee Thursday in a partisan 20-9 vote shot down House Bill 20, which sought to allocate $130 million in general revenue to secure $1.9 billion in federal funding to pay for the expansion Missouri voters approved in August by adopting Amendment 2.
The bill, crafted by House Budget Chair Rep. Cody Smith, R-Carthage, segregates Medicaid expansion appropriations from other Medicaid spending bills to be separately approved.
What happens next is uncertain. HB 20 does not have a Senate companion. It could find its way back onto the floor as the House deliberates Gov. Mike Parson’s $34.1 billion budget request next week.
Rep. Peter Merideth, D-St. Louis, said voters approved Amendment 2 and, by law, it must be implemented on July 1.
With the state only kicking in $130 million to garner nearly $2 billion in health care coverage – and flush with federal assistance allocations and sudden budgetary surpluses – maintaining the state can’t afford expansion is untrue, he said.
“We are being offered a false choice and a false narrative,” Merideth said.
Smith reiterated previously-stated arguments that state taxpayers cannot afford to subsidize health care for 275,000 adults and that the program needs to be streamlined and scrutinized.
“If we expand Medicaid without doing that we are simply pouring gasoline on the fire of problems that could come along due to increased spending,” Smith said.
“Are we willing to see the debt rise further?” said Budget Committee Vice Chairman Dirk Deaton, R-Noel. “Are we willing to take that vote, weaken our country at the expense of the Chinese and others?”
What debt? Democrats shot back. Missouri had a record budget surplus of $1.9 billion on March 1 and is expected to have $1.1 billion surplus on July 1.
“Stop acting like we don’t have money because you don’t want to give health care to people,” Merideth said. “It is a lie and ignoring what Missourians told us to do.”
Almost 1 million people are currently covered by Missouri’s Medicaid program, MOHealth.net. Amendment 2 requires the state to offer coverage to about 275,000 people with annual incomes up to $17,744 for an individual and $35,670 for a family of four.
Opponents argued Amendment 2 was illegal because the Missouri Constitution mandates that initiatives that require appropriations provide a dedicated source of money – not the state’s general fund – to pay for it.
The Western District Court of Appeals rejected legal challenges on the grounds that the funding source would be determined when the amendment was implemented.
That funding source was HB 20. Unless it is adopted, Republicans say, expansion cannot take place.
“If we want initiatives with appropriations, we need to be honest with the people and say where the money is coming from,” said Rep. David Evans, R-West Plains. “If they had drafted it, including what the constitution actually requires, it may not have gotten over that 50 percent mark.”
Parson’s budget request does not segregate Medicaid expansion costs and fully funds it, as he vowed to do after Amendment 2 was adopted despite opposing it.
The governor sets the cost of Medicaid expansion at $1.9 billion, including $120 million in state general revenues.
The overall budget proposal calls for $14.1 billion for Medicaid, including $2.7 billion in general revenue. Medicaid in Missouri cost $10.8 billion in fiscal 2020, about 4 percent more than the previous year, according to the state’s Department of Health.