Missouri Senate joins House in not funding voter-approved Medicaid expansion


JEFFERSON CITY. Mo. – After hours of debate Wednesday night inside the Senate chamber, Senators voted to not fund Medicaid expansion. 

Voters approved the measure on the August ballot and the House previously voted to not fund expansion, despite the governor recommending it. Starting July 1, an additional 275,000 Missourians will become eligible for Medicaid. 

Gov. Mike Parson said he’s prepared for the courts to get involved in funding Medicaid expansion since both chambers voted not to fund expansion. 

“We have general counsel looking at what options we have at the state level, so we’re just going to have to go through the process to see what we are going to be able to do,” Parson said. “Whatever the decision is, this is going to probably end up in the courts and this is going to be a long-term battle.

Democrats still pushing to fund expansion on the House floor Thursday, just hours after the Senate voted not to fund it. 

“Hopefully, we can avoid going to court because the governor is going to do his job,” Rep. Peter Merideth (D-St. Louis) said. 

During Wednesday night’s vote, four Republican senators sided with the 10 Democrats, one of those being Senate Majority Floor Leader Caleb Rowden (R-Columbia)

“I don’t believe that the question before us is whether or not we supported Medicaid expansion in the past, I think the question before us tonight is simply if we believe that we should fund the expansion that people of Missouri voted on,” Rowden said on the floor. 

Rowden’s district voted to expand Medicaid, but he said he didn’t support it. 

“The real question before is whether or not we’re willing to do something never done before in the state’s history and that is to not fund our Medicaid obligation,” Rowden said. 

The other three senators who joined Rowden and the Democrats were Sens. Mike Cierpiot (R-Lee’s Summit), Justin Brown (R-Rolla), and Lincoln Hough, (R-Springfield).

Expansion is estimated to cost $1.9 billion, with less than $130 million coming from the state. 

Senate Minority Floor Leader John Rizzo (D-Kansas City) tried adding expansion back into the budget twice on the Senate floor, both times it failed. 

“You will see hospitals come back to rural Missouri, you will see more doctors and nurses, you will see more health care jobs in this state,” Rizzo said. “Voters of the state of Missouri this last cycle said that they wanted to expand Medicaid.”

Vice-Chair of the Senate budget committee Sen. Hough tried to add expansion back into the budget last week, by recommending half of the governor’s request. That vote was tied 7-7 which means it was defeated. Hough was back on the Senate floor Wednesday night pushing to fund it. 

“So, the idea that we don’t have the money to do this, I don’t buy,” Hough said. “We don’t write a budget for individual districts, we write a budget for the whole state, we write a budget for six plus million people in the state of Missouri.”

The chair of the Senate Appropriations Committee, Dan Hegeman (R-Cosby), opposed funding expansion for the vote in committee and on the floor, saying he’s worried about depending on the federal government. 

“My fear about passing is not what it will do to the state budget this year, but what implementation will do to the state’s budget in years to come,” Hegeman said. “Even before the expansion, Medicaid has continued to grow at a rate that has put a great strain on our state budget.”

Hegeman, along with other Republicans in the Senate argued that voters weren’t given all the information on how expansion would be funded. 

“If the voters had all the information we do, I think they would have made a different decision,” Hegeman said. 

St. Louis Democratic Sen. Karla May called on Republicans for being pro-life but not caring about health care for the child once it’s born. 

“The audacity to take their tax dollars and sit up here and make decisions on where the heck their money should be spent and then not listen to them when they passed the initiative petition, I can’t believe it,” May said. “It’s just so hypocritical to me.”

The Missouri Hospital Association said Thursday, “We’re certainly disappointed in the outcome of the Senate vote and the earlier House rejection of the funding.”

House Minority Leader Crystal Quade (D-Springfield) said in a statement Thursday:

“Republican leaders in both legislative chambers have firmly established that their party stands for fiscal irresponsibility and disdain for the rule of law. Whether they like it or not, Medicaid eligibility is expanding to 138 percent of the federal poverty level as of July 1, and the Missouri Constitution mandates that services be provided to this population. Instead of doing what the constitution demands, the Republican legislative supermajorities have chosen to plunge Missouri’s health care system into chaos. The governor has pledged to enforce the will of Missourians and fully fund Medicaid and, as a former sheriff who respects the law, we trust he will fulfill his constitutional duty.”

Gov. Parson said Tuesday when asked about depending on the Senate for adding expansion back into the budget, it was too early to make a prediction. 

“I was very open that I opposed expansion before it happened, but I’m the governor of the state of Missouri and the people of the state voted for it,” Parson said “I don’t have a district anymore, I have to represent all Missourians and they voted for it so we put it in the budget, but again, there’s a process to be made to see how it ends up and then we will move forward.”

Missourians between the ages of 19 to 64 making less than $18,000 a year will be eligible July 1. 

Besides expansion, after nine hours of debate Wednesday afternoon into late Wednesday night, the Senate passed 12 budget bills to make up the state’s $35 billion budget for the next fiscal year. 

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