MO Senate rejects Medicaid expansion, setting up likely court challenge

Funding for Medicaid expansion in the state budget was dealt a final blow by the Senate late Wednesday night.

That funding had previously failed to gain support in the House. The next step is likely to be decided by the courts.

Gov. Mike Parson initially included $1.9 billion in the budget — the vast majority of it federal funds — to pay for expansion. That would cover the cost of at least 250,000 more Missourians who would become eligible for care.

Sen. John Rizzo, D-Independence, introduced an amendment to restore funding. It was supported by Sen. Lincoln Hough, R-Springfield, who voted to partially fund Medicaid expansion in the Senate Appropriations Committee last week. That measure failed in committee 7-7.

The amendment Rizzo first offered included about half of the amount of money Parson included in the budget to expand Medicaid. He then amended that proposal to fully fund expansion.

Sen. Caleb Rowden, R-Columbia, a longtime opponent of Medicaid expansion, supported funding expansion Wednesday. He was joined by a few Republicans, but the vote fell largely along party lines.

"I don't think the question before us is if we supported Medicaid expansion in the past," Rowden said. "The question is if we will uphold the decision that voters made... and I think the answer is we should."

Rowden said he believed if lawmakers fail to fund it now, courts will force them to do so later.

Rizzo addressed a number of concerns with funding Medicaid — including how to pay for the plan — by taking senators through the amount of federal dollars that would be used to offset the state's costs of Medicaid expansion. He concluded that over $7 billion would come into the state as a result of expanding Medicaid.

Hough and Rizzo also addressed constitutional arguments. They said Missouri voters were clear, when they approved a constitutional amendment to expand Medicaid last year.

"We don't write a budget for individual districts, we budget for the whole state," Hough said, in response to the argument that the districts represented by some senators voted against expansion. "We budget for over 6 million people."

Earlier Wednesday before debate began, Rizzo said he expected the amendment may fail on the floor of the Senate, but if it does he is confident the courts will side with his viewpoint and require that the funding be provided.

"I don't see a scenario where the courts, if we don't implement it ourselves, don't do it for us," Rizzo said.

Republican opponents argued that Missourians had a better option in the form of a federal two-year program created by the American Rescue Plan. Sens. Bob Onder, R-Lake Saint Louis, and Andrew Koenig, R-Manchester, said Medicaid is an inferior option, and not worth funding. Onder also feels confident courts will side with his perspective if the issue were to be litigated.

Sen. Barbara Anne Washington, D-Kansas City, responded with a story. She talked about her brother who died in a hospital nine days ago while receiving care through Medicaid.

"What we do know is that if you don't have health insurance, you don't have health care," Washington said. "It's not an inferior product... And finally, Medicaid expansion is what the voters asked for. So, we can't continue to be hypocritical in this chamber to choose when we want to listen to our voters."

Onder brought out a stack of paper that he said included 451 one of his constituents who said they do not want the Missouri Legislature to fund Medicaid.

Sen. Lauren Arthur took the floor and took up similar arguments. She emphasized that Parson does not support expanding Medicaid personally but committed to funding Medicaid regardless. She encouraged her Republican colleagues to do the same.

"The legislature thinks they can overturn the outcome of the election and just do whatever they please. It poses a real existential threat to our democracy," Arthur said.

Both Rizzo and Onder had very different messages to Missourians waiting to see whether they might become eligible for Medicaid as a result of Wednesday's debate.

"I hope they're watching, and I hope that they hold their elected officials accountable," Rizzo said.

"I would encourage them to look further at their options under the American Recovery Act... I think that's a better option. Private insurance is a better option than Medicaid," Onder said.