Missouri Republican lawmakers appear to be digging in their opposition to Medicaid expansion just as the state’s beginning to look like an outlier on the healthcare program.

After this month’s election, only three of eight surrounding states have failed to expand Medicaid to cover able-bodied low-income people between 19-and-64 years old who earn up to 138% of poverty level.

Expansion was a component of the Affordable Care Act (ACA) passed by Congress during the Obama administration but was stripped away by the Supreme Court in 2012.  The high bench upheld the constitutionality of the ACA’s individual mandate, which required most people to maintain health insurance coverage, but found the Medicaid expansion portion too intrusive on states.

Since that time, states have increasingly chosen to expand the federal healthcare program on their own as the Supreme Court decision left the option open.

The number of states opting in grew from 33 to 36 plus the District of Columbia in the recent general election when voters in Nebraska, Utah, and Idaho, three red states, passed ballot measures to implement expansion.

Kansas, Oklahoma, and Tennessee are the only holdouts among the eight states that border Missouri, and Kansas could be changing soon if history replays itself.

Kansas lawmakers passed Medicaid expansion in 2017, but then-Governor Sam Brownback vetoed it and the legislature didn’t have enough votes to override the veto.   A similar measure failed to advance during the state’s 2018 legislative session, although it passed one chamber.  Newly elected Democratic Governor Laura Kelly, who’ll take office in January, supports Medicaid expansion, and has vowed: “to advocate for and sign legislation to expand Medicaid in her first year.”

If Kansas follows through on Kelly’s pledge, Missouri and 12 other states, mostly in the south, would become more pronounced outliers.

Republicans in Missouri, who hold supermajorities in both legislative chambers, have been openly hostile to Medicaid expansion since the option became available.  The party could be reinforcing its opposition with recent appointments to key positions.

House Republicans overhauled their leadership, opting to place O’Fallon Republican John Wiemann for the second-in-command position of Speaker Pro-Tem.  Wiemann is heavily involved in the healthcare industry through his business as the owner of an insurance brokerage firm.  He also has a master’s degree in healthcare administration.  He sponsored a bill this year which expanded Medicaid providers to include chiropractors.  The measure passed into law with bipartisan support.

But Wiemann has told Missourinet he opposes Medicaid expansion and favors free-market solutions.   He predicted other states would retreat from Medicaid expansion earlier this year.  “You’re going to start seeing a reversal of that,” said Wiemann in January.  “A lot of the state’s that have done Medicaid expansion, they’re starting to regret that they’ve done that.”

Voters in one state, Montana, chose not to renew its expanded Medicaid arrangement which was scheduled to sunset in 2019.  The Montana ballot measure included a two-dollar hike in taxes on tobacco products that the industry spent heavily to defeat.

Republican Governor Mike Parson appointed term-limited outgoing House Speaker Todd Richardson to be Medicaid Director November 1st.   Richardson told Missourinet at a press conference that they’re focused on reforming Medicaid, not expanding the program.  “My focus is not going to be on expanding the Medicaid eligibility,” said Richardson.

Some GOP lawmakers not only oppose Medicaid expansion but also think its current arrangement in Missouri is already too expansive.  Republican Representative Cheri Toalson Reisch of Hallsville objects to its coverage of pregnant women up to 185% of the poverty level.

Missouri has some of the most restrictive eligibility requirements of all states for its Medicaid program.  Besides pregnant women, it offers medical coverage only to low-income seniors, blind and disabled people, uninsured women, children, and parents who earn 19 percent of the poverty level.

Because of Missouri’s level of poverty, the federal government covers 64.6% of Medicaid costs, where roughly 1/6 of the state’s 6 million residents are on the program.  State contributions to the program vary from state-to-state, but federal support is higher in those that have higher poverty levels.

If Missouri were to expand Medicaid, the federal government would cover no less than 90% of costs as of 2020 and a slightly larger percentage in 2019.  At 10%, Missouri would have to chip in $200 million annually on top the federal contribution of $1.8 billion to pay for expansion.  FamiliesUSA estimates that 293,000 people would be newly eligible for coverage if the state were to expand the program.

Democratic State Representative Deb Lavender of Kirkwood attempted to attach an amendment to expand Medicaid to a bill during a special session of the legislature this year.  The legislation to broaden the use of treatment courts as an alternative to criminal charges for certain offenders included language pertaining to Medicaid.  But Lavender’s amendment was deemed out of order and rejected as not being in the scope of the governor’s call for a special session which was specific as it related to treatment courts.

Lavender notes the fact that voters in three states just passed Medicaid expansion should be a signal for Missouri to place a measure on the ballot.   “I think that gives some strength to maybe some Missouri organizations that are looking for Medicaid expansion that they see some way forward with maybe a ballot initiative here as well,” said Lavender.

The State Representative who was elected to her third term in November’s election says she’ll still look for legislative ways to expand the federal healthcare program in Missouri, even with the Republican majority’s strong opposition toward such a move.  “I’m sure I’m going to keep looking for every bill that’s crawling, let alone moving, to attach Medicaid expansion to,” Lavender said.