Missouri’s Medicaid expansion lawsuit case is now in the hands of the seven-member state Supreme Court. The court heard about 35 minutes of oral arguments Tuesday morning in Jefferson City.

Missouri Solicitor General D. John Sauer addresses Judge Jon Edward Beetem on June 21, 2021 in Cole County Circuit Court in Jefferson City (file photo courtesy of Jefferson City News-Tribune pool photographer Julie Smith)

This case will likely come down to the definition of “appropriation.” Cole County Circuit Judge Jon Beetem ruled in June that Missouri’s August Medicaid expansion ballot measure was unconstitutional, because it did not contain a funding mechanism. Attorneys for three low-income women suing the state appealed to the Missouri Supreme Court.

Their attorney, Chuck Hatfield, says Missouri lawmakers approved Medicaid expansion when they approved the state’s $11 billion Medicaid budget. Hatfield says the voters have spoken, by approving Amendment Two in August.

“It’s very unusual to have a lawsuit after the election, about how the initiative was adopted. And I’m not sure they (Missouri Supreme Court) have any good law on exactly what you’re supposed to do,” Hatfield told Capitol reporters at the Supreme Court, after Tuesday’s arguments.

The three plaintiffs are Stephanie Doyle of St. Louis, Melinda Hille of Fenton and Autumn Stultz of Springfield. They suffer from diabetes and skin conditions, and want the state Department of Social Services (DSS) to allow them to enroll and receive the same Medicaid coverage as those who currently receive it.

Hatfield was joined in court and at the press briefing by attorney Joel Ferber of Legal Services of Eastern Missouri, who says Doyle, Hille and Stultz are struggling and just getting by. He says his clients are desperate, and were not at the Missouri Supreme Court on Tuesday.

Counselor Ferber says what’s at stake here is life-saving health care for prescription drugs, treatment and medical equipment and supplies for Missourians who need it.

One of the main things Hatfield emphasized several times Tuesday is that 53 percent of Missouri voters approved Medicaid expansion in August.

“It is absurd to say the people voted to expand Medicaid and to include our clients (three low-income Missouri women) in the Medicaid program, and then by virtue of some legislative maneuvering in an appropriations bill they could be excluded. You know, what that’s arguing to do is to overturn an election,” says Hatfield.

Missouri Solicitor General D. John Sauer represented the state during Tuesday’s oral arguments, as he did in late June in Judge Beetem’s courtroom. Sauer was joined in the courtroom by Assistant Attorney General Jesus Osete.

Solicitor General Sauer wants the Supreme Court to uphold Judge Beetem’s ruling. He says Missouri lawmakers rejected funding for Medicaid expansion numerous times this session, including in four House floor votes, two Senate floor votes, four different bills and eight proposed amendments.

Sauer also says Sauer State Rep. Sarah Unsicker (D-Shrewsbury) offered an amendment to House Bill 11 that would have used only federal American Rescue Plan Act funds for Medicaid expansion. Sauer says that amendment failed. The American Rescue Plan Act is a federal bill signed by President Joe Biden (D) earlier this year.

Mr. Sauer also says Governor Mike Parson (R) recommended more than $1.5 billion in his proposed budget for Medicaid expansion, but that the Legislature approved nothing for it.

Missouri’s Medicaid expansion lawsuit case is a high-profile one that impacts about 275,000 potential new Medicaid recipients. Medicaid is a federal and state program that assists with medical costs for residents with limited incomes.

In his six-page June ruling, Judge Beetem says Amendment Two requires appropriation of revenues not created by the initiative. Judge Beetem says Amendment Two would create a class of 275,000 new Medicaid recipients, and says the estimated cost for the expansion is more than $1 billion. He says Missouri’s Constitution says that state revenues cannot be expended without an appropriation. The judge cites language in Article III, section 51 of the Missouri Constitution, writing that it “provides that the people, by initiative, may only spend or appropriate the revenues that they raise in the initiative.”

As for Hatfield, he says Judge Beetem made several errors in his June ruling, including ignoring the distinction between substantive laws and appropriations.

Hatfield tells Capitol reporters that he’s not surprised by the lack of questions on Tuesday from Missouri Supreme Court judges, noting they just read briefs in the case on Monday.

He also says the plain language from Missouri House appropriation bills 10 and 11 gives the state authority to expend money to provide Medicaid benefits to Missourians who are eligible under Amendment Two.

Solicitor General Sauer also cites plain language from the same bills, and says they do not contain funding for Medicaid expansion.

There are also at least ten friend of the court briefs that have been filed, by groups that support and oppose Judge Beetem’s decision.

One of them is from the Missouri Chamber of Commerce and business groups in St. Louis, Kansas City and Springfield. Their brief says Medicaid expansion would create 16,000 new jobs in Missouri. They also say that Arkansas has saved $444 million from Medicaid expansion and that Montana has saved more than $50 million. The groups say Medicaid expansion would provide healthcare to Missourians who earn less than $18,000 annually.

Another filing is from Jeremy Cady and Americans for Prosperity, which agrees with Judge Beetem’s decision. In its friend of the court brief, Americans for Prosperity says courts have consistently held that the state Constitution prohibits elections on initiatives that mandate spending without new revenues.

There is no timeframe on when the Missouri Supreme Court will issue a ruling in this case. Counselor Hatfield told Missourinet on Tuesday that he expects a quick ruling from the court.

The oral arguments on Tuesday were the first ones for new Missouri Supreme Court Judge Robin Ransom. They were also the first ones for the incoming Missouri Supreme Court Chief Justice, Paul C. Wilson.

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