The Republican-controlled Missouri House of Representatives has given initial approval to defunding a Medicaid expansion effort approved by voters last year. The chamber could choose to use the governor’s $1.9 billion budget request for the expansion to instead help seniors in nursing homes, the developmentally disabled, expand mental health programs, add more public defenders, and for K-12 transportation costs.

Gov. Mike Parson

Here is what Gov. Mike Parson, a fellow Republican, has to say about the House’s effort.

“We’ll have to see how that goes in the Senate there. We did put the money in the budget for that. People did vote for it. Although I didn’t support it (expansion) at the time but the reality of it is, the people of the state voted for it. I thought it was my obligation as governor to make sure we try to get it implemented,” Parson tells Missourinet affiliate KDRO in Sedalia. “We’ll see though. The House voted against that – a little different maneuver I want to say, I guess. We’ll see what the Senate does and we’ll see how it comes out at the end of the day.”

Last year, 53% of Missouri voters approved a ballot measure to expand government-funded health care coverage to about 275,000 low-income adults. Per the measure, the expansion would start in July.

Under the expansion, 90% of the funding comes from the federal government. Missouri picks up the tab for the remaining 10%.

Missouri House Budget Committee Chairman Cody Smith of Carthage hsa been leading the anti-expansion effort.

“The state’s portion of that is in the hundreds of millions of dollars. The power of appropriation belongs solely to the General Assembly. Because the Constitutional amendment did not have a mechanism with which to pay for it, the General Assembly in Missouri has to decide how do we prioritize Medicaid expansion versus all the other budgetary needs we have in this state. So, it’s not a matter of can we carve out the money for this as much as it is a matter of what are we not prioritizing in place of this,” he tells Missourinet. “It is yet to be determined how the General Assembly will ultimately do that, but the implementation of Medicaid expansion requires an appropriation. Again, that is the job of the General Assembly. I’m not interested in pushing this to the courts to decide. I think our job as the General Assembly and as appropriators is to create a balanced budget year over year and that is a matter of prioritizing some needs over others. I’m not trying to set up a Constitutional battle that could ultimately be set up in the courts.”

Some House Democrats say Republicans are ignoring voters by not funding the expansion. They have called on the governor to ensure the effort is funded.

In excerpts from a statement from Missouri House Minority Leader Crystal Quade, D-Springfield, she says Republicans need to stop with the political grandstanding and games.

“The only thing House Republicans have done is declare they would rather bankrupt the state Medicaid program than respect the clear will of the voters and fulfill their most basic oath to follow the constitution. They would rather cling to extreme partisan dogma that holds our state back than accept the tremendous economic and public health benefits expansion will provide. This fight is so unnecessary and little more than a destructive temper tantrum by petulant children who didn’t get their way,” says Quade. “So, after expansion takes effect three months from now and more Missourians enroll, the program at some point will run out of spending authority if House Republicans are successful in defunding Medicaid in the final state budget. That will require the legislature to return for a costly special session to pass a supplemental budget bill to fund Medicaid for the full year. And if Republicans refuse to provide full funding in a supplemental, then the battle will shift to the judicial branch, where it inevitably ends with a court ordering Republicans to comply with the constitution. Every medical organization and patient advocacy group in the state supports expansion. Even the Missouri Chamber of Commerce – as Republican of a group as there is – supports expansion.”

Missouri Hospital Association spokesman Dave Dillon tells Missourinet the fate of this effort has yet to play out.

“We are not currently in a place where we believe that that nuclear option of Medicaid not being expanded is the likelihood,” says Dillon. “Whether this was a first point of negotiation, whether this was a last repudiation of the Affordable Care Act before it’s implemented, any of that is hard to know because there are other legislative paths and there are other activities that are going on that relate to whether we will actually expand on July 1. There is what they call a state plan amendment related to expansion that is close to being able to be send to the federal government to implement. It alone may create, if adopted by the federal government, an entitlement for this expansion. What we can’t know is if there will be lawsuits. We don’t know if the Senate will take action on it. So the essence of the challenge is this – there’s a lot of moving parts. But this isn’t a one and done. The effort isn’t over.”

The House budget bills require one more vote in support of them to get to the Senate.

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