The Missouri Legislature has voted to give final approval to an approximately $35 billion state operating budget, a budget that does not contain funding for Medicaid expansion.

Missouri House Minority Leader Crystal Quade (D-Springfield) briefs Capitol reporters in Jefferson City on May 7, 2021, as Rep. Peter Merideth (D-St. Louis) listens (photo courtesy of Ben Peters at House Communications)

Democratic lawmakers are appealing directly to GOP Governor Mike Parson, urging him to work to implement Medicaid expansion. GOP lawmakers say the money is best spent on the most vulnerable, including those with developmental disabilities.

Medicaid is officially known as MO HealthNet, and it’s a federal and state program that assists with medical costs for residents with limited incomes.

Medicaid expansion supporters say Amendment Two, the August ballot measure that passed, would help the working poor. They note it would expand Medicaid for residents between the ages of 19 and 64 with an income level at or below 133 percent of the federal poverty level.

State Rep. Sarah Unsicker (D-Shrewsbury) was one of several House Democrats who spoke on the House floor on Friday. She tells her House colleagues that 49 percent of low wage workers without insurance are in the industries of hospitality, retail and health care and social assistance.

“Nearly 13 percent of uninsured workers work in health care and social assistance. People who work in the industry of health care can’t get insurance through their employer. Having uninsured health care workers puts the health of their patients at risk,” Unsicker says.

She says there are 21 rural Missouri counties where more than 20 percent of the adult population is uninsured, including in northeast Missouri’s Scotland County. Unsicker says one of three adults there is uninsured.

“Oregon, Shannon, Knox, Ripley, McDonald, Morgan, Ozark, Cedar, Taney, Dunklin, Douglas, New Madrid, Wayne, Mississippi, Crawford, Carter, Wright, Grundy, Texas and Pemiscot counties,” says Unsicker.

She says residents in those rural counties would benefit the most from Medicaid expansion.

State Rep. Hannah Kelly (R-Mountain Grove) speaks on the Missouri House floor on April 12, 2021 (file photo courtesy of Tim Bommel at House Communications)

In August, 53 percent of Missouri voters approved Amendment Two, but it failed in 105 of the state’s 114 counties. The opposition to Medicaid expansion comes from rural GOP lawmakers in districts that voted against Medicaid expansion.

One of the counties mentioned by Representative Unsicker is southern Missouri’s Wright County, which is represented by Assistant House Majority Floor Leader Hannah Kelly (R-Mountain Grove). She spoke on the floor Friday, after Unsicker.

“And I would like for the record that Wright County overwhelmingly defeated Medicaid expansion. And my people talk to me every weekend when I come home about how glad they are for the end result of what we’re here to do today,” Kelly says.

House Democrats say Medicaid expansion would help rural areas, noting ten rural Missouri hospitals have closed since 2014. But State Rep. Dirk Deaton (R-Noel) says rural Missourians don’t want Medicaid expansion, including his constituents in McDonald County. That was also one of the counties mentioned by Unsicker.

“And I take issue and I wonder if you (Representative Kelly) do, with the thought that we don’t know what’s good for own counties and our people. Rural Missouri voted overwhelmingly against Medicaid expansion, but yet we seemingly are too backwards to know what’s good for us,” says Deaton.

House Republicans also note that the number of Missourians on Medicaid has increased from 903,000 in April 2020 to 1,059,000 today, and that the state Department of Social Services’ budget continues to grow.

House Minority Leader Crystal Quade (D-Springfield) is urging the governor to work to implement Medicaid expansion. Leader Quade notes the governor is a former sheriff, saying that he’s built a solid reputation for respecting and upholding the law.

While he opposed the August ballot measure and warned about its cost, Governor Parson called for Medicaid expansion implementation, during his January State of the State Address in Jefferson City.

“Like I have said many times, I will always uphold the will of the voters, and we will move forward with expanding Medicaid coverage to approximately 275,000 Missourians,” he told state lawmakers in January.

While most of the media focus from Friday’s heated debate has been on Medicaid expansion, there were numerous other parts of the budget that received strong, bipartisan support.

The budget provides a $90 million increase for Missouri foster and adoptive children, and also boosts the clothing allowance for foster children and foster teens.

It also includes a two percent pay increase for all of Missouri’s approximately 53,000 state employees.

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