JEFFERSON CITY — This fall, Missouri voters could be asked to expand Medicaid and allow more people to qualify for state-run health coverage.
A top Republican lawmaker would like them to also consider giving the legislature the option to disregard that vote.
House Budget Chair Cody Smith, R-Carthage, is pushing a resolution that would ask voters to make a number of health care-related changes to the state constitution, including one ensuring that all Medicaid spending is subject to legislative approval.
In a committee debate Tuesday, Smith said that if approved, the change could “theoretically” allow legislators to “choose not to fund Medicaid.”
Smith did not say whether or not he would choose to do that if voters approve Medicaid expansion, but under questioning from Rep. Peter Merideth, D-St. Louis, he acknowledged the potential for cuts.
“I do think we could get into a scenario in which we have to make choices between Medicaid and our other priorities, such as public education,” Smith said.
Merideth took Smith’s answers as an affront, suggesting his legislation would subvert the will of Missouri voters.
“This language would make it so the legislature can ignore expansion if we don't fund it in the budget process, correct?” he asked at one point.
But Smith cast the language as a perfectly reasonable attempt to ensure fiscal responsibility.
“I think it's important to budget for Medicaid just like everything else,” he said, “and if our Medicaid program becomes prohibitively expensive, that we have the ability to appropriate less for it in the spirit of appropriating for other priorities.”
Healthcare for Missouri, the organization proposing expansion as a ballot initiative this year, did not respond to a request for comment by deadline Monday.
But the debate echoed familiar arguments over expansion, which would extend coverage to people making up to 138 percent of the federal poverty line — around $17,600 for an individual or $30,000 for a family of three.
While Democrats and health care providers have cheered the idea of making more than 200,000 people newly eligible for coverage, GOP leaders have fretted over the cost.
The state would have to cover 10 percent of expansion for the federal government to do the rest, and House Speaker Elijah Haahr, R-Springfield, said last year that would “blow a sizable hole” in the state budget.
Studies have suggested otherwise.
A 2019 report from researchers at Washington University in St. Louis suggested the idea could actually save the state $932 million by 2024. and could drive down costs by helping patients address problems before they become expensive emergencies.
Another report released earlier this year by groups representing Missouri physicians, nurses and hospitals indicated costs could be offset by careful planning, too.
But the arguing hasn’t changed many minds, and each side has taken the pandemic as further justification for their position.
Gov. Mike Parson, a Republican, said last month he doesn’t think it’s the time to be expanding “anything in the state of Missouri right now” with revenues sliding amid the coronavirus-fueled downturn.
Democrats, on the other hand, have argued the health crisis has shown the idea to be even more worthwhile.
Merideth, the St. Louis Democrat, and Smith, the Republican budget chair, had a similar argument over another part of Smith’s plan to impose work requirements on some Medicaid participants.
The idea would require certain “able-bodied” beneficiaries ages 19-64 on the program would have to work, attend school, search for a job or volunteer for at least 80 hours a month to stay on the rolls.
People in a number of situations, including those caring for young children or dealing with a family emergency, such as a divorce or domestic violence, would be exempt.
Smith had said the provision would help manage the added cost of expansion, while Merideth said it would only lead to more bureaucratic expense.
The left-leaning Missouri Budget Project estimated a proposal similar to Smith’s could cost the state more than $215 million per year.
Merideth also accused Smith of trying to fool voters by also including provisions codifying popular federal Affordable Care Act barring health insurance companies from denying coverage for pre-existing conditions and allowing dependent children to stay on their parents’ health insurance until they’re 26 years old.
“It seems like a very transparent attempt to use popular pieces in order to get the unpopular pieces passed,” Merideth said.
Smith denied the charge.
“I don’t think that any of this is unpopular,” he said.
It certainly wasn’t to Republicans on the committee, especially once a provision was removed that would have taken money away from regional children’s hospitals that alarmed multiple GOP lawmakers near Kansas City.
Smith’s legislation passed the House budget committee on a party line vote. It now heads to the House floor for further consideration.
A similar resolution has been filed in the Senate.
The legislation is House Joint Resolution 106 and Senate Joint Resolution 60.