Gov. Mike Parson has pulled out of efforts to expand Medicaid, a move that almost certainly guarantees a lawsuit that could determine the future of a voter-passed initiative bolstering the health care program.
After voters approved a constitutional amendment last year expanding Medicaid, Parson鈥檚 administration had sent an amendment to the federal agency that oversees the program to follow through. The amendment would allow someone with an annual income of $17,600, or roughly $36,000 for a family of four, to get coverage.
But the GOP-led legislature declined to fund expansion, citing concerns over the long-term financial impact of the move. In a statement Thursday, Parson said he was withdrawing the amendment to the Centers for Medicare and Medicaid Services that would expand Medicaid.
鈥淚 think I鈥檝e been pretty open all along about that,鈥� said Parson on Thursday to reporters in Jefferson City. 鈥淚 didn鈥檛 support it originally. But when the people of this state voted for it, I put it in the budget. I think that was my job as the governor. But I also think the priority is the legislature has to fund it. There鈥檚 no other way around that. So when they simply didn鈥檛 do that, there weren't a lot of choices left.鈥�
Parson alluded to the fact that had he started enrolling people in the expansion population, the state Medicaid program would have run out of money because lawmakers didn鈥檛 appropriate funding. He expects that the issue will end up in court.
鈥淚 don鈥檛 want to speculate what the courts will do, because there鈥檚 a lot of moving parts to this,鈥� he said. 鈥淵ou know there鈥檚 going to be court actions on both sides, I鈥檓 sure.鈥�
One of the reasons Parson鈥檚 decision ensures litigation is that the constitutional amendment includes language requiring coverage for people in the expansion population. What will likely happen is someone will try to apply for Medicaid, get rejected, and then sue in order to get coverage.
If the courts rule that Parson鈥檚 administration must let people in the expansion population into the program, lawmakers will be under huge pressure to fund expansion. If they don鈥檛, hospitals and doctors won鈥檛 be reimbursed when they provide services to people on Medicaid because the program will have run out of funding.
But if the courts decide that the state doesn鈥檛 have to provide health care coverage without funding approval from the legislature, then it effectively renders the Medicaid expansion amendment inoperable.
Senate Appropriations Chairman Dan Hegeman, R-Cosby, acknowledged that the stakes in the impending legal battle are high.
鈥淏asically I think the governor鈥檚 responding to the actions of the legislature,鈥� Hegeman said. 鈥淭he whole issue largely being do initiative petitions have the right to bind the legislature without a funding source. We鈥檝e got a provision in the constitution that says you can鈥檛 do that.鈥�
A decision to not go forward with Medicaid expansion would also mean the state would not get more than a billion dollars from the latest federal coronavirus relief plan. A provision in that legislation provides money to states that have not expanded Medicaid yet. Many critics of Republicans refusing to fund expansion have pointed out that this money could be used to pay for the state鈥檚 portion of the effort, contradicting the idea that Medicaid expansion would be a financial drag on the state.
鈥淥f course we are extremely disappointed with this,鈥� said House Minority Leader Crystal Quade, D-Springfield. 鈥淚 will say though, I鈥檓 also not surprised. Because we鈥檙e continuing to see the administration and the Republican majority just completely not listen to the will of voters and not listen to the constitution.鈥�
This impending court case, which will likely be rendered from the Missouri Supreme Court, could have implications beyond the future of Medicaid expansion.
If the courts rule that expansion must happen, then it could be a pretext for Republicans to try to dismantle the Missouri Nonpartisan Court Plan that is used to select judges to the Supreme Court and the state鈥檚 appellate courts. Any changes to the plan would need voter approval.
鈥淲e have seen Republicans in Missouri try to undo this court plan for many, many years,鈥� Quade said. 鈥淭his is just another place where they鈥檙e going to try to do it. But we鈥檒l see if they use it as one.鈥�
Follow Jason on Twitter: @jrosenbaum
