Medicaid expansion, Planned Parenthood funds fought

JEFFERSON CITY, Mo. -- Missouri's Republican-led House on Thursday passed a stopgap budget funding voter-approved Medicaid expansion, then minutes later OK'd proposals allowing them effectively to undermine the program and make it harder for voters to pass other constitutional amendments in the future.

Republican lawmakers also tacked on a provision to the budget bill aimed at blocking any public funding for Planned Parenthood centers, including clinics that do not provide abortions.

Republican Gov. Mike Parson signed the bill within hours Thursday. He had called on lawmakers to finish work on the plan weeks ago in order to more quickly start pumping the extra money into state services, especially a minimum 5.5% raise for state workers.

The supplemental budget plan only covers the final months of Missouri's fiscal year, which ends in June.

The budget bill is primarily needed to dole out roughly $1.7 billion in federal Elementary and Secondary Education Emergency Relief Funding to school districts, as well as hundreds of millions of dollars in other federal funding for teacher retention, summer school and other education programs.

Republican lawmakers caved and included money to pay for Medicaid expansion under the terms of the 2010 federal health care law signed by former President Barack Obama in the budget plan. Voters in 2020 amended the state's Constitution to increase access to Medicaid to thousands more low-income adults following years of inaction by the Legislature.

GOP lawmakers -- who have cautioned against promising more people health care without knowing whether the state will be able to afford it down the road -- continued to fight the program's expansion, refusing to fund it last year.

They conceded after a judge last year ordered Parson's administration to allow newly eligible adults to enroll.

But shortly after passing the bill to fund Medicaid expansion through June, House members on Thursday also approved a proposal that would allow them to effectively undo Medicaid expansion by blocking funding for the program in future budgets. If approved by the GOP-led Senate, the proposal would go before voters.

Another measure passed by the House on Thursday would make it more difficult to amend the Missouri Constitution, as voters did in 2020 when they expanded Medicaid.

Republican proponents argued it's now too easy to change the constitution, while Democrats said Republicans are trying to block voters from enacting policies they disagree with.

"This is a slap in the face to voters," Democratic Minority Leader Crystal Quade said.

The latest proposal would require signatures from voters in all eight state congressional districts in order to put a constitutional amendment on the ballot and would ramp up the threshold to amend the constitution to a two-thirds vote.

Currently, signatures are needed from six of the state's eight districts and it takes a simple majority to amend the constitution.

Abortion opponents in Missouri have for years sought to stop any taxpayer money from going to Planned Parenthood. But legislators struggled with "loopholes" allowing Planned Parenthood clinics providing other health care to continue receiving funding.

Lawmakers were able to stop money from going to Planned Parenthood in the 2019 fiscal year by forgoing some federal funding to avoid requirements the clinics be reimbursed if low-income patients go there for birth control, cancer screenings and other preventative care. Missouri instead used state money to pay for those services.

But the Missouri Supreme Court in 2020 ruled lawmakers violated the constitution by making the policy change through the state budget, forcing the state to reimburse Planned Parenthood for health care provided to Medicaid patients.

Despite past court losses, Republican Senate Appropriations Committee Chairman Dan Hegeman said Thursday the latest attempt could work. He said the budget bill follows the steps the court outlined to try to block money for Planned Parenthood.

"We're once again trying to show the will of the people, as expressed through their elected senators and representatives, that they don't want taxpayer dollars going to organizations that support or do abortion services," Hegeman said.

Planned Parenthood pledged to fight to keep receiving Medicaid funding for health care.

"Gov. Parson: your next move could land you in court. Again," Yamelsie Rodriguez, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, said in a statement.

Ballentine reported from St. Louis.