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Medicaid Fight In Missouri Heats Up

AILSA CHANG, HOST:

Last summer, Missourians passed a ballot initiative to extend Medicaid coverage to hundreds of thousands of the poorest residents in the state. The Republican-controlled legislature and governor opposed the move. And now, even though the measure is part of the Missouri state constitution, some lawmakers are blocking funding for it. Sebastian Martinez Valdivia of member station KBIA reports.

SEBASTIAN MARTINEZ VALDIVIA, BYLINE: As of now, it's very hard to qualify for Medicaid as an adult in Missouri. Single adults aren't eligible for coverage at all. That was all set to change on July 1 thanks to a constitutional amendment voters approved last summer making Missouri the 38th state to expand Medicaid coverage through the Affordable Care Act. Single adults would be covered if they make under $18,000 or so. As many as 275,000 Missourians could get coverage if there's funding for the program. But if some lawmakers here have their way, there won't be.

(SOUNDBITE OF ARCHIVED RECORDING)

CODY SMITH: Medicaid expansion is wrong for Missouri. I think it's wrong for the state budget.

MARTINEZ VALDIVIA: That's Republican State Representative Cody Smith, who heads the House Budget Committee. In early March Smith stripped funding for Medicaid expansion out of the annual budget, saying it's too expensive - that despite the fact the federal government pays 90% of the cost of expanded coverage.

(SOUNDBITE OF ARCHIVED RECORDING)

SMITH: The federal government has no money. There was only taxpayer dollars. They are federal deficit spending at a rate that's unprecedented at this point, and we stand at a precipice.

MARTINEZ VALDIVIA: Democrats argue that Republicans are pushing ideology over the will of the people, who overwhelmingly voted to expand the program. Some Republicans contend the rural districts they represent voted against the measure. Others claim voters were misled. Here's Republican Representative John Simmons.

(SOUNDBITE OF ARCHIVED RECORDING)

JOHN SIMMONS: We are not a democracy. I hate the term when we say we're a democracy. We are a constitutional representative republic. People voted us in in November, too.

MARTINEZ VALDIVIA: But the ballot language was approved by the Republican secretary of state, who successfully defended it against two court challenges. Democrats contend the legislature is now required to fund expansion because it's in the Constitution.

(SOUNDBITE OF ARCHIVED RECORDING)

PETER MERIDETH: We are playing games with people's lives and with our state economy.

MARTINEZ VALDIVIA: That's Peter Merideth, the ranking Democrat on the House Budget Committee. He says Republican legislators are wrong to oppose expansion and wrong to leave money on the table.

MERIDETH: Ideology is driving the opposition. It has been all along. Even if we didn't have a surplus right now of dollars, we've seen in every other state that's expanded they've actually had cost savings as states and revenue increases.

MARTINEZ VALDIVIA: As part of the American Rescue Plan President Joe Biden signed into law last month, Washington will pitch in an extra 5% of costs for states that expand Medicaid. For Missouri, that could amount to $1 billion over the next two years. That's pushed other GOP-controlled states to consider expanding Medicaid as well. And Missouri's Republican Governor Mike Parson included expansion funding in his proposed budget.

(SOUNDBITE OF ARCHIVED RECORDING)

MIKE PARSON: It'll be challenged. There's no question about that. If it's not funded, there'll be challenges to that. I think we all know that, so we'll just have to see how that plays out.

MARTINEZ VALDIVIA: James Layton is a former solicitor general for the state of Missouri. He says if the state can't cover everyone eligible or can't reimburse hospitals at the end of the year, it will likely face a legal backlash.

JAMES LAYTON: If the department doesn't give them whatever it is they need to be able to go to the doctor and say, I'm on Medicaid, then that would be a lawsuit. It also could be that the federal government could take action to disqualify the state from participating in Medicaid because it didn't fulfill its obligations under Medicaid.

MARTINEZ VALDIVIA: Now the budget heads to the state Senate, where Republicans are split over what to do. While some have said they support including expansion funding, others are still speaking out against it.

For NPR News, I'm Sebastian Martinez Valdivia.

(SOUNDBITE OF A MAN CALLED ADAM SONG, "MOUNTAINS AND WATERFALLS") Transcript provided by NPR, Copyright NPR.