When Rep. Cody Smith, R-Carthage, budget committee chairman, split out funding for the Medicaid expansion from the general budget — an expansion that voters made part of our Missouri Constitution in August 2020 — we were concerned that it might have been a maneuver to highlight the spending, perhaps for future legal challenge or other political advantage.
Looks like it was more. It was an anti-constitutional maneuver to obstruct the will of Missouri voters and, even worse, to potentially deny medical care to the 275,000 residents of our state set to become eligible for coverage under the program.
Smith argued Medicaid already costs too much and needs changes to control costs and streamline services. “If we expand Medicaid without doing that, we are simply pouring gasoline on the fire of problems that could come along due to increased spending,” Smith said.
Yet this just doesn’t hold up to scrutiny. Instead of separating it out, the governor’s proposed $34.1 billion budget for fiscal year 2022 wrapped the cost into existing Medicaid spending for appropriation purposes. He did it without cutting other spending, and the state currently has a budget surplus given the amount of pandemic aid. A report in 2020 from Washington University’s Center for Health Economics and Policy concluded that a Medicaid expansion in Missouri “is approximately revenue-neutral and could create cost savings.”
GOP lawmakers’ arguments against funding the expansion at this point boil down to “we don’t want to spend the money.” That argument should be regarded as little more than stonewalling.
The federal government will pay 90% of the expansion. Medicaid expansion is the law of the land in Missouri. Putting the proposal before the committee in this manner to cut funding out from under it is wrong-headed. This effort is undemocratic and, frankly, a violation of the oath the committee members swore to “support the Constitution of the United States and of the state of Missouri, and faithfully perform the duties of my office.”
We are disappointed but not surprised, given that Smith has opposed other measures approved by voters through the initiative petition process — including introducing a bill to delay the minimum wage increase approved by voters — and voiced support for greater limits on the process.
In a statement Friday, Smith said that he was filing “a bill to use these funds to support seniors in nursing homes and provide care for the developmentally disabled … expand mental health programs, add public defenders to the criminal justice system, and boost K-12 school transportation funding.”
All are worthy causes that do not absolve Smith or other lawmakers of their responsibility for Medicaid expansion under the constitution.
The full House will soon debate the budget in floor sessions. The matter isn’t finished, and the Senate can always do the responsible thing by restoring the funding if the House will not.
We urge lawmakers to respect the will of the voters and honor their oaths of office by providing the funding required.
And voters should remember the effort to kill expanded coverage as it began, to deny medical care to the uninsured who are now promised coverage in our state constitution.