Medicaid is up to you now, Missouri Gov. Mike Parson — and you know the right answer

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The Kansas City Star Editorial Board
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Since the Republican majority in the Missouri legislature does not give a single tu-whit tu-whoo about what Gov. Mike Parson thinks, we can only hope that he returns the favor and forces Medicaid expansion anyway. For one thing because that’s what voters — remember them? — have said they want.

Why worry about so-called “election integrity” when the election results on ballot questions are routinely ignored in Missouri, you might ask.

Raise the minimum wage, said Missourians in 2018. Yet GOP lawmakers are still trying to hold off on the phased-in plan to do this. Because, you see, legislators know in their hearts that voters only said that because the poor things didn’t know any better.

“They don’t really have all of the information that they need to make the most informed decision, because it’s simply not available to them,” said House Budget Committee Chairman Cody Smith, in explaining his attempts to delay or stop the minimum wage increase altogether. “There are campaigns, political campaigns essentially, that are highlighting benefits of this and don’t highlight the negative consequences.” So, down with political campaigns, says the politician?

Now, unless something unexpected happens this week, ahead of the May 7 deadline for delivering a budget to Parson, the GOP-led Missouri House and Senate will have refused to fund the Medicaid expansion that voters approved last August.

They’re also mulling ways to make it harder to amend the Missouri Constitution in the future. “The people elected legislators to represent them,” says Secretary of State Jay Ashcroft, who supports legislation that would make ballot initiatives harder to pass. “We are not a democracy, we are a constitutional republic.” One that only respects “the people” when they agree with Republicans.

As you might remember, our Republican governor was not for expanding Medicaid, either. But he put money in the budget for it anyway, as required by the constitutional amendment passed by voters. “I have to represent all Missourians,” he said recently, “and they voted for it.”

So what will he do now? If the Parson administration blocks the some 275,000 newly eligible, low-income Missourians from enrolling on July 1, the issue will likely be settled by the courts. Because the constitutional amendment passed last year says those who make up to 138% of the federal poverty level — up to $26,500 a year for a family of four — “shall receive coverage for the health benefits service package.” Not “could,” “might” or “will if you like,” but “shall.”

GOP Senate majority leader changed his mind

These are working people, not the layabouts that the GOP always says will somehow be made indolent by access to health care. (Do healthier people really laze around more? Don’t think so.) And, by the way, they’re many of the same minimum wage workers the GOP wants to prevent from making a living wage.

Even Missouri Senate Majority Leader Caleb Rowden, a Columbia Republican, sees that resisting the expansion no longer makes any sense. He and three other Republicans joined all 10 Senate Democrats in supporting the expansion, though he, too, has opposed it in the past.

“I think some folks will paint this vote as a litmus test of how conservative you are, how steadfast you are in your opposition to Medicaid expansion,” he said in a floor speech. But “I think we will have to fund this population sooner than later … I think it’s the right thing to do, right now with the variables in front of us.”

It was always the right thing to do. And failing to do so was always particularly harmful to failing rural hospitals and rural voters, who struggle more with access to care.

But then, those who complain that Missouri can’t afford it, when the state has all along lost money by refusing to expand Medicaid, would apparently rather pay for a court fight it’s likely to lose than give the working poor better access to health care.

Parson could and absolutely should enroll newly eligible Missourians anyway, and call a special session to approve the necessary funding.

In January, the governor accused lawmakers of a “purposeful and disgusting scheme to embarrass me,” by changing the venue of his state of the state address because of the pandemic.

But it’s not in tit-for-tat retribution that he should follow the will of the people on Medicaid expansion.

Since the federal COVID-19 rescue plan signed by President Joe Biden provides enhanced subsidies for individuals making more than 100% of the federal poverty line to obtain private health coverage, there’s not even a dollars-and-cents argument against expansion.

Making hundreds of thousands of people who’ve in many cases already gone years without health care wait even longer, while the issue is settled in court, would be irrational as well as cruel.

“I am proud to stand against the will of the people” on Medicaid expansion, Republican state Rep. Justin Hill has said. Because in his undemocratic view, the people were misinformed, and should be corrected as needed.