Missouri Senate abandons plan for Medicaid limits on birth control, renews crucial tax

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The Missouri Senate voted early Saturday to renew a tax critical to funding Medicaid, but without divisive provisions that could have prohibited Medicaid coverage of certain forms of birth control and would have blocked payments to Planned Parenthood.

Senators approved the bill, which reauthorizes for three years a tax on hospitals that provides $4 billion annually for Medicaid. The 28- to-5 vote, which came at 12:37 a.m., culminated a lengthy day of closed-door negotiations. The measure now heads to the House.

The vote makes it much more likely the General Assembly will meet Gov. Mike Parson’s July 1 deadline to renew the tax. He has promised severe budget cuts without a bill on his desk by then.

The bill marked a defeat for conservative senators and anti-abortion activists who had hoped to use the tax, known as the Federal Reimbursement Allowance or FRA, to force Planned Parenthood, the state’s only abortion provider, out of Medicaid altogether. Sen. Bob Onder, a Lake St. Louis Republican, led the move against Planned Parenthood but a bipartisan coalition, fearing the possible loss of federal funds, rejected his proposal.

“The question for us is whether we’re just going to roll over and play dead,” Onder said, calling it a “sad day” for the Senate.

“We talk about pushing back against federal government overreach and we talk about pushing back against the liberal activist judiciary but then when it comes time to do anything about it we get weak-kneed,” he said.

The vote was a victory for Parson and Republican leaders, who had spent the week locked in an escalating showdown with Onder. They were supported by Democrats and advocates for women’s health services, who had balked at previous versions of the bill. Parson, who has an extensive anti-abortion record, found himself in the unfamiliar position of pushing back against anti-abortion activists and lawmakers who were demanding action against Planned Parenthood.

“The message is clear: it is not a winning strategy to use birth control – which is essential healthcare – as a bargaining chip,” said Michelle Trupiano, executive director of the Missouri Family Health Council, which supports broader access to contraception.

Federal law already prohibits Medicaid from paying for abortions. But Planned Parenthood also provides screenings for cancer, sexually-transmitted infections and other services to patients, including those on Medicaid. Onder and Missouri Right to Life wanted a total ban on any Medicaid dollars going to Planned Parenthood, even for non-abortion services.

Parson, who called lawmakers back to Jefferson City for a special session that began Wednesday, emphasized the urgency of renewing the FRA. Medical groups have warned of dire consequences if it is not extended.

“I’m going to say this to my fellow colleagues who are pro-life: you know, Sen. Onder really doesn’t have the ability to decide who’s pro-life and who’s not when it really comes down to it,” Parson told 97.1 FM on Friday. “He may have his opinion, but we don’t need to have somebody put a brand on us, a stamp on us saying hey, we’re pro-life or not.”

Sen. Mike Cierpiot, a Lee’s Summit Republican, said his colleagues realized that any move to strip Planned Parenthood of Medicaid dollars needed to include protections to ensure the federal Centers for Medicare and Medicaid Services, or CMS, wouldn’t withhold funding for Missouri over the move.

He emphasized the dangerous position Medicaid recipients would be put in if the federal government refused funding. He predicted Parson would use regulatory powers to target dollars going to Planned Parenthood.

“A pro-life position is to make sure our seniors in nursing homes, our pregnant women on Medicaid and neonatal care and families with developmental disabilities have got the funding for the resources they need,” Cierpiot said. “It’s a much bigger issue than the other issues with defunding Planned Parenthood.”

Despite the Senate vote, the fight isn’t over and the bill may face opposition in the House. But its supporters are more confident about passage in that chamber after it approved multiple renewals of the FRA earlier this year.

“I don’t think it would take us a lot of time to do our part,” Rep. Cody Smith, a Carthage Republican who chairs the House Budget Committee said in May.

Also scrapped was an agreement, initially hashed out between Parson and Senate Republicans, that included provisions prohibiting Medicaid from covering birth control when used to induce an abortion. The proposal had originally listed Plan B, IUDs and other forms of birth control as among those banned from coverage when used in abortions.

Democrats and medical providers repeatedly pointed out that Plan B and IUDs aren’t used in abortions but expressed fear their inclusion on the list would lead to Missouri not covering them under Medicaid anyway.

When the Senate started debate again Friday night, the list of drugs and devices was gone from the proposal. Instead, it only generally barred Medicaid from covering drugs and devices used in abortions.

“I think that people finally stood up for themselves and that was a key part of it and they understood how important this program was and cooler heads finally prevailed,” Senate Minority Leader John Rizzo, an Independence Democrat, said.

A bipartisan group of women senators appeared to play a role in getting the birth control language changed, but senators approached early Saturday after the vote didn’t go into detail. “We’re just all doing the work of the people,” Sen. Jeanie Riddle, a Mokane Republican, said.

The early Saturday vote came after a long hurry-up-and-wait day of debate. The Senate kicked off its proceedings just after 10 a.m. Friday and ultimately concluded at about 12:40 a.m. Saturday morning.

In order to allow for a final vote more quickly, the Senate adjourned for roughly an hour in the middle of the night before reconvening for a new legislative day — complete with an opening prayer, the pledge of allegiance and the reading of the Senate journal.

“We are grateful today for a new morning,” Senate Majority Leader Caleb Rowden, a Columbia Republican, prayed.

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