Gov. Mike Parson is calling Missouri lawmakers back to Jefferson City on noon Wednesday to renew a critical tax for the Medicaid program — and, as a concession to the hardest-right Republicans, pass legislation restricting state health payments for certain forms of birth control and to abortion facilities.
He issued his call for a special session at the Tuesday noon deadline he set for lawmakers to reach a deal on renewal or face deep state budget cuts.
The agreement is sure to be opposed by Democrats, who have called for renewal of the tax to be separated from anti-abortion efforts.
As governor, Parson has the power to set the agenda of legislation lawmakers can consider during the special session. He is asking for the tax to be renewed for three years. His call will allow consideration of a ban on Medicaid coverage of certain forms for birth control, such as IUDs and emergency contraceptives. Most anti-abortion lawmakers consider them tantamount to abortion.
Parson’s call also includes a proposed ban on state payments to “abortion facilities” through the Uninsured Women’s Health Program, a state-funded initiative outside of Medicaid. It covers family planning services, sexually transmitted disease treatments and pap smears for some lower-income women whose incomes disqualify them for traditional Medicaid, which primarily relies on federal funding.
Prohibiting Medicaid payments to Planned Parenthood, whose affiliates operate the state’s only abortion clinic in St. Louis as well as 11 family planning clinics across the state, was the latest obstacle to Republicans reaching a deal to renew the Medicaid tax. Under federal law, Medicaid already does not cover abortions.
Inclusion of the Planned Parenthood provision in Parson’s special session call signals that a greater number of Republicans, who hold a supermajority in the legislature, are aligning with the more stringently anti-abortion wing of the party.
But it doesn’t satisfy Sen. Bob Onder, a Lake St. Louis Republican who has led the push for the ban on Medicaid payments to Planned Parenthood. He noted on Twitter the state family planning program has a smaller budget than the traditional Medicaid program. Onder did not return a call seeking comment.
The proposed ban on payments to Planned Parenthood drew immediate opposition from Democrats. Senate Minority Leader John Rizzo, an Independence Democrat, wrote on Twitter, “The Senate Democratic Caucus will not support legislation blocking birth control for women. Full stop.”
The tax, which generates $1 billion in revenue annually and allows the state to receive more than $3 billion in federal funding, has become a bargaining chip for the state Senate’s most vocal opponents of abortion. They insist that any renewal also include the birth control coverage bans favored by Imperial Republican Sen. Paul Wieland.
The issue split the Senate, which adjourned in chaos in last month without passing the tax renewal. Parson said he would not call a special session to renew it until a deal was on the table. Last week, his office appeared to have reached a tentative agreement with Senate Republicans that included the birth control coverage ban. But a group led by Onder said it wasn’t enough without also restricting payments to Planned Parenthood.
That measure raised concern among Democrats, health care advocates and some Republicans that Missouri would risk violating federal law, which allows Medicaid recipients free choice of their health care provider.
“It’s my understanding that states cannot pick and choose who gets federal dollars,” House Budget Chair Cody Smith, a Carthage Republican, said Friday. “I’m hopeful that we can continue to seek a solution that would enable us to not send any taxpayer dollars whatsoever to any abortion providers or their affiliates, and at the same time keep our federal funding intact.”
On Monday afternoon, Parson resorted to an ultimatum to break the stalemate: come up with a deal by noon Tuesday or he would impose drastic budget cuts across schools and universities, social services and capital improvement projects to make up for the impending shortfall left by the tax’s expiration.
He accused Onder of “moving the goalposts” and “political maneuvering,” and stood by his own anti-abortion record.
But on Tuesday, an hour before Parson’s deadline, Onder and six other Senators who are part of the Conservative Caucus signed a letter to the governor urging a special session call that allows for “legislation to ensure taxpayer dollars are not used to pay for abortion services.”
Parson’s call appears to partially reflect those demands.
“Let me be clear, now is a time that demands leadership among legislators and not an opportunity to play games with billions of dollars and millions of livelihoods in pursuit of narrow political interests,” he said.
The degree to which the Medicaid-funding tax has become entangled in abortion politics has put Republican leaders in charge of the state budget in the delicate position of crafting anti-abortion restrictions that they hope won’t violate federal coverage rules.
Parson’s call restricting the Planned Parenthood legislation only to the state’s family planning program allows for that compromise, said Senate President Dave Schatz, a Sullivan Republican, because that program is state-funded.
In contrast, Missouri’s Medicaid program gets nearly 70% of its funds from the federal government, which requires that patients have a “free choice” of their medical provider as long as it is one considered qualified. Last fall, however, a federal appeals court ruled in favor of Texas for restricting Planned Parenthood from its Medicaid program.
Language in the state budget lawmakers sent Parson in May already restricts the state family planning program from making payments to Planned Parenthood. Onder had pushed a ban of Planned Parenthood from the entire Medicaid program. Anti-abortion lobbyist Sam Lee said he was “very disappointed” in Parson’s call.
“We will be doing everything in our power during the special session to enact something to completely defund Planned Parenthood,” Lee said.
Schatz said he was “hopeful there is a compromise position we can come to.”
Parson’s call on birth control, too, reflects an attempt by Republicans to write anti-abortion provisions narrowly. It calls for a list of implanted and emergency birth control methods, and the abortion pill, to be banned from Medicaid coverage “when used to induce an abortion.”
Health advocates have slammed the GOP’s link between birth control and abortion.
“We don’t know what that means and who gets to interpret that and how physicians or medical providers navigate that,” said Michelle Trupiano, executive director of the Missouri Family Health Council. “It’s conflating abortion and birth control in statute and is medically inaccurate.”