Republican politicians lost in Medicaid expansion standoff, and Missouri voters won

·3 min read

Thursday, the Missouri Supreme Court — with a clear, unanimous voice — said expanded Medicaid is constitutional. That means 275,000 people now eligible for Medicaid must soon be enrolled in the program if they apply.

It was a good day for the rule of law. It was a great day for the working poor, who will be able to get someone to take a look at that nagging cough or skin infection.

All Missourians should celebrate. They won their case.

The court reached its conclusion based on law and logic. It’s true, the judges said, that the state constitution prohibits a voter initiative “that authorizes the expenditure and disbursement of a specified amount for a specified purpose, without providing new revenue.”

But that didn’t happen when voters expanded Medicaid, the court said. The Medicaid amendment doesn’t spend a dime. It merely tells the state to enroll Missourians up to 138% of the federal poverty level, and that’s what the state must now do.

That means individuals earning up to $17,774 a year, or a four-person family earning up to $36,570, will soon be eligible for health coverage if they don’t have it now.

“This decision restores faith in our democracy and that the power of the people will continue to prevail over political grandstanding,” Caitlyn Adams, executive director of Missouri Jobs with Justice, said in a statement.

All Missourians should be happy their voices have finally been heard.

Now it’s up to Gov. Mike Parson, and MO HealthNet, the state’s Medicaid program, to structure the enrollment process for newly eligible Missourians as quickly as possible. Patients — some with serious, chronic conditions — should not have to wait for more red tape before they can get the insurance and health care they need.

The details must be hashed out in circuit court no later than the first of August, with full enrollment to begin a few days later.

It is tempting to ask Republican state legislators who disobeyed the will of the people to apologize for their misunderstanding of the law, and the people. The decision to refuse to allocate funds for Medicaid expansion clearly violated the state constitution, while slapping voters in the face.

For the most part, GOP leaders were silent in the hours after the decision was announced.

But supporters of expansion should avoid an extended victory lap. Instead, Missourians must demand that lawmakers move quickly to embed expanded Medicaid in state law and policy directives, and execute whatever other steps are needed to bring new federal Medicaid dollars into the state.

Already, Republicans are warning of cuts to other parts of the budget to pay for possible increases in Medicaid spending. A special session may be called for that purpose.

Don’t be fooled by this ruse. Missouri has more than enough money to meet its existing budget, and expand Medicaid, without raising taxes. Any other claim is political, and not based in reality.

The decision isn’t good news only for the working poor, by the way. The influx of new patients will help hospitals and clinics in rural areas. It might convince some Missourians in rural areas to get checked out earlier if they suspect they’ve caught COVID-19.

It will strengthen the safety net, add jobs, and should increase revenue to Missouri.

It took some time, but the Missouri Supreme Court has said what everyone knew: The voters had a right to require Medicaid expansion, which they exercised. In Missouri, the people still rule — not lawmakers who think the poor should suffer in silence.

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