Missouri’s government did not want to expand Medicaid. The state’s institutional structure allowed for a blocking coalition to stand firm for a decade.
The voters of the state approved a state constitutional amendment ordering the governor to file a state plan amendment to cover the expansion population.
The legislature refused to appropriate funds to pay for the coverage expansion.
Individuals who are eligible to enroll for Medicaid Expansion sued in state court.
A few weeks ago, a state district judge ruled that the constitutional amendment which passed Medicaid expansion was fatally flawed as it commanded the legislature to spend money.
On Thursday, in an unanimous decision, the state Supreme Court disagreed. They ruled that the constitutional amendment ordered the governor file for expansion and did not order an appropriation of state funds. The legislature can either appropriate funds or let the entire program run out of cash at some point in the next year. That is their choice.
1. Thank God
2. As cited in this article, the key is a directive to the Missouri exec. branch to cover the expansion population. The legislature does not have to appropriate funds for Missouri Medicaid to have an obligation to fund people entitled to coverage under Missouri law. https://t.co/kjMjGHsxPD— Eliot Fishman (@FishmanEliot) July 22, 2021
So sometime in the next few weeks to months, hundreds of thousands of more Missourians will get health insurance. More will get better coverage. And as a kicker, the state of Missouri will be paid, on net, almost a billion dollars in general fund revenue by the federal government, to overpay for health insurance for the working poor.
topclimber
Why would you want to minimize harmful pre-existing medical conditions via expanded health care during a pandemic? See “own the libs” ad nauseam.
To be fair, maybe the GQP types want to make sure hospitals and doctor offices don’t see any more non-Covid patients. Can’t throw anything more at staff and facilities swamped by covid cases, right?
bbleh
Let’s see, one of the 3 states with about 40% of current US COVID cases, a Gov and a lege determined not to take FREE MONEY to provide health care for its citizens, an abusive rapist for a former Gov, an all-but-out Nazi for a Senator … how is this sustainable? How are they not dooming themselves? Why would any young person, or even reasonably unconstrained non-young person, with talent and any sense at all want to stay there?
fake irishman
That American Rescue Act Money they stumbled into is amazing, and because it goes right to the Medicaid program, it won’t matter over the next two years if they actually appropriate money to cover the 10 percent, because the program will be drowning in cash.
What’s more interesting is that the act of expanding might even provide the mechanism to pay for itself, depending on Missouri’s underlying tax structure (not even relying on health improvements etc). Simply covering everyone in the prison system on Medicaid will save a bundle in state funds, not to mention increased receipts from hospital taxes, sales taxes, income taxes and the like resulting from the increased economic activity generated by hospitals and clinics getting paid.
Here’s an article that looks at that in Michigan, which Dave has probably cited quite a bit in his research (There’s a pay wall to the journal, but the abstract is public), Here’s the cite for those with access to university libraries and time on their hands:
Helen Levy; John Z. Ayanian; Thomas C. Buchmueller; Donald R. Grimes; Gabriel Ehrlich, Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan J Health Polit Policy Law (2020) 45 (1): 5–48.
Geminid
This great news for Missouri. Because of Republican oppostion, Virginia did not pass Medicaid expanion legislation until 2018. But by the time the pandemic hit, 400,000 more Virginians had health insurance.
Matt
@fake irishman:
LOL good luck with that. Any savings or increased revenue from the changes will be turned into tax cuts by the looters.
Cheryl Rofer
I was just thinking that I saw a really dumb media framing on this yesterday, and my Twitter feed just gave it to me! Greg Sargent is usually better than this. The point is to get that money to Missouri.
Baud
@Cheryl Rofer: Yeah, that’s not ironic. That was intended.
Sister Machine Gun of Quiet Harmony
As a St. Louisan who has spent years furiously voting against these idiots, suck it GOP legislature! You haters lost this round.
joel hanes
sometime in the next few weeks to months, hundreds of thousands of more Missourians will get health insurance. More will get better coverage. And as a kicker, the state of Missouri will be paid, on net, almost a billion dollars in general fund revenue by the federal government, to overpay for health insurance for the working poor.
Will MO Republican voters learn from this that their party’s ideology is inimical to their own interests?
Magic 8 Ball says : assumes ability to learn not present in evidence.
Cermet
This is where I wish the Puerto Rican nationalist would visit that legislature body and execute their 2nd amendment rights … /s Reference an old historical event in the 50’s for congress.
stinger
@bbleh: To vote and work and fight against the current governor and legislature of the state they love and want to be proud of.
fake irishman
@Matt:
I understand the cynicism, but it hasn’t played out that way in Arkansas, Ohio, Indiana, Iowa, North Dakota, Arizona or Kentucky, or New Hampshire, all of which are states that had high-profile Medicaid expansion fights and have since had periods of straight republican control. Sure, they’ve tried things like work requirements, created plenty of what Dave likes to call “Conservative Performance Art” to nibble around the margins in other ways, and have almost certainly diverted excess savings to pay for stupid tax cuts for silly groups. But through it all, they’ve quietly kept their expansions intact.
jimmiraybob
@bbleh:
Broadly speaking, the rural tribes resent and hate the urban tribes. It’s a big part of their religion. Unless, of course, you’re an urban shelling out money for a canoe.
fake irishman
Something else that Dave doesn’t mention in his post, but needs to be raised:
We are now up to six states that have expanded Medicaid via statewide voter referendum (Maine, Idaho, Utah, Nebraska, Oklahoma and Missouri). In five of those states, Republicans in the legislature or governor’s office have tried diligently to repudiate, ignore, undermine, water down or otherwise fuck with the expansion. They tried to cut back expansion populations. They tried to attach ridiculous work requirements. They tried to get all sorts of special waivers. They were able to delay it for a while in several states (Nebraska) and tried to do so permanently in two others (Missouri and Nebraska)
On many topics, state legislatures and governors can get away with this (See the 2001 book, Stealing the Initiative, or this excellent article by Phil Singer and Daniel Nelson, or how the Florida government watered down the felons voting rights initiative.)
But what’s amazing is that none of these states ultimately got away with it, despite overwhelming Republican control in five of them, with no real possibility of Democratic takeovers (Maine voters did take care of business in 2018, replacing Paul Le Page with Janet Mills). So far, Medicaid expansion has proven extremely effective as public policy, AND remarkably politically fertile and durable in places with ferocious ideological resistance and lots of institutional tools available to thwart it.
This should give a lot of us on this here blog some hope in our own efficacy: Good policy matters, and you can sometimes get it if you work together to fight for it.
(Speaking of which, thanks to everyone here who is working on voter rights in the various key states we’ve ID’d here, and to those that have given support to Voces de la Frontera)
Soprano2
For sure this will happen here.
rikyrah
Good for the citizens of Missouri????
Soprano2
It’s because their voters think this only benefits “those people” in the cities who sit on their asses and collect welfare (“those people”, such as they are, already get Medicaid!). They also think having Medicaid motivates women who are on welfare to have 10 kids, just for the benefits. The people in the legislature know that it actually mostly covers the working poor, and will actually save several rural hospitals here in MO, but they’d rather play to their voter’s prejudices than do the right thing for the citizens of MO. Expect to hear a lot of caterwauling about this from the Republicans. This will probably cover a couple of my employees, at least I hope it does, because they desperately need it. I don’t know why more small employers don’t advocate for universal health care, because it would help people not be so sick, and we can’t afford to pay for health insurance with the system the way it is now.
Soprano2
These idiots tried to argue that because their voters were against it, the citizens actually were against it. They also tried to say that the voters didn’t actually know what they were voting for.
How do you do those little smilies in your posts? I can’t figure out how to do it.
Another Scott
@Soprano2: In a desktop browser, you can copy and paste emojis from elsewhere into the visual editor.
e.g. https://getemoji.com/
✂️ Copy and ? Paste Emoji ?
On a smart phone, the virtual keyboard often has emoji options.
HTH!
Cheers,
Scott.
L85NJGT
Expansion in holdout states is polling above 70%, and above 50% among republicans. Acceptance by that polity is important to the long term success and durability of the program.
Sometimes it is best to let the process play out, and take the wins.
H.R. 4406 – the Supporting Medicaid in the U.S. Territories Act of 2021 is currently working through the House. This provides five years of Medicaid funding for Puerto Rico and eight years of funding for other U.S. territories.
marcopolo
Haven’t posted here much for a bit, but as a Missourian this news yesterday prompted me to open a beer and drink a toast. As I’ve been telling all my friends, take your victories & celebrated them when they happen.
Wishing everyone a lovely weekend.
fake irishman
@marcopolo:
Cheers!
Duane
Thanks Obama!