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Missouri Republicans horrified by the prospect that poor people might get medical care


Even though the citizens of the state voted to accept $1.6 billion per year in federal funds to help poor people pay for their medical needs, the Missouri GOP has decided that as a matter of principle that’s just wrong:

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Thursday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.

The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million in state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.

The increased eligibility would allow an estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July, after voters approved a ballot question last August with a 53% majority. . .

Missouri’s Medicaid program does not currently cover most adults without children. Only the disabled, children and parents with incomes under 18% of federal poverty level — less than $5,800 a year for a family of four — are eligible. It is one of the lowest eligibility thresholds in the nation. The expansion will allow adults earning up to 138% of the federal poverty level to be covered. . . .

Nine Democrats voted for the bill and 20 Republicans, including Smith, voted against. Missouri Secretary of State Jay Ashcroft wrote on Twitter after the vote to commend Smith and committee vice chair Dirk Deaton, a Noel Republican, for their “commitment to fiscal responsibility.”

Expansion opponents said the state can’t afford to take on the cost. Deaton said the budget bills present “binary choices” between Medicaid expansion and social services for blind and disabled Missourians.

“It is to give free health care, government health care to able-bodied adults who can do for themselves,” Deaton said.

Smith has also cut $245 million of general revenue spending from Parson’s proposed budget, including some money for new mental health centers.

Democrats slammed that characterization, pointing out that state revenues are higher than expected and the state will get more than $1.1 billion from the federal government specifically for Medicaid expansion through the latest coronavirus relief bill, in addition to the $2.8 billion in other federal aid.

“I am flabbergasted by the narrative that we have to rob Peter to pay Paul here,” said Kansas City Rep. Maggie Nurrenbern. “If this committee votes this down … I am unbelievably disappointed because you have forsaken your duty as a state representative.”

Proponents of expansion have said the influx of federal dollars would be an economic boon to rural hospitals and the health care sector.

Rural Republicans pushed back on Democrats’ arguments that voters had approved an expansion, saying voters could not require the state to spend money. Last year, a state appeals court judge found the expansion initiative did not have language directing the General Assembly to spend money, allowing it to be placed on the ballot.

Moberly Rep. Ed Lewis said despite that 53% of those who cast ballots in favor of expansion, the number did not amount to a majority of Missouri’s eligible voters or population.

I think that’s called Democracy Calvinball.

“Rural Missouri said no,” said Rep. Sara Walsh, of Ashland. “I don’t believe it is the will of the people to bankrupt our state.”

I think we all know what “rural” means here.

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