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Missouri Gov. Mike Parson opposes the Medicaid expansion, but after voters approved it last August, he said he would respect the will of the people.

The General Assembly can make this impossible.

The Senate rejected funding for the expansion on Wednesday night, marking another unsuccessful attempt to implement the program after the House passed a budget without it. Barring an 11-hour breakthrough, lawmakers are unlikely to approve funding for the expansion until May 7, when they are required to provide Parson with a budget.

The 14-20 vote came despite a last-minute announcement of support from majority leader Caleb Rowden, a Republican from Colombia. Rowden and three other Republicans joined the 10 Democrats voting to expand eligibility for the federal state health insurance program for low-income residents.

“I think some people will describe this vote as a litmus test of how conservative you are, how firm you are in opposing the Medicaid expansion,” said Rowden, who has opposed the expansion on several occasions, in a rare speech. “I think we’ll have to fund this population as soon as possible … I think it’s the right thing to do, now with the variables in front of us.”

Rowden and Democratic senators have predicted that without the funding, a judge will ultimately force the state to spend the money in an all-but-certain lawsuit brought by supporters of the expansion.

This puts Parson in a politically difficult situation.

Voters approved an amendment to the state’s constitution requiring state agencies under the governor’s control to expand eligibility to some 275,000 low-income Missourians by July 1.

The Republican governor, despite his opposition to the expansion, nonetheless included its funding in his budget proposal. If the GOP-dominated General Assembly ultimately refuses to approve the $ 130 million needed for the expansion, that would represent a scathing rejection of its agenda – and the final instance of lawmakers willing to cross paths with a governor of their own. left.

Parson could decide to bar new eligible candidates from registering, which would violate Missouri’s constitution and take the state to court. He could also enroll the new population and convene a special session to approve the funding, a move likely to anger Republicans and undermine his credibility as a Tory.

None of the options are likely to be attractive.

“I find it quite interesting that the Republican governor recommended that we do this … and that his party be in the supermajority, and that he basically thumbed his nose,” said the Senate Minority Leader, John Rizzo, an Independence Democrat.

A united front?

Parson’s relationship with the legislature has already been tested. Earlier this year, he accused Republican House leaders of a “disgusting ploy” after being forced to deliver the state of state speech in the Senate chamber instead of its traditional location at the House, apparently due to concerns about COVID-19.

A special session he called last summer to address the issue of violent crime ended with just one of a half-dozen proposals he was backing to become law. The House ostensibly adjourned without voting on a measure he supported to allow the attorney general to prosecute the St. Louis murder cases.

More recently, he and Republican legislative leaders have formed a more united front, appearing together for a signing ceremony for two bills expanding tax benefits for foster and adoptive families.

Parson has been optimistic in public about the possibility that he may be grappling with a Medicaid expansion disorder. He declined to criticize Republicans for voting against the funding, instead saying he had an obligation to include the money in his proposed budget because he represents all residents.

“The majority of the people in the state voted for it and that’s why I put it in my budget,” Parson said recently.

James Harris, a Republican consultant based in Jefferson City and linked to Parson, said the governor was not frustrated with lawmakers for not funding the expansion. He said Parson, as a former lawmaker, understands the legislative process and has a good working relationship with members of the House and Senate budget committees.

“I would say there’s probably no frustration, anger, whatever, because he understands they’re trying to do the best job they can,” Harris said.

Harris also pointed to a provision of a spending plan passed by Congress and signed by President Joe Biden earlier this year, which provides enhanced grants for people who reach more than 100% of the federal poverty line to obtain a private health coverage.

“I think for the administration there are some great answers, there is a better option than what was presented to voters, the options available last August,” said Harris.

Resistance elsewhere

Parson’s administration declined to say whether it would enroll the 275,000 newly eligible Missourians without additional funding on July 1.

“The Department of Social Services will determine the next steps once the budget process is complete,” said spokesperson Rebecca Woelfel.

Parson appeared ready to go to court last week.

“We’re now talking about scenarios, if it doesn’t go through, what can we do, what obligations do we have to do, what it’s going to look like in courtrooms,” he said.

Rizzo, the Independence Democrat, initially proposed Wednesday to write only half of the amount Parson recommended for the expansion into the budget. But he quickly changed his proposal, saying senators should vote on the total amount requested by the governor.

The debate over this measure echoed previous ground battles in the General Assembly this year. Supporters have emphasized the health needs of the working poor, while opponents decried the expansion of Medicaid as a “massive expansion of the welfare state.”

Cosby’s Republican and Credit Committee Chairman Sen Dan Hegeman said if the state has healthy revenues now, he believes it could face high Medicaid costs in the future.

“Where’s the shortfall, you might ask?” he said. “For me, it comes in the unknown.”

Similar resistance has manifested itself in other states where voters have agreed to expand Medicaid eligibility.

“Unfortunately, it’s a bit the same for the course in states that have developed through a voting initiative, for the legislature to step in afterwards and try to tinker with it, repeal it no matter how you want to call it, ”Jesse Cross said. Call, senior policy analyst at the Center on Budget and Policy Priorities, a liberal-leaning group in Washington.

In Oklahoma, voters also approved a constitutional amendment for the expansion last year. Lawmakers have yet to decide how to pay, but the state has announced that registrations will begin in June.

Senator Lauren Arthur, a Democrat from Kansas City, criticized her colleagues for putting Medicaid on the new eligibles, “many of whom have gone years without” health insurance, in limbo of a court case.

“People need certainty,” she says. “Subjecting them to the uncertainty of a long and drawn out court case and various appeals increases the burden of stress and anxiety, and it is wrong.”

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