Bridget Hughes can’t afford to treat her cervical cancer and diabetes. Richard Eiker cuts his prescription pills in half. Kenya Banks can’t afford an operation for her fibroid tumors. Bill Thompson can’t afford to go to a doctor following a heart attack — he already had $10,000 in medical debt. 

These are all uninsured Missourians who would have been helped by the planned expansion of the state’s Medicaid program, which was approved as a constitutional amendment by a 53.3% majority vote in August 2020. The expansion would have allowed 275,000 adult Missourians to qualify for Medicaid, known as MO HealthNet, by income alone.

Instead, in March, the General Assembly said it would not fund the program. Then on May 13, Missouri Gov. Mike Parson announced he withdrew the Medicaid State Plan Amendment, which is a plan states send to the federal government for approval when making changes to Medicaid. The following day, protests led by a coalition of organizations were held across the state.

Medicaid expansion is likely headed to the courts, said Richard von Glahn, policy director with Missouri Jobs with Justice. He added that the state is constitutionally required to start the program on July 1, when the constitutional amendment takes effect.

“So we’re certainly going to defend Missouri’s constitution and make sure that takes place and that people in that eligibility are able to do that, despite the governor seemingly backtracking on his promise to voters that he would follow that,” von Glahn said.

In the meantime, Missouri Jobs for Justice will continue to ask the governor to reverse his decision, and educate the public about their constitutional right to enroll for Medicaid.

A day of rallies ‘to defend and secure Medicaid expansion’

Rallies and events were  live-streamed on Facebook from St. Louis, Springfield, Kansas City, Columbia, Joplin, West Plains, Vernon County and Jefferson County.  

The organizations sponsoring protests included Missouri Jobs with Justice, Missouri Health Care for All, Missouri Faith Voices, Metropolitan Congregations United, Planned Parenthood Advocates in Missouri, SEIU-Healthcare, NARAL Pro-Choice America, Metro Organization for Racial and Economic Equity and Our Revolution KC.

Protestors led crowds in chants like “I believe we will win,” and “What do we want? Medicaid. When do we want it? Now.” They carried signs that read, “I’m a health care voter,” and “Governor Parson shame on you.”

People who would have qualified for Medicaid under the expansion spoke out. Alice Nelms, a Kansas City resident, went into medical debt in 2019 when she didn’t have access to health care coverage. She currently works at a nonprofit.

“It’s a lot of stress to worry about the stability of my job during a global pandemic, during an economic downturn and then worry about my insurance coverage on top of that,” Nelms said. “Medicaid expansion is the law, and we will not allow Gov. Parson to succeed.”

Terrence Wise, an uninsured Missouri father and McDonald’s employee, is a leader with Stand Up KC, an advocacy group of fast-food and retail workers across Kansas City.

“I hope and pray. For the last 20 years, that’s all I’ve been able to do when it comes to my health,” Wise said at the protest. “Anything less than fully funded Medicaid is an attack on our health care, attack on my family and attack on everyone.”

Health care workers, like LaTanya Richardson, SEIU Healthcare member and worker at Truman Medical Centers, also spoke up.

“At a hospital, we’re not just treating for our health, but everyone’s health,” Richardson said. “This is for people who actually need it.”

Sam Letke, a nurse at the Columbia protest, talked about the special population of patients she serves who mainly are brought to the hospital after car accidents. Her patients don’t have the option to not go to the hospital, she said.

“We see there is a big gap in people who can (get) Medicaid and are forced to self-pay and this often results in them being completely broke,” she said. “It’s heartbreaking.”

Leaders with Missouri Jobs for Justice, like Glenn Winfrey, who did volunteer work to support Medicaid expansion, also spoke to the crowd.

“The bottom line is that the people of Missouri voted for this by an overwhelming margin,” he said. “If the government doesn’t enact this, they are not fulfilling the will of the people.”

Where funds are going instead

On April 28, the Missouri Senate voted not to fund Medicaid expansion in the state’s budget for the 2022 fiscal year. The Missouri House previously voted against funding the expansion, which would have covered adults with incomes up to 138% of the federal poverty level, about $17,609 a year for an individual.

One state senator, Karla Eslinger, said she voted against the expansion because the 33rd district she represents voted against it and because the ballot measure did not include a way to fund it. Her district is in south central Missouri.

“These new expenses are not currently included in our budget,” Eslinger wrote in a column. “It is a time of unknowns, as we continue to work through this issue. Either way, this will most likely end up in the courts, which is of great concern.”

Out of the legislators who voted, all 10 Democrats in the Missouri Senate supported the funding, along with four Republicans. The 20 remaining Republicans voted against the funding.

Gov. Mike Parson signs the supplemental budget on May 13, 2021. Photo courtesy of the Office of Missouri Governor

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” said Parson in a news release.

“Without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time,” Parson said. 

A spokesperson for Parson previously told The Beacon that Missouri couldn’t afford Medicaid expansion because of strain on the budget.

The state would have paid about $120 million for the expansion, with the federal government paying $1.78 billion.

Instead, the Missouri House voted to reallocate the money originally set aside for Medicaid expansion — $88 million to nursing homes, $25 million to services for those with developmental disabilities, $15.5 million to pay for K-12 school bussing, and money for hiring 15 public defenders.

Von Glahn, with Missouri Jobs for Justice, said that underfunding for the Medicaid expansion won’t be a problem. The funding could be solved with a supplemental budget, he said.

“The narrative that the governor has relied on that the legislature has tried to push that we can’t follow our constitution because we choose not to fund it is factually not accurate.”

Timeline of Medicaid expansion program

May 22, 2020: When Medicaid expansion  was approved to be on ballot

Aug. 4, 2020: Voters approve by 53% majority

March 20, 2021: Missouri House votes against funding the expansion

April 28, 2021: Missouri Senate votes against funding the expansion

May 13, 2021: Gov. Mike Parson withdraws request to federal agency for Medicaid expansion funding

May 14, 2021: Protests held across Missouri

July 1, 2021: When Medicaid expansion was scheduled to go into effect

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Brittany Callan covered health and environment at The Beacon, and was a Report for America corps member for 2020-2021. Funding for this reporting was provided in part by the Health Forward Foundation.