Missouri can step up to make things better

The Examiner

Now that Missouri has joined 39 other states in expanding Medicaid coverage, we will hear grumbling from legislators about how they are going to pay for it. Fifty-three percent of Missourians said that they want to expand Medicaid.

Bob Buckley

The Missouri Republican Party, including the governor, opposed the ballot measure, and some think the governor put it on the August ballot thinking a lower turnout would make it more difficult to pass. Missouri joins six other Republican-led states in supporting expansion of Medicaid, the lifeline of health care for many Missourians.

One of the arguments made in favor of expansion was to spend tax dollars here rather than shipping them to the other states. Because 90 percent of the cost of the expansion is paid by the federal government, we have been helping to fund expansion in the other 37 states with our tax dollars. Only 65 per cent comes from the federal government on the current program. Thus, Missouri will get its fair share of federal dollars to help provide healthcare to all Missourians.

The ballot proposition did not do well in rural areas, which was somewhat surprising since at least 12 rural hospitals were in danger of closing if the measure did not pass. Health-care providers in Missouri strongly advocated expansion of Medicaid, which should tell us how important the expansion is to them.

The proposition that was passed in August was for an amendment to the Missouri Constitution and in particular Section 36(c) of Article IV. The amendment expands eligibility to adults 19 and older and less than 65 years of age whose income is 133 per cent of the federal poverty level. The amendment prohibits any further restrictions on the expanded population who qualify for coverage. It also requires Missouri to use the maximum amount of federal money available under the Affordable Care Act.

The Missouri legislature is concerned about how the cost of Medicaid will affect the state budget even though the state obligation will decrease from 35 percent to 10 percent because of the influx of federal dollars.

When legislators convene in January, they do have an option they can pursue and that is to put another measure on the ballot to raise the cigarette taxes in Missouri. It would not only help pay for Medicaid but help fund public education as approximately one-third of current cigarette taxes are designated for the state school moneys fund to be distributed to the various public school districts under the foundation formula.

Missouri has the lowest cigarette tax in the country at 17 cents per pack. Georgia is next at 37 cents followed by North Carolina, a tobacco state, at 48 cents per pack.

In Missouri the cigarette tax generates approximately $95 million in annual revenue. All adjoining states have much higher taxes. Kansas is $1.29, Illinois is $1.98, Iowa is $1.36, and Arkansas is $1.15. I suspect smokers from those states come to Missouri to buy their product. If Missouri increased the tax to the Kansas level, it would generate over $500 million in revenue; If we raised it to the Illinois level, it would be almost $1 billion in revenue.

The last time such a proposition was submitted to the voters was in 2016 when there were two submissions on the ballot. Amendment 3 was promoted by the big tobacco companies and would have increased the tax by 60 cents; Proposition A provided for a 23-cent increase in the tax to be used strictly to fund transportation infrastructure projects. The tobacco companies promoted the larger increase because it banned research funding for research into the harmful effects of smoking, created a bureaucracy for allocating funds through creation of the Early Childhood Health and Education Trust that allowed for a raid on public school funds, and authorized use of tax dollars to fund private and religious schools. The American Cancer Society Network and the American Heart Association opposed the measure because it did not deter smoking, a stated goal of an increase in the cigarette tax.

The vote on the 23-cent increase was 55 percent opposed and on the 60-cent increase nearly 60 percent were opposed. Most of the newspapers in the state opposed both measures.

Missouri has one of the highest smoking rates in the country. According to the Centers for Disease Control and Prevention, approximately 20 percent of Missourians smoke, which provides a base for opposition to any increase. Thus, my suggestion will not be popular. Obviously, the tobacco lobby has a huge influence on legislators in Jefferson City. I would imagine there are some contributions to some of the legislators and statewide officials running for re-election.

There is a public health rationale for higher cigarette taxes. I confess that I do not smoke. I know that cessation is easier said than done as I have watched members of my own family struggle with it. Smoking does cause health problems, and so using an increased tax to pay for some of the costs of health care has some logic.

Public education could certainly benefit from a seven-fold increase in funding from the cigarette tax.

Certainly, public education could use more money. Governor Parson just cut the appropriation to the public schools by $131 million and to higher education by $41 million. Since one-third of the tax money goes to the state school moneys fund, they could begin to replace what they lost when the governor cut funding. If we raised the taxes to the level of Kanas or Illinois, maybe we could also start paying school teachers what they deserve.

Health care for people who can’t afford it and more money for public education. What a concept!

Bob Buckley is an attorney in Independence. Email him at bbuckley@wagblaw.com.