Bill crucial to Missouri Medicaid funding fails

By Jason Hancock, Rudi Keller and Tessa Weinberg
Missouri Independent

Missouri lawmakers ended the 2021 legislative session with a $2 billion question left unanswered.  

For the first time in 30 years, the General Assembly failed to renew taxes on hospitals, nursing homes and pharmacies that last year accounted for $2.3 billion of Missouri’s $10.8 billion Medicaid program.  

Now, lawmakers have no choice but to return to Jefferson City for a special session before the taxes expire in September.  

Yet the issues that upended the process in the first place aren’t going anywhere.  

Sen. Paul Wieland, R-Imperial, sponsored the amendment that locked the Senate in a debate over whether to put restrictions on the types of contraceptives available to Medicaid recipients. 

He isn’t expected to back down. 

“Next week will be a time to kind of sit back and regroup, figure out where we’re at and refocus on where we’re going to go right now,” Wieland said.  

Republicans celebrated a litany of legislative wins on Friday. But the 2021 legislative session may likely be remembered more for what lawmakers didn’t do — pass the Medicaid tax bill, known as the federal reimbursement allowance, or fund voter-approved Medicaid expansion. 

The last gasp for the FRA came after 3 a.m. Friday morning, when Senate leadership made a final stab at passing the extension without including provisions about contraceptive coverage. 

But Senate leadership faced a dilemma.  

An extension that included a ban on certain contraceptives would trigger a Democratic filibuster. An extension without it would trigger a filibuster by Republicans. 

The vehicle was a bill on hearing aids sponsored by Sen. Bill White, R-Joplin. 

The House added a one-year extension, and when White asked the Senate to pass it, Sen. Bob Onder, R-Lake St. Louis, asked instead that the bill be sent back to add language limiting the type of contraceptive products and medications the state will allow. 

“Taking this to conference is a dead end which kills FRA funding,” White said, later adding: “There would be no other choice to have a special session if we do this.” 

As debate went on, Wieland suggested White was not committed to opposing abortion rights.  

“I’m just trying to find out if you are pro-life or not,” Wieland said. 

White exploded. 

“I think in my life I have been a little more pro-life than a lot of people who want to talk about it,” White said, noting he has adopted foster children and worked with juveniles, among other actions. 

Onder prevailed 16-14, with the help of Senate President Pro Tem Dave Schatz, killing the chances of passing an FRA extension during the regular session.  

Democrats, enraged over what they saw as a betrayal by Schatz, retaliated with a day-long filibuster Friday morning that eventually forced the chamber to adjourn four hours early. 

“It’s sad, because it’s not about providing health care for people by passing FRA, it’s not about providing health care through expanded Medicaid like the people want,” said Senate Minority Leader John Rizzo, D-Independence. “It is about their next office. It’s about how fast and quickly they can get more power.” 

The provider taxes expire Sept. 30 and the constitution gives lawmakers 60 days for a special session. An extension is simple legislatively if the only issue is how long to extend it, House Budget Committee Chairman Cody Smith acknowledged, but politically complicated because of the determination of Wieland and others to add the contraceptive ban language.