On Tuesday, Missouri voters will be asked to approve or deny an expansion of Medicaid services across the state, but local lawmakers are concerned the costs associated with the expansion are far more than the public is being told by television commercials promoting passage of the referendum.
The Medicaid expansion was placed on the Aug. 4 ballots by an initiative petition, which allows amendments to the Missouri Constitution directly by voters without the involvement of the Legislature.
This too has lawmakers concerned after the passage of the Right to Work and Clean Missouri initiative petitions in recent elections.
If passed, this measure has no direct impact on taxes.
Missouri Senate pro tem Dave Schatz, R-Sullivan, said Amendment 2 is just an expansion of Obamacare, but he thinks it will pass.
“I’m voting no, plain and simple,” Schatz said. “There is no mechanism for funding the expansion. Where does the money come from?”
Schatz said K-12 education is the biggest bucket of money from which the state may have to draw to pay for the expansion.
“This is going to cost much more than the television commercials are saying,” Schatz said. “It’s going to come at the cost of education, but people can choose what is most valuable. It seems very appealing, but my fear is people are uninformed.”
Schatz said there needs to be a higher threshold for passage of initiative petition referendums considering a small number of voters can add an amendment to the constitution, which can openly be changed by another vote of the people.
“If I had to guess, I think it has a good chance of passing,” Schatz said. “If this was such a good idea, the Legislature would have passed something is the past. If voters trust me on other things, they should trust me on this. It’s not a good idea.”
State Rep. Aaron Griesheimer, R-Washington, who sits on the House Budget Committee, is against the Medicaid expansion and said it will cause a huge hit to funding for other state programs.
“Medicaid already encompasses one-third of the annual state budget,” Griesheimer said. “This expansion could boost that to 40 percent and cost $1 billion a year, which would have to be taken from other departments.”
Griesheimer said without cutting from other services, the only other option to fund the expansion would be asking voters to raise taxes on themselves, which has not been successful in the past and many Republican lawmakers have signed a no tax increase pledge. He is also not happy about the potential expansion circumventing the legislative process.
“Voters denied raising tobacco taxes (Prop A, 2016) and the gas tax (Prop D, 2018) to fund road repairs,” Griesheimer said. “They can’t beat us at the polls so they are beating us on initiative petitions.”
Griesheimer said those behind the push for Medicaid expansion are not telling the true story of how much it will cost taxpayers in the long run and the Legislature hasn’t taken action because the funding is not there and state budgets will be even more conservative because of lost revenue due to COVID-19.
“The commercials are very good and the groups behind them have millions of dollars to paint their picture,” Griesheimer said. “The state doesn’t have the same resources. My gut tells me this is going to pass. I just ask people to do their own homework and make an educated decision.”
State Rep. Nate Tate, R-St. Clair, is not in favor of the Medicaid expansion and agrees there needs to be a funding mechanism in place before an expansion can be approved.
“This could cost an additional $3.5 billion per year. Who’s going to pay for the mandate?” Tate said. “I’ve seen the ads and from my understanding the state of Missouri already gets more money from the federal government than we send to them.”
Tate said he thinks the referendum will pass and doesn’t think there will be a tax hike.
“I think a lot of services and programs are going to be left to foot the bill,” Tate said. “The money has to come from some place. I don’t know what people are expecting. I’m going to vote no.”
For nearly two years, State Rep. John Simmons, R-Krakow, has been very outspoken against the use of initiative petitions to change the constitution, and has filed referendum reform bills in the past two legislative sessions.
“Small turnouts at the polls result in a very low percentage of voters having a voice in this,” Simmons said. “It is even worse when the referendum mandates funding the state does not have.”
Simmons, a physician, echoed his colleagues in opposition to Medicaid expansion.
“I think it’s a terrible idea and it will decimate the state budget,” Simmons said. “It’s not expanding services, it’s just putting more people on the rolls. Many of these are able-bodied people.”
Simmons said much of the push to expand Medicaid is coming from hospitals, especially in rural parts of the state.
“They have a great marketing plan, but voters aren’t getting all of the information,” Simmons said. “In the Legislature we have hearing after hearing, and vetting after vetting from experts on both sides before we make decisions. If it’s that important of an issue, you shouldn’t have to talk people into it.”
Simmons said in a free market system, hospitals which are hurting financially should look at their internal business plans before searching for more government money.
State Rep. Dottie Bailey, R-Eureka said she will not be supporting Medicaid expansion because if it passes, it would push extreme budget cuts in other areas and more.
“Proponents say Medicaid expansion will “bring our tax dollars back to Missouri,” stating that Missourians pay federal taxes that go to other states that have already expanded Medicaid. This is categorically false,” Bailey said. “Expanding Medicaid will simply add billions annually to the rapidly growing federal deficit.
Proponents say this will save the state money.
“It is impossible to add hundreds of thousands of people to a government program and achieve less state spending,” Bailey said. “Even if the federal government pays for 90 percent of the expansion in perpetuity, which is not guaranteed, the state portion will still cost hundreds of millions of dollars.”
Bailey said since Missouri must have a balanced budget, the cost of the state portion of Medicaid expansion will force legislators to make difficult cuts to competing priorities like public education, transportation infrastructure, and public safety. Especially in an environment of marginal, flat, or negative state revenue growth such as the one we find ourselves in due to the pandemic.