Photo by Robert Stinnett, Creative Commons License 2.0

The Missouri state Supreme Court ruled unanimously yesterday that the state's voter-passed Medicaid expansion is completely legal and that the state's Republican legislature and governor can't just make it go away by refusing to fund it, so knock it off, you jerks. We may have embellished that a tiny bit.

Here's the dealio: Voters passed a constitutional amendment authorizing the expansion last August, but the state legislature repeatedly refused to appropriate the funds to pay for the state's 10 percent share. In May, Gov. Mike Parson shelved the expansion, claiming he couldn't let anyone sign up if it hadn't been funded, and then supporters of the expansion sued, along with three women who would have qualified under the expanded eligibility rules.

The state Supreme Court's decision clears the way for roughly 275,000 low-income Missourians to get healthcare. As the Kansas City Star explains, the Court ruled that

The Department of Social Services and the state's Medicaid program, MO HealthNet, "are bound by" the constitutional amendment governing eligibility, regardless of the amount of money lawmakers put toward the program.

"DSS has appropriation authority to provide services for all individuals eligible for MO HealthNet, including individuals eligible for coverage and services pursuant to" the amendment, judges ruled.

This is terrific news, although you probably also won't be too surprised that the Parson administration is already making less than compliant noises, because why let a mere unanimous state supreme court decision get in the way of a good culture war?


The Court reversed an earlier ruling by Cole County Circuit Court Judge Jon Beetem, who had ruled against the plaintiffs. Basically, Beetem said that Parson wasn't bound by the constitutional amendment, because another section of the state constitution forbids voters from using ballot measures to require new spending, because the power to appropriate money is reserved to the legislature.

Republicans had relied on that argument during the legislative session this year to say that because the program's expansion would cost the state extra money, the decision to expand still lay with them.

The state Supremes said nahh, not buying that; the ballot measure didn't interfere with the legislature's budget authority, it ruled. If the Lege chooses to appropriate too little funding for Medicaid, that might be an incredibly stupid choice, but that can't keep people from being eligible to enroll, which is what the amendment was about. (Again, we're paraphrasing.) And there was rejoicing, at least for the moment:

The decision was cheered by Democrats, health care advocates and Missourians who are newly eligible for Medicaid under the expansion. Nina Canaleo, a 38-year-old Kansas City mother with multiple sclerosis, said in a statement released by Missouri Jobs With Justice that the coverage would help her "get the treatment I need to literally be able to keep walking."

"I have been waiting for this confirmation for so long," she said.

Unfortunately, a spokesperson for Parson seemed to suggest the ruling isn't exactly going to prompt the governor to rush out and open Medicaid enrollment, at least not immediately.

"After today's court decision, the Executive Branch still lacks the necessary budget authority to implement MO HealthNet coverage to the expanded population," Kelli Jones said in a statement. "We are looking at what options may be available to us to seek additional budget authority and also pursuing legal clarity."

She did not clarify whether "budget authority" meant more money, or funds that lawmakers approve specifically for expansion.

So this crap could well drag out even further, because Republicans just hate Barack Obama and people who made bad decisions like not being born to wealthy parents.

As the Star explains, Missouri has some of the stingiest Medicaid eligibility rules in our great stingy Republic. Virtually no adults without children qualify, and even families with children are only eligible if they earn "less than 22 percent of the federal poverty level," which works out to about $5,800 for a family of four. Yes, that means most people below the poverty line are too well off for Medicaid in Missouri.

Under the ACA's Medicaid expansion, people can qualify for the program if they make up to 138 percent of poverty level. Like, even a single adult whooping it up on as much as $17,700 a year.

Missouri Republicans should probably point out that at least those who qualify for Medicaid aren't required to run a gauntlet of Fox News viewers spitting on them on the way in and out of doctors' offices, so they should maybe stop and consider how good they have it.

The Republican-controlled state legislature has fought off all attempts to expand Medicaid under the ACA for years, even though the federal government covers 90 percent of the costs. Missouri can't possibly afford the costs, and besides, Medicaid expansion would let lazy freeloader childless adults get healthcare, which might encourage idleness!

Back in 2014, one fine member of the state Senate, Republican Ed Emery, wrote to petitioners who asked him to vote to expand Medicaid to suggest that if poor people wanted healthcare, they could move to another state, no one's forcing them to stay in Missouri. Dude suffered no political consequences for it, and kept being reelected until last year, when he was term limited. He's already filed to run again in 2022.

The Star explains that after the constitutional amendment passed, state officials had filed the necessary paperwork for the federal government to start paying 90 percent of the costs of expanded Medicaid, but then rescinded the application after Parson shelved expansion in May.

And while the Court's decision yesterday requires the state to allow people to enroll in expanded Medicaid, it doesn't require the legislature to adequately fund Medicaid, which

portends a rocky financial future for Medicaid, which does not have enough money in its current budget to cover tens of thousands of new enrollees for a full year. Parson may be forced to ask lawmakers who have adamantly rejected expansion to return to Jefferson City to allocate more funds.

Hmm. It's the Missouri Republican Party in 2021. Wonder what they'll do next to weasel out of doing the right thing?

[Kansas City Star / NPR / Photo by Robert Stinnett, Creative Commons License 2.0]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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