Maybe Gov. Mike Parson has learned a lesson.
Maybe he can read polls.
Or maybe he’s learned why groups pushing initiative petitions have turned more and more to using constitutional amendments, which take more work to put on the ballot than statutory changes, which can be altered if lawmakers and the governor have the will to do so.
For whatever reason, Parson said something different last week about his duty as governor than he did a year ago when he was asked whether he would implement the Medicaid expansion initiative now circulating for the 2020 ballot.
“If the people of the state of Missouri — that is their will and they vote to do that — that’s what I’m supposed to do is uphold the will of the people of this state, and that’s what I intend to do regardless of whether I agree with the issue or whether I don’t,” Parson told reporters at a news conference after filing paperwork for President Donald Trump to be on the Republican presidential primary ballot.
In December 2018, after voters took legislative redistricting out of the hands of a commission dominated by partisan appointees, Parson said he wanted to repeal the new constitutional provisions.
“Fundamentally, you think when the people vote you shouldn’t be changing that vote,” Parson told the Associated Press in an interview. “But the reality of it is that is somewhat what your job is sometimes, if you know something’s unconstitutional, if you know some of it’s not right.”
Parson’s plan didn’t get far in the legislature and, if it had found favor, it still needed another statewide vote because that’s the only way to alter the constitution.
That’s far tougher than in 2011, when Parson, then a state senator, engineered significant changes in a law passed by voters in 2010 to regulate dog breeders, or in 1997, when voter-approved campaign contribution limits were increased after a court struck them down due to a provision unrelated to the limits themselves.
Maybe that is the lesson.
The polls show Medicaid expansion could pass easily in Missouri if it makes the ballot and voters are convinced it will actually save the state money.
The initiative to expand Medicaid under the Affordable Care Act — Obamacare — is supported by 44 percent of Missouri voters, according to a September poll commissioned by the private state news service Missouri Scout. That support increases to 61 percent if the plan is proven to save the state money and falls to 34 percent if it costs the state money AND a new tax would be needed to pay for it.
And with a Washington University study showing the annual savings to the state could be as much as $932 million by 2024, the case that it will save money is easier to make.
Parson, a Republican who opposes Medicaid expansion, faces an election campaign against the Democrats' only statewide officeholder, Auditor Nicole Galloway, who supports it.
Last month, he watched a Republican governor in Kentucky lose his job after trying to gut that state’s expanded Medicaid program and a Democratic governor in Louisiana prevail in his re-election after expanding the program.
To see how Medicaid expansion will actually increase state revenue for other programs, it’s important to know how the program works. First of all, it’s based on a shared state and federal responsibility, and each state’s matching rate is based on how poor or rich the state’s residents are compared to the national average.
This year, the federal share of Missouri’s Medicaid cost is 65.65 cents of every dollar. The $11 billion program in the state is a bare-bones program, covering people with disabilities and those over 65, women who are pregnant or recently gave birth, and children. The income limits vary based on circumstances, up to 196 percent of the federal poverty guideline.
For single adults, there is no coverage. And for adults with children, the income limit for eligibility is under $300 a month.
Under an expanded program, covering everyone up to 138 percent of the poverty guideline, the federal share is 90 cents of every dollar. And along with the newly eligible, new enrollees could be moved into the expansion pool.
The new spending would support new jobs in health care, generating additional income and sales tax revenue.
And finally, Missouri has a provider tax on hospitals, pharmacies, nursing homes and ambulances that is paid by debits on Medicaid payments. Little money is actually received at the treasury, but the federal government recognizes it as being spent. That already saves taxpayers $2 billion annually and I anticipate it would also increase with more medical spending
The petition to expand Medicaid would place it in the state constitution, where it really doesn’t belong. But if the voters can’t impose their will by statute, it’s the only way to make sure they get a say in whether it is changed.
And the next governor, whoever wins, must swear to uphold it.
Rudi Keller is news editor for the Columbia Daily Tribune. He can be reached at firstname.lastname@example.org.