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Battle To Expand Medicaid In Missouri Heads To Court

LULU GARCIA-NAVARRO, HOST:

A historic legal battle is underway in Missouri, whether the state legislature can stop a voter-approved initiative to expand Medicaid. St. Louis Public Radio's Jason Rosenbaum breaks down the argument both sides are using in courts and what the stakes are for the tens of thousands of people in Missouri.

JASON ROSENBAUM, BYLINE: You've probably heard the term Medicaid expansion thrown around for the past decade or so but might not be exactly sure what it means. To put it simply, it's a provision in the Affordable Care Act where the federal government picks up most of the tab if a state opens the health care program up to the working poor, which in 2021 dollars is about $17,800 a year for a single person. And when I say most of the tab, I mean 90% of it. Missouri did not take the federal government up on that offer. And that means a mom or dad raising a kid by themselves has to make less than $3,000 a year to qualify. Eventually, the state's hospitals and progressive groups got fed up.

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UNIDENTIFIED PERSON: All Missourians need life-saving care. That's why we're launching our campaign to put Medicaid expansion on the ballot.

ROSENBAUM: They successfully pushed through a constitutional amendment last August to adopt Medicaid expansion. Thirty-seven other states, including red ones, have either expanded Medicaid or are in the process of expanding. But Missouri state legislature refused to shell out money to implement it. And that prompted Governor Mike Parson to pull the plug on plans to bolster the health care program.

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MIKE PARSON: The legislature has to fund it. There's no other way around that. So when they simply didn't do that, there wasn't a lot of choices left other than I do believe it would end up in the courts.

ROSENBAUM: Parson was spot-on that his move would spark a legal fight. Three women brought a lawsuit forward to open up enrollment to the Medicaid expansion population. That includes Autumn Stultz, a single mom who lives in Springfield, who works as a caregiver.

AUTUMN STULTZ: I would be able to attend doctors offices without spending 160-some odd dollars every time. I'd be able to get my tonsils taken out.

ROSENBAUM: The case hinges on a very straightforward question. Does the legislature have to specifically approve funds for Medicaid expansion for the voter-approved initiative to go into effect? Republicans like State Representative Dean Plocher contend the answer is yes.

DEAN PLOCHER: It's up to the legislative body to allocate funding and spend the money. And I think as a whole, we have to be good fiscal stewards of how we're doing that.

LOWELL PEARSON: The way it was structured was very intentional in order to create this constitutional right.

ROSENBAUM: That's Lowell Pearson, one of the attorneys who is representing the three women in court. He's citing very specific language in the ballot item that passed last year that requires the state to accept people in the expansion population. He also flatly rejects the idea the legislature needs to specifically authorize money for expansion for the working poor to sign up for Medicaid.

PEARSON: This is as important a case as I've worked on. I mean, I want to win every case. Every client deserves 110%. But this one - it affects more people than most.

PLOCHER: Pearson is not exaggerating about how high the stakes are in this case, which the Missouri Supreme Court will likely decide. Victory means roughly 275,000 people could gain access to a program that pays for critical health care needs. And a win could also be a boon for Missouri's budget.

During an interview with me in March, Vice President Kamala Harris noted that the new federal stimulus package would provide more than a billion dollars to Missouri if it implements Medicaid expansion. That money means the feds could pay for all of the program for years, not just that 90% figure I talked about earlier.

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VICE PRESIDENT KAMALA HARRIS: Sadly, we've seen real partisanship around elected people but not around the American people. And as evidenced by - in Missouri, it's my understanding - in 2020, Missouri residents voted for Medicaid expansion. So the people voted for it.

ROSENBAUM: But GOP legislators like Representative Cody Smith say Medicaid expansion could fundamentally change who Missouri state government should take care of.

CODY SMITH: We chose to prioritize the most vulnerable in society in Missouri that do rely on Medicaid benefits - those folks that aren't able to work, that are unable to provide for themselves or obtain health benefits.

ROSENBAUM: If courts side with Republican legislators, it's unlikely Missouri will join other states in expanding Medicaid. And that adds even more stakes to one of the most important legal battles in recent Missouri political history. For NPR News, I'm Jason Rosenbaum in St. Louis. Transcript provided by NPR, Copyright NPR.