Sen. Mike Cunningham’s Legislative Column for July 24, 2020

Legislative Column for July 24, 2020

On Tuesday, Aug. 4, Missourians will go to the polls to vote in the primary election. The consequences of this election are far greater than simply deciding who gets to run for office in November, however. We will also be asked to decide whether a program that already consumes about 35 cents of every dollar the government spends should grow even more.

Placed on the ballot through a petition drive, Amendment 2 gives voters the option of expanding Missouri’s participation in “Obamacare,” otherwise known as the Affordable Care Act. Passage of Amendment 2 would require Missouri taxpayers to provide Medicaid health insurance to able-bodied adults. A “yes” vote indicates you believe Missouri should cover health care costs for anyone age 19 to 64 years old who earns less than 133 percent of the federal poverty level. A “no” vote keeps Missouri’s Medicaid program unchanged.

Currently, Mo HealthNet – the Medicaid program in Missouri – provides health care coverage to children of families who earn up to three times the federal poverty level. The program also covers blind and disabled Missourians and low-income pregnant women. Many older Missourians also rely on Medicaid to supplement Medicare insurance. According to the Kaiser Family Foundation, Medicaid already provides benefits to nearly one out of every 10 adults in Missouri. One-third of children, and two-thirds of nursing home residents, rely on the program, as do about 25% of disabled individuals. All told, about 900,000 Missourians receive Mo Health Net benefits.

Proponents of expanding Medicaid estimate nearly a quarter-million more people will receive subsidized health care if voters approve Amendment 2. Some estimates range considerably higher. If we expand Medicaid, any individual earning up to $18,000 a year could receive free health care from the government. A family of four will qualify if they earn less than $36,000.

Medicaid is already the single largest drain on Missouri’s state budget. The Mo HealthNet program costs about $10 billion each year, or roughly one-third of the state budget in a normal year (the 2021 budget is an outlier due to COVID-19 expenses). The share of Missouri’s budget devoted to caring for the young, sick, aged and disabled increases every year and is expected to continue to grow. Other programs, including schools, roads and public safety, scrape by as Medicaid consumes more and more taxpayer dollars every year.

The groups arguing for Medicaid expansion claim most of the increased cost will be borne by Washington, D.C. It is true the federal government will cover 90 percent of expanded coverage initially. The other 10 percent has to come from somewhere, though. The ballot language voters will see on Aug. 4 says the on-going costs of Medicaid expansion are “unknown,” but could reach $200 million a year, according to official budget estimates. This comes at a time when the governor has announced more than $400 million in withholds from the 2021 budget. If we don’t have the money to meet our current budget projections, I don’t know where the state will find an extra $200 million to pay for Medicaid expansion.

Proponents claim expansion won’t cost that much, or it could even save us money. Let’s just say I’m skeptical. Other states where Medicaid has expanded have reported costs and enrollments exceeding original estimates. It would not surprise me if the rosy scenarios presented by expansion advocates in Missouri turn out to be wishful thinking as well. Regardless of how the numbers actually play out, there’s no guarantee the federal government will continue to fund 90 percent of the program in the future. What then? Do we then deny coverage after we’ve provided it, or do we raise taxes and reduce services to cover the ever-rising costs?

I have been a state legislator for nearly 16 years now. I have served on the Senate Appropriations Committee and have seen first-hand how difficult it is to stretch limited state resources to provide services to Missouri’s most vulnerable citizens. In a perfect world, I suppose we might want to provide health care coverage to everyone, but I don’t believe the money is there to do that. For that reason, I will vote “no” on Amendment 2.

It’s my opinion that Amendment 2 offers voters an impossible choice. The measure asks voters whether we should expand Medicaid, but it doesn’t say how we’re going to pay for it, or what sacrifices will need to be made to maintain the increased coverage. Those are critical factors to consider as we decide whether to grow an already oversized program. I hope every voter will consider those questions as they decide how they’ll vote on Aug. 4.

It is my great honor to represent the citizens of the 33rd Senatorial District. Although the Legislature has adjourned for 2020, I remain your senator throughout the year. If there’s anything that I can do to assist you, please feel free to contact my Capitol office at (573) 751-1882.