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Holding Medicaid hostage over birth control defies law and reason

While playing politics with health care in Missouri is certainly nothing new, holding Missouri Medicaid hostage over basic birth control is a stunning — and consequential — shift.

State Sen. Paul Wieland has put the entire Missouri Medicaid program in jeopardy with his late-night amendment to a mandatory Medicaid funding bill — a move he intended only to further restrict abortion in Missouri. Unfortunate for the almost 1 million Missourians enrolled in MO HealthNet (Medicaid), however, the amendment has significant consequences that reach far beyond that intention, despite claims to the contrary.

The Senator’s amendment would prohibit any FDA-approved medication or device that would destroy or prevent a fertilized egg from implanting in the uterus. Birth control, including emergency contraception and intrauterine devices (IUDs), works by preventing ovulation or fertilization. Scientific and medical experts agree, that is not an abortion. However, the Senator’s amendment would ban these forms of birth control.

Almost 1 million Missourians rely on Medicaid services, including more than one in three Missouri children, a percentage even higher in many rural areas of the state. People with disabilities, the elderly, and pregnant women also rely on the program for critical health coverage.

Almost 50,000 women rely on the Women’s Health Services Program, the state family planning program as well. These are our most vulnerable citizens who are otherwise uninsured, disproportionately rural and communities of color. These are real people with real lives, not political bargaining chips.

Birth control is not controversial, it’s basic health care, used by ninety-nine percent of sexually active women of reproductive age. Ninety-nine percent.

Our family planning programs alone — spread throughout the state at health departments, federally-qualified health centers, hospitals, and other stand-alone sites — provided birth control to more than 38,000 Missourians last year. Nationally, 21 million people are in need of publicly funded family planning services.

It isn’t likely this amendment puts MO Medicaid out of compliance with federal law, it’s a certainty.

Family planning is a federally required Medicaid benefit. While states do have some discretion in delivering that benefit, they are still required to adhere to several requirements, including that program participants must be free from coercion or pressure in choosing their method of contraception. That means limiting what methods are available for any reason is unlawful.

The Biden administration has already demonstrated its commitment to uphold federal Medicaid law and eschew other encumbrances to the program, such as work requirements.

Litigation costs incurred by the state over failed legal battles are also nothing to sneeze at.

In February, the State of Missouri was ordered to pay Planned Parenthood $140,000 in legal fees after it instigated and lost a legal licensing battle. The State is also likely to foot the bill of the additional $88,000 being sought in related legal fees stemming from the administrative legal battle.

Planned Parenthood, 4251 Forest Park Avenue in the Central West End. Photo courtesy Planned Parenthood-St. Louis

Anti-abortion Missourians may be alarmed to learn that the state is one of Planned Parenthood’s biggest donors.

Missouri lawmakers can’t tell Missourians we don’t have the funds to expand Medicaid, but do have the funds for losing legal battles over abortion ideology. Last year, there were thirty-nine abortions performed in Missouri, and the state routinely ranks among the lowest states. Meanwhile, Missouri has appalling disparities in infant and maternal mortality and spends $180 million annually on premature births.

Missouri also ranks forty-eighth in overall health, taking big hits in preventive health indicators over the last year. Let us not forget that Missouri also remains under a state travel advisory warning of high risk to Black civil rights and provides no discrimination protections for LGBTQ citizens.

There is no shortage of ways to improve the lives of Missourians.

Countless bills to restrict access to reproductive and general health care are flying through the state legislature. Yet, the few bills that would proactively improve Missourians’ ability to control if, when, and how they become pregnant aren’t even being provided a hearing.

One such bill is SB 472, which requires insurance companies that already provide birth control to cover a yearlong supply at a time, putting Missouri in alignment with public health recommendations and twenty other states. Less trips to the pharmacy and more birth control coverage means less gaps in refills, which over 43 percent of people experience in a year, increasing the likelihood of unintended pregnancy.

While Weiland is crusading Medicaid out of Missouri, he has simultaneously refused to give a committee hearing to this bill, parked at his Senate Insurance and Banking Committee for over a month.

Perhaps the Senate should also study the implications of that.

This commentary by Mandy Hagseth is published by permission of The Missouri Independent.

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