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Missouri lawmakers strike deal on anti-abortion language in Medicaid funding bill

Abortion opponents think they have a deal that would curtail the availability of some contraceptive options for Medicaid recipients that won’t endanger the entire system of medical care for the indigent.

If approved, the language would be inserted into a bill vital to financing the state’s share of Medicaid. Lawmakers involved in the discussions declined to provide details of the deal they’ve worked out.

That bill has been in limbo since late last month, when Sen. Paul Wieland, R-Imperial, succeeded in adding language blocking the state Medicaid program from paying for any FDA-approved medication or device that would cause “destruction of, or prevent the implantation of” a fertilized ovum.

“We have had a conversation and we are close to having a plan worked out,” said Sen. Dan Hegeman, R-Cosby, and sponsor of the bill to renew provider taxes that generate $3 billion annually for Medicaid.

Called the federal reimbursement allowance, the taxes on hospitals, pharmacies, nursing homes and ambulance services lessen the program’s burdens on general revenue and allow the state to pay higher rates to providers than it could otherwise.

“I would love to get the FRA done,” Hegeman said. But there’s no timeline for getting the bill back on the Senate floor, Hegeman said. 

There is a deadline, however, for passing the state budget, which includes about $3 billion from provider taxes. Lawmakers must be finished with appropriation bills by May 7.

Gov. Mike Parson’s budget for the coming fiscal year pegged the cost of Medicaid at $14.1 billion, including $2.7 billion of general revenue. That amount includes about $1.9 billion to pay for expanded Medicaid coverage for working-age adults.

Wieland’s original amendment put the entire program in danger because it would block access to commonly used contraceptives, a health care service required by federal law.

The Affordable Care Act passed in 2010 made birth control an essential health benefit that all insurance plans must provide. Every state Medicaid program must provide the same set of health benefits, and failure to do so puts the state out of compliance with federal law.

Those products include levonorgestrel, commonly called the “morning after” pill; and some intrauterine devices, or IUDs. 

Levonorgestrel can prevent fertilization if used soon after intercourse. IUDs are designed to prevent fertilization as well either through spermicidal action or hormonal treatments. Both types of contraception also prevent implantation if fertilization occurs.

Federal law already bars the use of federal Medicaid funds to pay for abortions, and Missouri law mirrors that limitation.

Wieland declined to give details of the substitute language, saying he would hold it until the bill returned to the floor.

“I think we have come to a spot where we can reach a compromise,” he said. “There are a few wrinkles to iron out, but I think we are going to be OK.”

With strong anti-abortion sentiment dominating the legislature, every significant step taken to limit access or funding generates a court challenge. Last June the Missouri Supreme Court ruled that lawmakers could not bar Planned Parenthood from being a Medicaid provider just because some of its clinics offer abortions.

Every Democrat in the Senate opposed Wieland’s original amendment during debate in March and have been excluded from negotiations over revisions.

Minority Leader John Rizzo, D-Independence, said Tuesday that he could not comment on the deal between Hegeman and Wieland because he had not seen the new language and had not spoken to either senator.

This article by Rudi Keller is published by permission of The Missouri Independent.

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