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Legislative season ends without passing bill crucial to Medicaid funding

Special session is planned to renew $2.3 billion in provider taxes

JEFFERSON CITY – Missouri lawmakers ended the 2021 legislative session with a $2 billion question left unanswered

For the first time in 30 years, the Legislature failed to renew taxes on hospitals, nursing homes and pharmacies that last year accounted for $2.3 billion of Missouri’s $10.8 billion Medicaid program. 

A fight over birth control and abortion derailed the typically routine renewal, exposed deep fissures within the Senate GOP caucus and sparked a filibuster by Democrats that sunk the session’s final day.

Now, lawmakers have no choice but to return to Jefferson City for a special session before the taxes expire in September. 

Yet the issues that upended the process in the first place aren’t going anywhere. 

Sen. Paul Wieland, R-Imperial, sponsored the amendment that locked the Senate in a debate over whether to put restrictions on the types of contraceptives available to Medicaid recipients.

He isn’t expected to back down.

“Next week will be a time to kind of sit back and regroup, figure out where we’re at and refocus on where we’re going to go right now,” Wieland said. 

For Democrats who held the floor from the moment the final day’s session started Friday until the Senate adjourned four hours before the constitutional deadline, the failure was one of politics getting in the way of responsible government.

“It’s sad, because it’s not about providing health care for people by passing FRA, it’s not about providing health care through expanded Medicaid like the people want,” said Senate Minority Leader John Rizzo, D-Independence. “It is about their next office. It’s about how fast and quickly they can get more power.”

The failure of the tax bill, known as the federal reimbursement allowance (FRA), capped a legislative session that made history — not only for bills that lived or died, but for the drama. 

The Republican-dominated legislature ended Missouri’s designation as the only state without a prescription drug monitoring program to combat opioid abuse.  They also muscled through the first tax hike that would go into effect on a governor’s signature in 28 years, voting to incrementally increase the gas tax from to 29.5 cents per gallon by 2025. 

In a major victory for school-choice advocates, lawmakers voted to create a scholarship program designed to cover certain education costs, such as private school tuition.

Legislation that would allow Missouri utility companies to speed their transition to renewable energy won near unanimous support.  

A bill that criminalizes the enforcement of certain federal gun laws — and fines officers that “infringe” on Second Amendment rights — overcame Democratic resistance to win passage.

And a crime bill won passage that included a myriad of reforms long sought by advocates, from banning police chokeholds to permitting local prosecutors to ask a judge to throw out convictions in innocence cases.

“We are standing here today, standing on the top of a record of accomplishments, conservative accomplishments, things that we’ve worked for decades, in some cases, as it relates to education reform, to get across the finish line,” said Senate Majority Leader Caleb Rowden, R-Columbia.

But lawmakers made history for other reasons in 2021. 

For the first time since the Civil War, the Missouri House expelled one of its members, and for the first time ever a representative was censured. Another member was booted from the GOP caucus after being indicted on federal medical fraud charges

Fight over Medicaid

Senate President Pro Tem Dave Schatz, left, listens to an answer from Senate Majority Leader Caleb Rowden (Rudi Keller/Missouri Independent).

Republicans celebrated a litany of legislative wins on Friday. But the 2021 legislative session may likely be remembered more for what lawmakers didn’t do — pass the FRA or fund voter-approved Medicaid expansion.

The last gasp for the FRA came after 3 a.m. Friday morning, when Senate leadership made a final stab at passing the extension without including provisions about contraceptive coverage.

But Senate leadership faced a dilemma. 

An extension that included a ban on certain contraceptives would trigger a Democratic filibuster. An extension without it would trigger a filibuster by Republicans.

The vehicle was a bill on hearing aids sponsored by Sen. Bill White, R-Joplin.

The House added a one-year extension, and when White asked the Senate to pass it, Sen. Bob Onder, R-Lake St. Louis, asked instead that the bill be sent back to add language limiting the type of contraceptive products and medications the state will allow.

“Taking this to conference is a dead end which kills FRA funding,” White said, later adding: “There would be no other choice to have a special session if we do this.”

As debate went on, Wieland suggested White was not committed to opposing abortion rights. 

“I’m just trying to find out if you are pro-life or not,” Wieland said.

White exploded.

“I think in my life I have been a little more pro-life than a lot of people who want to talk about it,” White said, noting he has adopted foster children and worked with juveniles, among other actions.

Onder prevailed 16-14, with the help of Senate President Pro Tem Dave Schatz, killing the chances of passing an FRA extension during the regular session. 

Democrats, enraged over what they saw as a betrayal by Schatz, retaliated with a day-long filibuster Friday morning that eventually forced the chamber to adjourn four-hours early. 

The provider taxes expire Sept. 30 and the constitution gives lawmakers 60 days for a special session. An extension is simple legislatively if the only issue is how long to extend it, House Budget Committee Chairman Cody Smith acknowledged at a post-session news conference, but politically complicated because of the determination of Wieland and others to add the contraceptive ban language.

One idea is give the taxes a long sunset that will prevent political brinksmanship.

“I’ve got about four years left in the house, including this year,” Smith said. “So I’m thinking maybe a four-year renewal sounds pretty good right now. I think that’s where we’ll start the conversation.”

The early adjournment upset Republicans in the House, who said it was disrespectful for the Senate to go home and kill so many legislative priorities. 

“If you pass any Senate bill in this chamber, you’re voting to encourage bad behavior,” said Rep. Don Rone, R-Portageville.

Cooler heads prevailed, and the House continued working on bills through the afternoon.

Beyond the FRA, the House and Senate also refused to allocate funding for Medicaid expansion, despite voters approving a constitutional amendment last year expanding coverage to 275,000 Missourians. 

Parson originally included the funding in his budget and vowed to abide by the will of the voters. But on Thursday he did an about face, abandoning his expansion plans and citing the lack of funding as his reason. 

Democrats and healthcare advocates decried the move, saying Parson was thumbing his nose at the constitution and the voters of the state. 

“Medicaid expansion will still happen, as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it,” said House Minority Leader Crystal Quade, D-Springfield.


The Missouri House chamber (photo courtesy Tim Bommel/Missouri House Communications)

When lawmakers returned to Jefferson City in January, proceedings were almost immediately disrupted by COVID-19

An early Capitol outbreak caused the House to cancel a week of session and later forced Parson to forgo the traditional State of the State address in the House chamber. Weeks later, the virus hit the Senate

Yet as the virus’ spread began to dwindle in Missouri and around the country, the outbreaks in the Capitol also petered out, and the final months progressed without any further cancellations. 

But the pandemic did inspire several pieces of legislation. 

One bill aims to rein in local public health orders and ban so-called vaccine passports

Under the bill, restrictions during a state of emergency would be capped at 30 days in a 180-day period. Extensions for an additional 30 days must be approved by a simple majority vote of the local health authority’s governing body — such as a county commission or city council — after a report is provided outlining the need for such an extension.

If health orders are issued outside of a state of emergency, then their length would be limited to 21 days in a 180-day period and require a two-thirds majority vote for extensions.

The bill also contains a provision that would bar cities, counties, towns or villages receiving public funds from requiring documentation of someone’s COVID vaccination status to access transportation of public accommodations.

Another bill that would shield businesses and healthcare providers from most COVID-related lawsuits remained under consideration in the House as the clock for the session ticked down.

GOP infighting

Missouri Gov. Mike Parson delivered his State of the State address on Jan. 27, 2021 (photo courtesy of Missouri Governor’s Office).

The Senate’s implosion over the FRA extension may have been the most high-profile squabble of the session. But it was far from the only one in a session marked by intra-party conflict. 

After Parson was prevented from delivering his State of the State in the House, he sent an aggrieved letter to GOP lawmakers accusing House leadership of a “purposeful and disgusting scheme to embarrass me.” 

The governor also faced off with senators over his appointments to the University of Missouri Board of Curators, with a handful of Republicans leading a short-lived filibuster of the nomination of former Missouri GOP Chairman Todd Graves. 

Parson secured Graves’ nomination by cutting a deal with Senate Democrats

The House Budget committee criticized the Parson administration for delays and barriers lawmakers have faced getting information about vaccination distribution. Another committee slammed the Department of Social Services for underreporting to lawmakers the number of substantiated cases of abuse and neglect at youth residential facilities.

And over the last week, Parson has threatened to veto two efforts by the House to enhance its investigatory authority. 

Both the House and Senate criticized Parson’s refusal to forgive mistakenly paid unemployment benefits from 2020, though a bill forcing the governor’s hand died when the Senate adjourned. 

Failure to act on the unemployment debt is one of the disappointments of the session, House Speaker Rob Vescovo said.

“I would say that issue is not over,” he said. “I will tell you that the majority of the people standing behind me cared about that issue, we still continue to care about that issue.”

In the Senate, some Republicans bristled at GOP leadership, saying the chamber was prioritizing things such as raising the gas tax and a prescription drug monitoring program over issues such as abortion and gun rights. 

“We’re passing bills that almost embarrass me,” Wieland said. “When I go home, people say ‘I thought we elected a bunch of conservative Republicans.’”

Winners and losers

A few stragglers collect their papers in the Missouri Senate after the body adjourned four hours ahead of the constitutional deadline on May 14, 2021 (Rudi Keller/Missouri Independent).

Among the other proposals to find success this session were a pair of bills that expand tax credits for foster and adoptive families and another that aims to provide greater oversight and better protections for students at unlicensed religious reform schools.

House and Senate negotiators agreed on a compromise that allowed for passage of a bill allowing the collection of taxes on online sales

Also heading to Parson’s desk is a bill penalizing cities that cut police budgets and bolstering protections for officers under investigation for misconduct. 

Lawmakers signed off on legislation removing several St. Louis area counties from a federally-mandated emissions inspection program, potentially putting millions of dollars in federal funds at risk. 

But several GOP priorities never made it across the finish line. 

A push to reinstate a photo ID requirement to vote ran out of steam in the Senate, as did a push to make it harder for Missourians to change state law through the initiative petition process. 

A three-pronged effort to expand gambling in Missouri while suppressing unregulated devices that offer cash prizes to players sputtered. The same happened to legislation that would effectively kill the proposed Grain Belt Express transmission line.

An effort to bar the state’s Department of Natural Resources from enacting stricter hazardous waste than the federal Environmental Protection Agency died in the House. The bill would have also removed the authority of the Hazardous Waste Management Commission, the Air Conservation Commission and the Clean Water Commission to set permit fees, starting in August.

Republicans were also unsuccessful in their efforts to ban transgender students participating on the sports teams that match their gender identity. And despite proponents using procedural maneuvers to try to get it done, a bill outlawing discrimination against LGBTQ Missourians failed to get traction for the 23rd straight year. 

House Democrats took the GOP defeats as caucus victories. Many of the major bills that passed, such as the gas tax increase, the online sales tax and the prescription drug monitoring program, were only passed because Democrats backed them and worked alongside Republicans, Quade said at the Democrats’ session ending news conference.

House Democrats saw 25 of their bills passed, many with Republicans as lead sponsors to build support, but it shows their legislative savvy, Quade said.

“I think that our caucus is getting stronger and stronger every single day,” she said. “And our ability to maneuver throughout this building is getting stronger every day. And it doesn’t take a supermajority, to me, to pass the legislation.”

This article in published by permission of The Missouri Independent. The Independent’s Jason Hancock, Rudi Keller, Tessa Weinberg, Allison Kite and Rebecca Rivas collaborated on this report. 

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