The ‘Government’ Will Pay For It
“I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence, the money of their constituents.” ̶ James Madison, U.S. president, co-author of the Federalist Papers
In August, Missouri voters will be asked to consider expanding a government program that already consumes nearly one-third of the state’s budget. Amendment 2, placed on the ballot by initiative petition, would require Missouri to provide health care coverage to any adult, age 19-64, who earns less than 133 percent of the federal poverty level.
In 2010, Congress passed the Patient Protection and Affordable Care Act, sometimes referred to as “Obamacare.” The most comprehensive expansion of health care coverage since the creation of Medicaid and Medicare in 1965, Obamacare has endured a number of legal challenges and legislative revisions since its passage. In 2014, the Supreme Court ruled states could opt-out of a provision requiring Medicaid coverage for low-income residents. Missouri is one of 14 states that have chosen not to expend taxpayer funds to insure able-bodied adults.
In Missouri, Medicaid is administered by the Mo HealthNet program. Coverage is generally limited to low-income children, parents of low-income children, pregnant women and blind or disabled individuals. More than 60% of those receiving benefits are children. Low-income seniors may also receive Medicaid benefits in addition to Medicare. Currently, about 900,000 Missourians receive Mo HealthNet benefits. That’s one out of every seven Missourians. The Kaiser Family Foundation, a proponent of Medicaid expansion, predicts passage of Amendment 2 will provide taxpayer-funded health insurance to an additional 200,000 Missourians. The Urban Institute puts the number closer to 350,000. Backers of Medicaid expansion argue that most of the increased cost will be paid by the federal government – ignoring the fact that Missourians pay federal taxes. Opponents of expansion worry the state share of Medicaid expansion will bankrupt available resources and only grow over time.
In 2019, the Missouri Department of Social Services published a review of the Mo HealthNet program showing Medicaid is consuming an ever-larger share of state resources, increasing from 17 percent in 2009 to 24 percent in 2018. The department predicted Medicaid would require 30 percent of Missouri’s general revenue by 2023. General revenue – the portion of the state budget you pay for in taxes – is only part of the picture, however. Medicaid expenditures are also paid with federal funding (your tax dollars) and fees and taxes paid by health providers (and inevitably passed along to patients). Viewed from the perspective of the total state budget, Medicaid is already Missouri’s single largest expense.
With health care costs outpacing growth in the economy even before COVID-19 took its toll, we face the prospect of serious challenges to Missouri’s budget. If voters approve Amendment 2, the taxpayers of Missouri will provide health care insurance to able-bodied individuals earning less than $17,608 per year (or a family of four who earn less than $36,000). One can argue that providing insurance to those who struggle to afford care is an act of compassion, but where will the money come from? Ultimately, it will come from you, the taxpayer. But in terms of the budget, something else will need to be cut to cover the added cost. Will it be schools? Roads? Public safety? Should we raise taxes to cover the added expense?
Busting the budget or raising taxes are not our only options. In my opinion, greater price transparency and further reliance on telehealth technology can help make health care more affordable. We can also combat the run-away cost of health care by reforming oversight of the medical profession and increasing competitiveness.
I hope all voters will educate themselves about the costs of Medicaid expansion. I have found compelling arguments against Amendment 2 from the Americans For Prosperity organization and look forward to a series of town halls the group will host in cities across Missouri in June and July. If you’d like to learn more about this topic, I’d encourage you to seek them out.
COVID-19 UPDATE: As Missourians continue to recover from the economic downturn caused by COVID-19 they need to be aware of changes to two programs intended to provide relief.
Employers who borrowed money through the U.S. Small Business Administration’s Paycheck Protection Program now have until Dec. 31 to qualify for loan forgiveness. Originally, borrowed money must have been spent on qualified expenses prior to June 30. Legislation recently passed by Congress also increases the percentage of non-payroll expenses eligible for forgiveness.
The second update applies to Missourians who receive unemployment insurance benefits.
Effective July 5, the Division of Employment Security is reinstating two long-standing provisions of the unemployment insurance system. Individuals receiving benefits will again be required to demonstrate they’re trying to find a job. Each unemployment claimant will need to report three work search activities each week. Also, new applicants for unemployment benefits will again be subject to a one-week delay before receiving their first check.
Finally, recently I have received emails from constituents asking for nothing, but assuring me that during these trying times they are praying for me and for my colleagues in public service. The assurance of their prayers lifts my spirits and humbles me before Almighty God who, alone, can direct our path through and out of the trials of our day. May you look to Him and find Him faithful in the midst of your storms.
Thank you for reading this legislative report. You can contact my office at (573) 751-2108 if you have any questions. Thank you and we welcome your prayers for the proper application of state government.
Jefferson City, MO 65101
The ‘Government’ Will Pay For It