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Opinion: To fund or not to fund … the expansion question


Since this time last year, I’ve engaged my constituents on the important question of Medicaid expansion. My membership on the House Budget Committee proved invaluable as I communicated critical details related to this question. We now face the question to fund or not to fund expansion. Once again, knowing the state’s budget and, more importantly, the state’s ongoing priorities has proven helpful.

Many Missourians are conflicted as they observe the General Assembly coming closer to the formal decision not to fund expansion. The questions that they’re raising are appropriate. The answers explaining the legislature’s current direction are appropriate as well. For those still striving for perspective, the following includes the most common questions and their related answers:

State Rep. Doug Richey

First, “Didn’t Missourians vote to expand? Why would the legislature ignore this mandate?” Missourians did authorize expansion. The authors of the ballot initiative left the question of funding to the General Assembly. They could’ve included the funding component if they desired, by including a tax increase or new tax mechanism. They chose not to include that language. Article III, Section 51, of the Missouri Constitution sets these parameters, and as such, there’s no voter mandate to fund.

Second, “But why not fund expansion?” I can only speak for my reasoning not to fund expansion, along with those shared publicly by fellow members. Simply stated, we have limited taxpayer resources and competing priorities. Each year we observe the unsustainable growth of Medicaid. We’ve experienced a 52 percent cost growth in our current Medicaid program over the past 10 years. This is within a state budget that already sees over 40 percent of our taxpayer resources devoted to social services. It’s obvious to the casual observer that both the federal and state budgets must address this unsustainability. Missouri’s budget must be balanced and reflect the prioritization of state services tied to limited taxpayer resources.

Prioritization involves comparing needs within the social services context. State services caring for the most vulnerable among us are facing a staffing crisis. That’s their description, not mine. This staffing crisis is tied to the will of the voters. When Missourians voted to increase minimum wage, they set the stage for this flashpoint. For our providers, serving the elderly and disabled, to properly staff these services, they must receive additional funding to address the increased minimum wage and wage compression. As it stands, we’re in need of over $260 million in new state tax dollars to begin addressing this issue. When you add this need to the $340 million in new funding required for the current Medicaid program to continue, you begin to see the position within which we stand. Medicaid expansion requires $130 million in new state tax dollars at a time we’re needing those dollars to address the needs of a more vulnerable population. I’m on record for believing that our elderly and disabled population should be prioritized over our younger, healthy, able-bodied Missourians.

Third, “We have federal stimulus dollars available, so why not use those funds to cover the cost of expansion?” Federal stimulus dollars are available; however, they are tied to unique, one-time federal appropriations. Missouri can’t afford to assume that because we have money today, we can afford to expand state services. The expansion of state services necessarily creates perpetual budget obligations into the future. Federal stimulus dollars will dry up, while the costs associated with Medicaid will continually increase. It should be said as well that federal stimulus dollars will dry up, but the federal debt incurred will be with us for generations to come. Remember, the billions required for expansion aren’t Missouri taxpayer dollars returning to our state; they represent Missouri taxpayer indebtedness that will be created every year that we participate.

More can be offered to substantiate the position not to fund expansion, but the aforementioned addresses the most often raised questions. As this discussion continues, Missourians can remain confident that our state demonstrates dedicated compassion within our social services. In many areas, Missouri generously supports the needs of children and the most vulnerable among us. In other areas, we are committed to doing what we can with the limited resources available to us. At the end of the day, we can’t provide everything for everyone that struggles. We have to make difficult choices. One such difficult choice — to fund or not to fund — is before us. I’m grateful that the majority of my colleagues, thus far, have lived up to their responsibility in prioritizing the vulnerable by not funding Medicaid expansion.