Abortion fight continues on Missouri Medicaid provider taxes

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An attempt to renew a law essential to financing Missouri’s Medicaid program drew fire late Monday from a state Senator who wants to bar Planned Parenthood from participating in the program and an anti-abortion group seeking to block access to contraceptives.

A renewal of the taxes that provide more than $2 billion annually for Medicaid was added Monday by the Missouri House added to a bill that began its legislative life in the Senate as a proposal to allow needle exchange programs. The House Emerging Issues Committee expanded it to cover a variety of health-related topics, from requiring jails to provide feminine hygiene products to training requirements for ambulance district directors.

In a series of quick moves that allowed for no debate, House Budget Committee Chairman Cody Smith added a one-year renewal of the taxes to the bill. His version of the renewal included a provision to ask federal permission to refuse to pay for some contraceptive drugs and devices that prevent implantation of a fertilized ovum.

But Smith did not include the ban on Planned Parenthood participation in Medicaid that is being pushed by Sen. Bob Onder, R-Lake St. Louis, and Onder reacted swiftly on the Senate floor.

“We are certainly not going to (take a final vote on) this tonight, not if I am alive,” Onder said.

Onder said he would request Sen. Holly Rehder, R-Sikeston, to ask the Senate to give permission to add his Planned Parenthood ban during negotiations of a final bill.

Rehder, speaking to The Independent, said she is uncertain whether she will try to get the Senate to pass the bill as approved by the House or seek negotiations for a compromise version.

The state relies on taxes paid by hospitals, pharmacies, nursing homes, and ambulances to finance more than half of Missouri’s share of Medicaid costs. The taxes, known in legislative jargon as reimbursement allowance taxes, were first enacted in 1992 and have been renewed 16 times.

The laws imposing the taxes are currently set to expire on Sept. 30. If there is no renewal by the time lawmakers adjourn Friday, it would mean Gov. Mike Parson will have to call the General Assembly into a special session to pass the extension.

The abortion issue was injected into the debate over the taxes by Sen. Paul Wieland, R-Imperial. In March, the Senate voted 21-12 to add his amendment barring purchases of drugs or devices that prevent implantation of a fertilized ovum.

The primary purpose of the drugs and devices targeted by Wieland are to prevent fertilization but they also work to block a pregnancy if fertilization occurs.

Federal Medicaid rules require states to provide family planning services. Wieland’s amendment stalled the renewal until he agreed to language that would make his amendment moot if it was successfully challenged in court or if it threatened to put Missouri out of compliance with federal rules.

Smith’s amendment to Rehder’s bill directs the state to seek a waiver of those federal rules. That drew the attention of Missouri Right to Life, the state’s largest anti-abortion group. In a memo to lawmakers tweeted by Onder, the organization said there is no chance President Joe Biden’s administration will grant the waiver.

‘Pro-life Missourians are asking ‘Why did Republicans do this when we have a super-majorities in the House and Senate?” the memo signed by three top officials of the organization stated.

Anti-abortion groups are targeting the provider tax renewal because it is one of the few bills moving through the legislature that open the statutes governing Medicaid. Last year, the Missouri Supreme Court ruled that lawmakers could not use appropriation bills to block Planned Parenthood from receiving Medicaid payments. That means the ban must go into stater law, Onder said Monday.

“We keep hearing that (federal reimbursement allowance) is a must-pass bill,” Onder said. “If the Supreme Court tells us we cannot make policy choices about what to fund and what not to fund in the budget, that leaves the statute. The FRA opens up exactly the part of the statute books that need this amendment.”

Rudi Keller


Rudi Keller covers the state budget, energy, and the legislature. He’s spent 22 of his 30 years in journalism covering Missouri government and politics, most recently as the news editor of the Columbia Daily Tribune. Keller has won awards for spot news and investigative reporting.

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