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On the Trail, an occasional column by St. Louis Public Radio political reporter Jason Rosenbaum, takes an analytical look at politics and policy across Missouri.

Medicaid Fight Showcases Broader Missouri GOP Effort To Raise Ballot Initiative Bar

Illinois was one of three states that held primaries on March 17, 2020. Voter turnout was lower than usual, officials say.
David Kovaluk | St. Louis Public Radio
Missouri lawmakers are mulling whether to make it harder to pass ballot initiatives.

Autumn Stultz makes too much money to qualify for Medicaid, but would if Missouri follows through with a ballot initiative that passed last year.

With the legislature refusing to fund expansion, Stultz, who works as a caregiver for her mother in Springfield, is understandably anxious about whether she can afford medical care for herself.

“They’re not listening to the Missouri voters. They’re not listening to their constituents,” Stultz said. “And it’s really ticking a lot of people off.”

Republicans have put forth a number of reasons why they’re not funding Medicaid expansion, primarily how they don’t want to saddle the state with future financial commitments. But the debate over that ballot item is part of a broader aversion among some Republicans to the initiative petition process. And Missouri is following other GOP-led states in trying to curtail groups from getting big policy proposals up for a public vote.

Friday Legislative Roundup With The Missouri Independent
Missouri Independent editor-in-chief Jason Hancock explains what’s happening in the Missouri legislature. The discussion delves into various topics, including the decision to not fund Medicaid expansion, COVID-19 liability and vaccine passports.

GOP lawmakers believe that the legislature is a better method for hashing out complicated policy matters. They also contend that groups pushing ballot items often mislead voters into supporting things with far-reaching consequences.

“So I am proud to stand against the will of the people who were lied to,” said state Rep. Justin Hill, R-St. Charles County, in a recent debate on Medicaid expansion. “Because that’s our job. We took an oath to protect our citizens.”

Others, though, say that lawmakers should leave the initiative petition process alone, especially since it can be used to get around an intransigent legislature that refused to pass important public policy proposals.

“Legislators are inside trying to subvert our will and deny funding for implementing expansion,” said Mallory Rusch of the anti-poverty group Empower Missouri. “This is why we need a strong initiative petition process.”

Missouri Gov. Mike Parson enters the Senate Chambers before delivering his State of the State address on Wednesday, January 27, 2021, at the Missouri State Capitol in Jefferson City.
Daniel Shular
Special to St. Louis Public Radio
Missouri Gov. Mike Parson enters the Senate chambers before delivering his State of the State address in January at the state Capitol in Jefferson City. Parson declared in the speech that Medicaid expansion funding would be in his budget, but lawmakers have declined to actually appropriate that money.

Ballot items in GOP focus

Unlike states such as Illinois, Missouri offers the ability for groups to put particular issues up for a vote if they submit enough signatures in different congressional districts. While this process requires groups to be well-organized and well-funded, it has allowed initiatives like Medicaid expansion, an overhaul of state legislative redistricting and a minimum wage hike to pass in recent years.

When Democratic Gov. Jay Nixon was in office, conservative-leaning groups used the ballot item process to pass gun, health care and agricultural initiatives.

Last year, the GOP legislature placed a constitutional amendment on the ballot known as Amendment 3 that repealed the so-called Clean Missouri state legislative redistricting system. Voters backed Amendment 3, even though opponents outspent supporters.

Medicaid expansion opponents are taking a different approach this legislative session. They contend that since the constitutional amendment doesn’t specify a particular funding source for expansion, the legislature doesn’t have to budget for it.

This also comes as people like House Budget Committee Chairman Cody Smith have sought to slow down a 2018 ballot initiative that raised the minimum wage to $12 an hour by 2023. Smith said voters didn’t understand the consequences of that measure toward certain businesses.

“And they don’t really have all of the information that they need to make the most informed decision, because it’s simply not available to them,” Smith said. “There are campaigns, political campaigns essentially that are highlighting benefits of this and don’t highlight the negative consequences of this.”

Republican leaders like Secretary of State Jay Ashcroft have long contended that the initiative petition process isn’t a good venue to hash out complicated policy initiatives. Rather, he said, the legislature is the better venue.

“The people elected legislators to represent them,” Ashcroft said. “We are not a democracy, we are a constitutional republic.”

Jonathan Rand of Kansas City holds a sign during a rally of groups at the State Capitol looking to stop state legislation they say will hurt voters rights.
Jonathan Ahl
St. Louis Public Radio
Jonathan Rand of Kansas City holds a sign this week during a rally of groups at the state Capitol looking to stop legislation they say will hurt voters rights.

Higher bar?

Ashcroft supports efforts currently moving through the legislature that would raise the bar to get certain initiative petitions up for a vote.

GOP lawmakers have put forward proposals that would increase the number of signatures necessary for measures to get on the ballot. They’ve also backed plans that would raise the amount of votes needed for a constitutional amendment to pass from a simple majority to two-thirds.

“This is the constitution of the state of Missouri. And I think we have to hold it to a higher standard,” said state Rep. Dan Shaul, R-Jefferson County, who heads the House Elections Committee. “It needs to be a higher standard than the dog catcher election this year.”

Whether those changes actually are implemented is up to Missouri voters, since some of the plans being debated are constitutional amendments that require statewide ballot approval. And it’s likely those proposals will engender bipartisan opposition.

Benjamin Singer, executive director of Show Me Integrity, which is trying to get a measure on the ballot altering the state’s legislative term limits, said that raising the signature and passage threshold for amendments is a mistake.

“It’s pretty much impossible to get two-thirds of Missourians to support anything,” Singer said. “It’s a deliberately insurmountable supermajority that is designed to make it impossible to pass anything via the ballot initiative process.”

Carl Bearden of United for Missouri, which backs conservative issues, doesn’t like the Medicaid expansion ballot initiative but doesn’t agree with efforts to make the initiative petition process more difficult. He said doing so would make it more difficult for conservative groups to implement policy change if the legislature or governor shifts leftward.

He also said that Republicans complaining about the initiative petition process should really be more upset that conservative groups offered up underfunded opposition campaigns to things like Medicaid expansion or the minimum wage increase.

“You can beat a lot of things if you have opposition to them,” Bearden said. “And so when people think that these left-leaning things are passing because it’s what the people of Missouri want, it’s because there’s been no two-sided argument.”

Missouri House Minority Leader Crystal Quade gives a response to Governor Mike Parson's State of the State address and takes questions from reporters outside of her office on Wednesday, January 27, 2021, at the Missouri State Capitol Building in Jefferson City.
File photo I Daniel Shular
Special to St. Louis Public Radio
Missouri House Minority Leader Crystal Quade has said the fight over Medicaid expansion is "no more than a temper tantrum from petulant children who didn’t get their way.”

Waiting and seeing

Whether the GOP-controlled legislature moves to place changes to the initiative petition process on the ballot this year remains to be seen. But it’s likely Medicaid expansion will end up in the courts.

Democrats like state Rep. Ashley Bland Manlove of Kansas City say the fight is somewhat ironic, since it’s possible that Medicaid expansion could help rural Missourians more than anyone else. That’s the same group of people that tend to vote for Republican legislative candidates.

“It’s the rural hospitals that are closing,” Bland Manlove said. “And it’s the rural people who don’t have the access. So they’re hurting their own constituency. And I don’t think they’re educating their constituency on what that effect will really be.”

C. Garcia, a Kansas City resident who would qualify for Medicaid if expansion goes through, said the issue should prompt more people to become engaged and pay attention to health care.

“And when our basic needs aren’t met, this is where we need our government and our society and our systems to change,” Garcia said. “I think regardless of who applies the pressure, that mindset needs to be held among the judges, among the legislature, and among people. Health care is a basic human right, and we should start treating it as such.”

Follow Jason on Twitter: @jrosenbaum

Jason is the politics correspondent for St. Louis Public Radio.