© 2024 St. Louis Public Radio
Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations
We will broadcast special coverage of both the Republican and Democratic National Conventions, starting with the RNC tonight at 8.

Missouri Senate gives initial approval to tax that funds state Medicaid system

Senator Rick Brattin, R-Harrisonville, speaks during a post-session press conference on Thursday, Jan. 25, 2024, in Jefferson City. Senate Republican leadership has clashed with members of the Missouri Freedom Caucus holding up business.
Eric Lee
St. Louis Public Radio
Sen. Rick Brattin, pictured in January, was one of the members of the Missouri Freedom Caucus filibustering the passage of the Federal Reimbursement Allowance. Brattin wanted to see the Senate first pass a resolution that would make it harder to amend the Missouri Constitution. He also wanted Gov. Mike Parson to sign a bill that prevents state funding from going to abortion providers or their affiliates. The filibuster ended before those demands were met.

Updated at 11:10 a.m. May 2 with filibuster's end and preliminary approval

The Missouri Senate has given initial approval to a tax that funds roughly one-third of the state’s Medicaid program.

By a voice vote, senators approved a reauthorization to the Federal Reimbursement Allowance. It must still go through another vote to pass out of the Senate.

The tax is set to expire at the end of September. The new legislation extends the FRA through September 2029.

The approval came after a filibuster that lasted over 40 hours.

A group of Senate Republicans said it was not going to allow the FRA to move forward unless the Senate passed a resolution making it harder to amend the constitution.

They also wanted Gov. Mike Parson to sign into law a bill that stops public funding from going to abortion providers or their affiliates, such as Planned Parenthood.

Just before 3:30 a.m. Thursday, the filibuster ended without the demands being met.

Original story from May 1: 

A faction of Republican Missouri senators has spent over 29 hours filibustering a tax that funds a large portion of the state’s Medicaid program.

Five senators, all members of the Missouri Freedom Caucus, began their filibuster of the Federal Reimbursement Allowance around 10:30 a.m. Tuesday, and it continued on Wednesday.

The allowance, which is a tax on hospitals, ambulance districts and other health care-related providers, funds roughly $4.3 billion of the state's Medicaid system — about a third.

The senators say they will continue to stop the allowance from moving forward until the Senate passes an unrelated resolution making it harder to amend the constitution.

They also are demanding Gov. Mike Parson sign into law a bill that would stop public funds from going to abortion providers and their affiliates, like Planned Parenthood.

Sen. Rick Brattin, R-Harrisonville, expressed frustration that the legislature has yet to pass a resolution that, if approved by voters, would make it harder to amend the Missouri constitution.

“I don't see why this is a fight, why we're having to stand up on this floor, why we're there requiring Republicans to have to stand up and raise the issue of the No. 1 priority,” Brattin said.

Making it harder to amend the Missouri constitution has been a priority for Republicans for years. The last few sessions, the issue has died before it could make it out of both chambers.

This year, the proposed resolution would raise the threshold of votes needed to pass a constitutional amendment from a simple majority to both a simple majority and a majority of Missouri’s eight congressional districts.

While the Senate version only contained that threshold increase, the House sent back the Senate resolution with additional provisions that critics have called ballot candy meant to make the measure more appealing to voters.

House Speaker Dean Plocher, R-Des Peres, sent a letter Tuesday to Senate leaders asking them to pass the initiative petition resolution.

“I'm here to ask the Senate to stand up for Missouri's voters,” Plocher said.

Making it harder to amend the state’s constitution has been tied this session to a proposed amendment that would enshrine abortion rights in the Missouri constitution.

If the resolution goes to voters, it could set up a scenario in which the initiative petition resolution is on the ballot in August. If it's approved, the measure could make it harder to pass the abortion amendment in November.

Sen. Nick Schroer, R-Defiance, referenced the abortion amendment Wednesday morning.

“Common sense would dictate that the pressure [is] on and that doomsday [is] before us. It would be now more important than ever to get this to the governor's desk. especially with it being one vote away,” Schroer said.

The last time the Federal Reimbursement Allowance was up for reauthorization in 2021, it took a special session to pass it due to disagreements between Republicans on whether the tax should include anti-abortion language.

This year, similar disagreements have emerged.

Members of the Freedom Caucus said earlier in the session that before the legislature could pass an FRA without anti-abortion language attached, it needed to pass legislation that prohibits public funds from going to abortion providers and their affiliates, like Planned Parenthood.

The legislature has passed that bill, but the caucus now is asking for Parson to sign it.

A statement issued by Parson said he would sign the bill “on his own timeline.”

Speaking about the Federal Reimbursement Allowance on Tuesday night, Sen. Lincoln Hough, R-Springfield, said the tax is a voluntary one that hospitals, nursing homes and others pay into.

That money is then reimbursed by the federal government on a greater scale.

“It draws down about a 3-to-1 return from the federal government,” Hough said.

The allowance is set to expire at the end of September. The legislation up for debate would extend the tax through September 2029. Both Republicans and Democrats have said that reauthorizing the FRA is a priority for this year.

“It was No. 1 on the calendar. It was a situation that we all knew how important this was. Every senator from the top senator to the last senator understood this was essential to passing a balanced budget, to keeping rural hospitals open, to keeping the nursing homes open, Medicaid, all these things right?” Senate Minority Leader John Rizzo, D-Independence, said. “Hospitals, just the complete health care network in the state of Missouri, is relying upon this thing.”

With fewer than three weeks left in the 2024 Missouri legislative session, the legislature must also meet its constitutional obligation to pass a state budget.

The budget, which must pass through the Senate and then is likely to require compromise legislation between the House and Senate, is due May 10.

That means the window to pass the FRA, which must also pass the House if it makes it through the Senate, could be narrow.

The last day of the 2024 session is May 17.

Sarah Kellogg is a Missouri Statehouse and Politics Reporter for St. Louis Public Radio and other public radio stations across the state.