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Missouri Senate clears bill ending Planned Parenthood's Medicaid reimbursements

The Planned Parenthood of the St. Louis Region & Southwest Missouri clinic on Wednesday, April 19, 2023, in the Central West End.
Brian Munoz
St. Louis Public Radio
The Planned Parenthood of the St. Louis Region & Southwest Missouri clinic in April 2023 in St. Louis' Central West End neighborhood.

A bill that would make Planned Parenthood ineligible to receive reimbursements from the state’s Medicaid program passed out of the Missouri Senate early Wednesday morning after an 11-hour Democrat filibuster.

The bill now returns to the House, where it can be sent to Gov. Mike Parson to sign into law.

This legislation, originally filed by Republican state Rep. Cody Smith of Carthage, is nearly identical to a bill filed by state Sen. Mary Elizabeth Coleman, a Republican from Arnold, which was blocked by a Democratic filibuster in February.

The legislation would make it financially tenuous, if not impossible, for the state’s Planned Parenthood clinics to continue seeing patients on Medicaid since the clinics would no longer be reimbursed for the cost of seeing these low-income patients.

Coleman, who is running for Secretary of State, said Tuesday afternoon that she hopes putting her bill into law makes it “abundantly clear to the state of Missouri that people who are engaged in, are associated with, who are providing abortions in the state of Missouri, shall be ineligible to be part of the Medicaid program.”

Missouri was the first state to outlaw abortion in June 2022 after the constitutional right to the procedure was overturned by the U.S. Supreme Court. From June 2022 through 2023 , there were 52 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services.

None took place at Missouri Planned Parenthood clinics; however, Planned Parenthood clinics in the neighboring states of Kansas and Illinois still provide abortions.

“Dollars are fungible,” Coleman said Tuesday.

Her Democratic colleagues blocked a vote on the legislation past midnight, arguing that the state’s health care safety net couldn’t reasonably support displaced Medicaid patients.

State Sen. Tracy McCreery, a Democrat from Olivette, called the bill a “bizarre quest to just continue to punish Planned Parenthood.”

“But the reality is it’s not punishing Planned Parenthood,” she said. “This is hurting our very own constituents.”

Missouri’s Medicaid program, called MO HealthNet, serves low-income and disabled citizens, and has long banned funding for abortion, with limited exceptions. Planned Parenthood clinics primarily provide contraceptives, STI testing, cancer screenings and wellness checks.

The bill was ultimately approved along party lines around 12:30 a.m.

Fog rises off the Missouri River in front of the Missouri State Capitol building on the morning of Wednesday, Jan. 3, 2024 in Jefferson City, Mo.
Tristen Rouse
St. Louis Public Radio
Fog rises off the Missouri River in front of the Missouri State Capitol building on the morning of Jan. 3 in Jefferson City.

Capacity at safety net clinics

The bills filed this session attempt to cut Planned Parenthood’s funding through state law after Missouri Republicans twice tried to end Medicaid reimbursements through the state budget. Both times, including as recently as February, courts ruled those attempts unconstitutional.

Despite the legal victories, Planned Parenthood affiliates in Missouri last month said they have not received any Medicaid reimbursements since 2022.

Emily Wales, CEO and president of Planned Parenthood Great Plains, which oversees clinics in western Missouri, Kansas, Oklahoma and Arkansas, said previously that her organization has been privately fundraising to offset the cost of care to continue seeing Missouri Medicaid patients.

When a similar law passed in Arkansas several years ago, clinics immediately ceased seeing Medicaid patients. Arkansas’ law was upheld by the 8th U.S. Circuit Court of Appeals in St. Louis.

Nearly one in five Planned Parenthood patients in Missouri are on Medicaid. Wales said they’re still evaluating their options if the bill becomes law.

Coleman on Tuesday said this bill is not about access to health care, reiterating that federally qualified health centers, which also take patients on Medicaid, could take on the patients. She again suggested that Planned Parenthood clinics could also drop their Planned Parenthood affiliation to become eligible for reimbursements.

“It’s no politician’s business to tell somebody where they can and can’t go for healthcare,” McCreery said, emphasizing her concerns that patients won’t quickly be able to find new providers.

The Missouri Family Health Council Inc has over the past two years informally surveyed the capacity at the state’s safety net clinics.

When calling to inquire about availability for new patients, the organization found wait times at the state’s Planned Parenthood clinics averaged between the same day and three days to get an appointment. Across the other safety net clinics, wait times averaged between five and seven weeks, with some clinics as few as two weeks and some pausing new patients completely.

In 2022, across all 68 safety net clinics in the state that take Title X funding, around 24% of the clients were on Medicaid, said Michelle Trupiano, the council’s executive director. She previously testified that Planned Parenthood is the primary family planning services provider for about 20,000 patients across the state.

State Sen. Karla May, a Democrat from St. Louis, said in her travels around rural Missouri last year she heard a resounding cry for more health care providers. A bill like this, she argued, would create “chaos.”

McCreery on Tuesday brought forward an amendment that would exempt in vitro fertilization from Missouri’s current statute which states that life begins at conception.

The amendment never made it to a vote, but it fueled much of the Democratic senators’ filibuster.

“I assumed wrongly, stupidly, that when the legislature passed a total ban on abortion, that that would be enough. People would feel like they had their pro life credentials,” said state Sen. Lauren Arthur, a Democrat from Kansas City. “What I have since realized is it’s never enough.”

This story was originally published by The Missouri Independent, part of the States Newsroom.

Anna Spoerre covers reproductive health care for the Missouri Independent.