A coalition of 33 health organizations, providers, researchers, and scholars filed a friend-of-the-court brief in support of Medicaid expansion after three plaintiffs requested emergency relief from the state’s highest court in response to a Cole County Circuit judge ruling against them.
“This amicus brief grew out of my relationship with the National Health Law Program,” said St. Louis attorney John J. Ammann who served as local counsel for the 33 national groups and individuals in filing the brief. “The expansion population are people who go to the emergency room now because they don't have insurance. They might be able to address their health issues without going to the emergency room, which is more expensive if they had access.”
The plaintiffs in Stephanie Doyle, et al. v. Jennifer Tidball, et al appealed to the Missouri Supreme Court after Judge Jon E. Beetem ruled on June 23 that a ballot initiative to approve Medicaid expansion is unconstitutional because the Missouri Constitution requires an appropriation of state revenues.
The high court heard oral arguments on Tuesday, July 13.
“It was an interesting debate,” Ammann told the St. Louis Record. “Judge Brent Powell raised the issue of whether you can even challenge the contents of this constitutional amendment, approved by voters since it's already been passed.”
As previously reported in the St. Louis Record, the ballot initiative in question is Missouri Amendment 2, also known as the Medicaid Expansion Initiative, which voters approved on Aug. 4, 2020. Some 676,687 voted in favor and 593,491 voted against.
“It's hard to see why any state would oppose Medicaid expansion,” Ammann said. “There are philosophical reasons why they don't want to support it but economically and from a health perspective it makes all the sense in the world.”
Another concern that was raised during oral arguments, according to Ammann, was the issue of appropriation.
“The court was interested in whether this constitutional amendment requires an appropriation and does it address appropriations because there's another amendment that says they should not deal with money unless there's a new funding source,” Ammann said.
Medicaid expansion happened nationwide on July 1, however Missouri’s Medicaid plan was withdrawn on May 13 after the legislature failed to include $1.9 billion in the state budget to cover expansion cost.
The Missouri Independent estimates that 275,000 Missouri residents are eligible statewide.
“If the court gives the green light for Medicaid expansion, the Department of Social Services will be able to catch up but it will take some time,” Ammann said. “Advocates will say it should be retroactive. The Department of Social Services has many professionals who deal with Medicaid all the time. It's a matter of computer programs to get up and running that will be done if that is the ruling of the court.”
In the alternative, the amicus brief asks that zero state expenditures be required due to the enactment of the American Rescue Plan Act, which increased the federal matching Medicaid payment rate by 5% on a term basis for 12 holdout states, including Missouri.
“The American Rescue Plan that was recently adopted by Congress and signed by President Biden includes bonus money for states that expand Medicaid,” Ammann added. “Our tax revenues would increase, employment would rise, and it would be good for the economy if we had Medicaid expansion because any money that the state spent, we would get back several times over by the economic expansion.”
The National Health Law Program led the effort in preparing the amicus brief, according to Ammann.