In 2018, Missouri’s prosecutor General of the time, Josh Hawley, signed disputes to several states aimed at canceling the 2010 law on health care – a decision which, in the event of success, would have eliminated protections for people with pre -existing conditions and ended the expansion of Medicaid to millions of low -income people.
Now, as a senior senator representing the Missouri, Hawley finds himself in the unlikely position to defend Medicaid while his republican colleagues travel $ 880 billion to help prolong the tax cuts by President Donald Trump and pay increased funding for border security.
Hawley has clearly indicated his position in recent weeks: he will not support any proposal that would cause reductions in the benefits of Medicaid for Missourians.
“I just want to know, in the end, whatever reforms or packages of proposed things, this will cause reductions in advantages for Missourians?” It’s my test. ”
What has changed for Hawley, a long-standing critic of the 2010 health care law?
Ballot
In 2020, a majority of Missouri voters Approved a voting measure To enlarge Medicaid in the state to cover more than 348,000 adults winning $ 21,597 per year or less.
“Our voters voted for this. It is not as if the legislative assembly could simply adjust it. It is in our constitution. Our voters voted for this by a great margin,” said Hawley in an interview.
This is an unexpected subject for Hawley, a conservative senator with a long -standing opposition to the 2010 and 85% health care law and 85% notation of the conservative political action conference.
“Senator Hawley is among Medicaid’s most surprising defenders among the Republicans in Congress given his past positions,” said Larry Levitt, executive vice-president of KFF, organization of health policies.
Budget amendment
On April 5, Hawley joined Oregon Democratic Senator Ron Wyden to introduce an amendment to the budgetary resolution which would take an instruction from the Chamber Energy and Trade Committee to find $ 880 billion in savings, most of which should probably come from Medicaid. THE amendment has not been adopted.
Only two other Republicans voted for this: meaning. Susan Collins from Maine and Lisa Murkowski from Alaska. The two also opposed the 2017 efforts to repeal the 2010 law on health care.
However, the three Republicans said that they are open to the institution of work requirements in Medicaid, which, according to criticism, are a means for the same side: saving money via people who lose coverage.
A congress budget office estimate From this provision indicated that by implementing Medicaid’s work requirements, “the employment status and the hours worked by the beneficiaries of Medicaid would be unchanged and the costs of the state would increase”, while the federal costs would decrease by $ 109 billion over 10 years. About 600,000 people could become unlike, projected the CBO.
“Work requirements – I want to be clear – I am for,” said Hawley, who said he had Trump’s commitment not to sign a bill that could reduce Medicaid services. “But beyond that, real reductions in services, no, I will not vote for it.”
Overall, the Republicans, including Hawley, have long opposed the expansion of Medicaid, the legislators of states resident to do so for several years after the 2010 health care law has authorized States the option, even with the federal government which raised 90% of costs.
But voters feel differently, as evidenced by voters of seven states with republican governors Approving the expansion of Medicaid Thanks to voting initiatives.
“To a certain extent, the political dynamics we see on Medicaid reflects the changing republican political basis. In particular with the emergence of President Trump, the republican base has evolved more towards low -income and working class, many of whom depend on Medicaid for coverage,” said Levitt.
The expansion of Medicaid in the red states has built a political salience for the program and made more difficult for republican legislators to cut it, said Kelly Hall, executive director of the equity project, who helped launch the campaigns of the voting initiative to the expansion of Medicaid.
“This is not the last time that we will have to fight this fight, and the next time we need more Republicans,” said Hall in 2017 when former senator John McCain, R-Ariz., Blocked the repeal of the health care law with a now famous movement.
“To have a conversation in 2025, where we are talking not only about millions of people who obtained coverage of Medicaid thanks to these voting measures, but seeing Josh Hawley, who was not a friend of the (health care law) during most of his career, now standing and saying:” I will oppose Medicaid Cuts because of what it means for my state, ” declared Hall.
“This really represents this important notion when you develop Medicaid anywhere, you help protect it everywhere.”
Consecrated in state constitutions
The Missouri is one of the three states, including Oklahoma and Dakota from the South, where voters have not only expanded Medicaid, but also devoted it to the Constitution of the State. This means that if the federal part of the financing of the expansion population was to drop, the Missouri should find other ways to pay for this.
“A state like Missouri should continue with expansion, which would cause a huge change in cost to the state,” said Levitt.
The legislators of certain states already play with the idea of reducing expansion, fueled by an ideological opposition, but also by the fear of the way in which the actions of the congress could have an impact on their budgets.
But at the Missouri, linked by the Constitution to maintain the expansion of Medicaid, Governor Mike Kehoe, a Republican, told Hawley that “significant” changes at the rate of federal correspondence could blow a hole of $ 1 billion in the state budget.
Defenders fear that because the State would not be able to reduce the advantages of the expansion population, it could pursue economy measures to Other populations These states do not have to cover under the law, mainly children, pregnant and older adults who are more than the level of federal poverty. For example, during recessions in 2003 and 2008, some states reduced or frozen suppliers’ reimbursement rates and reduces “optional” advantages not required by law, such as domestic and community services, dental and visual care.
Rate reductions or gels could lead to service providers to accept Medicaid – already A problem in progress at Missouri and elsewhere.
“People could say that we are not going to reduce this, but my concern, in particular because of the constitutional amendment of the Missouri, are the populations that would be available for reduction would be mainly elderly and disabled people who are not necessarily part of the expansion population,” said Richard von Glahn, the director of the Missouri question policies, the state.
Optional services Covered by Missouri Medicaid includes dental, home care, pharmacy services, medical equipment and more.
At Missouri, 26% State spending go to Medicaid – one of the highest rates in the country. The coverage of Medicaid is widespread in the Missouri, covering a fifth of the population, or 1.3 million people, including 2 residents of out of 3 nursing homes, 1 medical beneficiary out of 6 and 40% of births.
Despite the debate on the cost of expansion of Medicaid, most expenses go to the elderly and disabled people who are more likely to have higher health care costs.
Hawley said he would not support legislation that changes the costs of states.
“We are a balanced budget state, which is great. I support that. But that would mean reductions in massive services, “said Hawley.