Hartmann: Missouri Republicans Can't Quit Medicaid

Apparently, drowning puppies didn’t poll well enough.

So, state Representative Cody Smith, R-Carthage, has settled for the next best evil pursuit he could find: taking away health care from poor people across Missouri at the next opportunity.

Smith, the House budget chairman, has proposed — once again — that Missouri’s politicians be granted their God-given right to deny health care for working poor folk in the state. Presumably in the name of Jesus.

If Smith has his way, voters will go to the polls in November and return the state legislature’s power to deny health care to many of those who received it when the same voters demanded Medicaid expansion in August 2020. It’s conveniently timed to turn out the Republican base for the 2022 U.S. Senate race, among others in the general election.

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Well, it’s some of the same voters, just not the ones Smith represents in rural Missouri. The 2020 vote passed by a solid 6.5-point margin (53.27 percent to 46.73 percent). Trouble is, much of that 46.73 percent were real Americans in places like Smith’s hometown of Carthage near the Kansas and Oklahoma borders. The majority included too many minorities.

Smith was one of the Republicans who wasn’t such a good loser back then. It hadn’t yet become fashionable at the time to blame all GOP election defeats upon nonexistent voter fraud, so Smith had this to say on the day after the vote:

“Amendment 2 will be a knockout blow to the state budget as more services will be cut or eliminated to pay for the health care of able-bodied adults.”

Well, that was certainly prescient. If by “knockout blow” Smith meant getting forced to receive nearly a billion federal dollars ($968 million) for expanding Medicaid, then that’s Missouri on the canvas.

In fairness to Smith, it’s tough being a budget chairman at a time of unprecedented billions in budget surpluses when your lodestar is that government spending is evil. Well, except for lending a helping hand to the right sorts of folks, if you know what I mean.

Now it does remain to be seen whether Smith was merely acting out some Marie Antoinette fantasies or actually speaking for his party when he made news last Friday on this subject. Given that Smith is indeed part of the Missouri House leadership, the following passage in the news coverage raised a few eyebrows:

“House Speaker Rob Vescovo, R-Arnold, offered no hint of his position on Smith’s proposal Friday. ‘I need to talk to Cody about it,’ Vescovo told the St. Louis Post-Dispatch. ‘I’ve read it; I just don’t have any comment on it yet.’”

Vescovo, from Arnold, is in his final year in the House because of term limits. Like Smith, he’s one of the more conservative members of the caucus. (His lifetime rating of 89.26 percent from the American Conservative Union ranks him 23rd among 111 GOP House members. Smith ranks two places ahead at 21st.)

But the Missouri Supreme Court just last year unanimously affirmed the constitutionality of the 2020 vote to expand Medicaid. And any decision to mount such a craven attack on Missouri’s working poor would ultimately seem more political than ideological.

Perhaps Vescovo was blindsided by Smith’s proposal. Or maybe this was all scripted. Perhaps Republicans are suffering from truly poor communication among their leaders. They did, after all, come out of the gates warring with one another while Democrats — you might recognize them as the only people wearing masks — enjoyed their popcorn.

But at the end of the day, the bigger story is that Smith — and presumably other Republicans — just cannot let go of their Medicaid obsession. It’s one part heartlessness, the other part fiscal insanity. As to the latter, reinstating the policy of forgoing annual billions in federal tax dollars so that they might better be spent by other states speaks for itself.

And so does this: Providing modest health care to working poor people — those barely above the poverty level despite the fact they are employed — is obviously the right thing to do from a moral perspective. And Medicaid expansion promotes everyone’s health, including those of us not on the program.

Don’t try to tell this to Republicans during a pandemic, but there is an interactive component to public health. For example, just about all of us interact with employees at fast-food restaurants, convenience stores and the like. Many of them fall into the category of people for whom Smith and company would deny coverage.

As I’ve asked before, if you go into a fast-food place and there are two cashier lines — one with a sign that says “this cashier has health care” and the other indicating “this cashier doesn’t have health care” — which one would you get into? Even Republicans would gladly wait in line a bit longer for their McNuggets.

The logical extension of that principle of interactivity is that one ought not to have the right to spread infectious disease to others as “a personal health-care choice.” But I digress.

Back to the denial of health care to the poor — Smith’s favorite cause when he’s not fighting against following the voters’ dictate to raise the minimum wage — the House Budget Committee chairman has even dredged up the strange MAGA argument that Missouri must establish a “work requirement” to be met by the working poor.

That brilliant idea was annihilated all the way back in 2018 in the Journal of the American Medical Association:

“A Kaiser Family Foundation analysis from spring of 2017 found that almost 80% of adults in Medicaid are from working families. Almost 60% are working themselves, and this is without any work requirements at all. Of those who don’t work, about 35% are unable to work because of disability or illness. Another 28% are taking care of other members of their families in lieu of jobs. Of those that remain, 18% are students, 8% are looking for work but can’t find it, and 8% are retired. That leaves about 3% of the nonworking adult Medicaid population who we could, possibly, define as ‘able-bodied’ yet choosing not to work.”

What a fine group of people to target in 2022 here in Missouri. After all, why should hard-working taxpayers be subsidizing lazy welfare loafers like people with disabilities or illness or people taking care of their families or going to school?

Why, Missouri needs to crack down now. If not, it’s only a matter of time before we’ll be giving handouts to people staying at home to take care of their dogs.

And the polling certainly would be different on that.

Ray Hartmann founded the Riverfront Times in 1977. Contact him at [email protected] or catch him on Donnybrook at 7 p.m. on Thursdays on the Nine Network and St. Louis In the Know With Ray Hartmann from 9 to 11 p.m. Monday thru Friday on KTRS (550 AM).