Rural voters said no.
That’s what state Rep. Sara Walsh, R-Ashland, says is the reason why Republicans on the budget committee refuse to follow the Missouri Constitution and fund Medicaid expansion as approved by voters last August.
Never mind that the amendment passed with 53% approval of the voters. Never mind that Gov. Mike Parson, a Republican who opposed Medicaid expansion, properly funded the increased health care for poor people in the state. Never mind that that Parson’s proposed budget recognized precisely what proponents said Medicaid expansion would do, and that is lower some Medicaid costs and create enough jobs that the money from the state budget needed to expand wouldn’t actually take resources from any other priorities, in part because nearly all of the expansion money comes from the federal government.
And never mind that the passage of the American Rescue Plan even made Medicaid expansion better for Missouri’s economy because the federal program rewards states that cover more poor people with health insurance.
Walsh and her fellow Republicans, eschewing democracy, the state constitution and facts, said no, because in the new Republican ethic, only Rural Voters Matter. The move in the House budget committee, which, if it isn’t reversed on the House floor, or later by the Senate, will end up in court. There, Attorney General Eric Schmitt, currently running for the U.S. Senate, will have to decide whether to do his job and defend the Missouri Constitution, or pander to the new overarching identity of the GOP, that elections only matter when Republicans win.
On the same day Missouri Republicans were thumbing their nose at an election, and the state constitution, in Georgia, Republicans were similarly taking a blowtorch to democracy, passing a wide-ranging law inspired by Donald Trump’s Big Lie that will make it significantly harder to vote in that state, particularly if you are poor and Black, and will also make it easier for Republicans to overturn any election results they don’t like.
The two actions are not unrelated. Similar anti-voting measures are advancing in Missouri. Is it any wonder that the Legislature’s only Black Republican, Rep. Shamed Dogan, R-Ballwin, voted against the anti-Democracy bills?
Walsh’s statement, and her colleague’s actions, are the reason for the state’s rural-urban divide, and make no mistake, race is a part of the equation. She, like her Republican friends in Georgia, might as well have said: Black Voters Don’t Matter.
What makes the Missouri Legislature’s action so absurd, and to borrow President Joe Biden’s description of the Georgia vote, “despicable,” is that it hurts rural voters as much or more than those in the city. Missouri has lost multiple rural hospitals because of its delay in expanding Medicaid. Such expansions have been wildly popular, and successful in other Republican-led states that have reaped the economic benefits, such as Arkansas, Kentucky, Indiana and Arizona.
Walsh is right, in that most rural Missouri counties voted against Medicaid expansion. But not her voters. Walsh lives in Ashland, which is in Boone County, home of the University of Missouri and its expansive health care facilities. Boone County voters approved Medicaid expansion by a margin of 2-1. If you add up all of the votes in the counties that Walsh represents: Boone, Cooper, Cole and Moniteau, the yes votes win. The Republican hotbeds of St. Charles County and Greene County both voted for Medicaid expansion, too. That’s a lot of rural Republicans written off by Walsh, et al.
According to a Washington University study, the highest percentage of predicted increase in Medicaid enrollment after expansion happens (and despite the Republican obstruction, it will, one way or another) is in rural counties, from Nodaway, Taney, Stone, Phelps, Osage, McDonald, Maries counties, and, yes, Walsh’s Boone County.
One of the reasons voters in Boone County voted yes is because they were educated on the issue. Here’s what the Boone County Journal, which is based in Walsh’s hometown of Ashland, wrote last year: “Missouri can anticipate a wave of job growth and annual economic output from Medicaid expansion of more than double the expected $1 billion in yearly savings to the state budget. That’s the conclusion of a new report released Tuesday by the Missouri Foundation for Health. The independent study concludes that Medicaid expansion will create more than 16,000 new jobs annually over its first five years, with nearly 80% of those from outside of the health care industry,” the Journal wrote. “And 90% of the new jobs would pay more than $15 an hour, with most of the new positions located outside of St Louis and Kansas City.”
Imagine that. Medicaid expansion creates rural jobs. Just not in Missouri, if job-killing rural Republicans have their way. In the new age of Trump still being the titular head of the Republican Party, majorities no longer matter. Only the losing side’s voters matter, if they are Republicans, and the winners can take their democracy and shove it in the abandoned shell of a shuttered rural hospital.