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Medicaid expansion in Missouri could come down to one man’s vote. Lt. Gov. Mike Kehoe won’t say where he stands.

Medicaid expansion in Missouri could come down to one man’s vote. Lt. Gov. Mike Kehoe won’t say where he stands.


JEFFERSON CITY — The fight over expanding Medicaid to 275,000 Missourians could come down to one man, and he’s not offering any hints about what he’ll do.

Lt. Gov. Mike Kehoe, a Republican from Jefferson City, presides over the Senate and casts tiebreaking votes if needed.

On the issue of funding Medicaid in the state’s new budget, he’s staying tight-lipped.

“Mike has never commented in advance about how he might vote in the event of a tie, and he is not going to do so in this instance,” said Kehoe spokesman Adam Gresham.

The prospect of a 17-17 tie on the issue of Medicaid surfaced last week when a Senate budget panel tied 7-7 over the issue of funding.

Republican Sens. Lincoln Hough of Springfield, Justin Brown of Rolla and Mike Cierpiot of Lee’s Summit joined four Democrats on the committee in voting to fund the expansion.

In the case of the Senate Appropriations Committee, a tie vote meant there would be no money set aside for expansion in the spending plan for the year beginning July 1.

But, with the 34-member Senate tentatively scheduled to take action on the state’s $34 billion spending plan on Wednesday, more drama is expected.

In a sign of the high stakes involved in the issue, Democrats in the House held an 11th-hour rally Tuesday outside the Capitol, urging the Senate to approve the spending.

During the rally, Democratic lawmakers told the crowd of at least 100 to put pressure on their senators to include Medicaid funding in the budget.

“Please talk to your senators, we need the votes,” said Sen. Barbara Washington, D-Kansas City, who addressed the rally alongside Democratic Sens. Brian Williams of University City and Karla May of St. Louis. “We just need 18 votes to say, ‘Fund Medicaid expansion.’”

Cathy Primm, who traveled from Springfield to attend the rally, said she had already reached out to Hough, who confirmed his plans to vote for expansion because it is what his constituents wanted. “I’m very proud of him,” she said.

Primm said she “passed the petition” to get Medicaid expansion on the statewide ballot last year. “I feel rather betrayed,” she said of the current situation.

Republicans control the upper chamber with 24 members. There are 10 Democrats.

If the Democrats vote for expansion and four more Republicans join with Hough, Brown and Cierpiot, it would result in a tie vote, putting Kehoe in the position of breaking the tie.

If that happens, it would be a rarity.

Former Lt. Gov. Peter Kinder, a Republican who served 12 years in the post, said he never had to cast a tiebreaking vote.

“It just doesn’t happen very often,” Kinder said.

Kehoe, a former senator, took over as lieutenant governor in 2018 after the departure of former Gov. Eric Greitens. He won a full, four-year term in November and announced earlier this year that he will run for governor in 2024.

In the committee hearing, a compromise sponsored by Hough would have dedicated $60 million in state dollars to the expansion, rather than the $120 million sought by Gov. Mike Parson or the zero dollars supported by the House.

Hough recommended the plan as a “more measured approach” to the earlier House decision to not fund expansion, but said more talks are afoot.

Brown joined other supporters in voting “yes,” saying he’d rather have the state control the spending instead of putting the decision in the hands of a judge.

His decision came despite voters in his central Missouri district voting against the expansion.

Parson, a Republican who previously opposed expansion, presented a budget in January calling for the state to spend $1.9 billion in state and federal funds to fulfill a plan approved by voters in August.

The GOP-controlled House, however, approved an alternative plan last week to spend state money that Parson had budgeted for Medicaid on other programs.

The Senate committee’s vote, similar to the House action, runs counter to what Missouri voters said last year, when they amended the state constitution to expand Medicaid eligibility.

Missouri’s Medicaid program currently does not cover most adults without children, and its income eligibility threshold for parents is one of the lowest in the nation at about one-fifth of the poverty level. It’s been estimated that an additional 275,000 Missourians would be eligible for Medicaid under the expansion.

If the state budget is approved without the funding, the issue is likely headed to the courts, specifically when people become eligible for the program on July 1 under the state Constitution.

The deadline to send the spending blueprint to Parson is May 7.

Maria Benevento of the Post-Dispatch contributed to this report.

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