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Red-state Republicans to ignore voters, reject Medicaid expansion

Most Missouri voters backed Medicaid expansion. Missouri's Republican-dominated legislature has decided not to care.

By any fair measure, Republicans in Missouri had reason to be delighted with the 2020 election cycle. As we've discussed, Donald Trump won the state by 15 points; Gov. Mike Parson (R) cruised to a similarly lopsided victory; GOP representatives won six of the state's eight congressional seats; and Republicans continued to dominate in both chambers of the state legislature.

But while Missouri may be earning its reputation as a ruby-red state, the electoral news for Republicans last year wasn't all good. Last summer, during the state's Aug. 4 primaries, a majority of Missouri voters approved Medicaid expansion -- a decision that was poised to extend health security to nearly 300,000 low-income Missourians currently going without.

GOP officials urged voters to reject the ballot measure. A 53% majority of the state's voters ignored the advice and passed it anyway.

And while that appeared to be the end of the fight, it now appears to have been the start of a different kind of fight. NBC News reported yesterday that Mike Parson, Missouri's Republican governor, has decided not to expand Medicaid in his state.

Parson ... claimed that the state could not afford to fund the program's expansion after the Republican-controlled state Assembly refused to fund that aspect of the budget. The governor formally withdrew the state's plan for Medicaid expansion Thursday.... The budget released by Parson's office earlier this year included funding for expansion, but Republicans in the state Assembly voted to strip it from the state budget.

In case this isn't obvious, it's worth emphasizing that Missouri's voters didn't simply request Medicaid expansion, they amended the Missouri constitution to require it.

The principal talking point from GOP officials in the state focuses on finances: Missouri Republicans have spent recent months insisting that they simply don't have the money to help so many low-income families have health coverage.

The problem, of course, is that arithmetic keeps getting in Republicans' way. As NBC News' report explained, Medicaid expansion would cost Missouri roughly $130 million, but the state would also secure a federal match of about $1.4 billion to pay for the program. Just as importantly, thanks to the Democrats' COVID relief package, states adopting Medicaid expansion would get additional federal resources for the next two years, more than covering Missouri's $130 million commitment.

Or put another way, the idea that Missouri can't afford this is impossible to take seriously.

But this isn't just a story about health care or Republican state officials who apparently lack access to calculators. It's also a story about democracy and one of the nation's major party's growing indifference toward election results.

Missouri voters were offered an opportunity to change their own constitution to extend coverage to families in need. Those voters heard the debate and made a decision. Republican officials, however, concluded that election results and the revised language of the state constitution can be ignored -- because they say so. The voters made a choice; GOP officials thought they made the wrong choice; so the will of the electorate has put aside.

It's part of a larger problem in which Republicans see democracy as an annoyance to be ignored at their discretion. It's an approach that rationalizes voter-suppression laws, maximalist gerrymandering, and a refusal to certify election results the GOP disapproves of.

In Missouri, litigation is now an inevitability. Watch this space.