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Why a red state wants to ignore voters, reject Medicaid expansion

Most Missouri voters backed Medicaid expansion. Missouri's Republican-dominated legislature doesn't much care.
Image: St. Louis
The Old Courthouse is seen in front of the Gateway Arch in St. Louis, Mo., on Nov. 1, 2018.Mandel Ngan / AFP - Getty Images file

By any fair measure, Republicans in Missouri were delighted with the 2020 election cycle. 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 halves 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 would extend health security to roughly 230,000 low-income Missourians currently going without.

GOP officials urged voters to reject the ballot measure; 53% of the state's voters ignored the advice.

Evidently, however, that was not the end of the political fight. The Kansas City Star reported late yesterday:

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Thursday, posing a setback for the voter-approved plan to increase eligibility for the state health care program. The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million in state funds and $1.6 billion in federal money to pay for the program's expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.

It's worth noting for context that there have been disputes along these lines before in other states, which tend to be worked out in one way or another. Missouri's law is scheduled to take effect in July, and whether yesterday's developments prove to be a major hindrance or a minor speedbump remains to be seen.

But what struck me as especially interesting was the rationale among GOP legislators who don't much care what a majority of Missourians voted for. From the Star's article:

Moberly Rep. Ed Lewis said despite that 53% of those who cast ballots in favor of expansion, the number did not amount to a majority of Missouri's eligible voters or population. "Rural Missouri said no," said Rep. Sara Walsh, of Ashland. "I don't believe it is the will of the people to bankrupt our state."

First, Medicaid expansion is a financially responsible thing to do, and there is no scenario in which it would "bankrupt" this or any other state. Second, plenty of rural voters in Missouri voted for Medicaid expansion because it's a good idea.

But of particular interest is the ideological perspective: sure, there was an election; voters had their say; and health care prevailed, but "rural Missouri said no."

It's not subtle: the Missouri residents Republicans care about voted one way, while those other Missouri residents voted the other way.

This is the same kind of thinking too much of the GOP brings to election results and voting rights: real Americans -- folks who look and think like Republican lawmakers -- deserve to be heard, but others' voices have inherently less value.

The more the GOP is hostile toward democracy, the more common these disputes become.