JEFFERSON CITY — In August 2020, advocates for Medicaid expansion celebrated victory. More than 53% of voters said the health care program should broaden to include more than 200,000 more Missouri residents. Months later, it seems those celebrations may have been premature.

On Thursday, Republican members of the House Budget Committee voted down House Bill 20 — which would have provided almost $1.9 billion in funding for the Medicaid expansion that voters approved.

Democrats on the committee, who voted for the bill, characterized the vote as a betrayal of Missouri’s voters.

“Fifty-three percent of Missourians understood that Medicaid expansion was the right thing to do,” said Rep. Rasheen Aldridge, D-St. Louis. “Allow the people to have a voice; they’ve already spoken.”

Rep. Maggie Nurrenbern, D-Kansas City, acknowledged that at times she has been unhappy with the way people in Missouri vote.

“I’ll be the first to say I don’t always like what our people vote for, but I always respect the will of the voters,” Nurrenbern said.

After the hearing, Minority Floor Leader Crystal Quade, D-Springfield, released a statement criticizing those who killed the bill.

“Medicaid expansion is mandated by the Missouri Constitution. Any elected official who refuses to accept that reality needs to find another line of work,” Quade said. “House Republicans have made a habit of ignoring voters, but their decision today — with the basic needs of so many people in our state hanging in the balance — sets the bar so low, it may as well be touching the ground.”

The 20 members who voted ‘no’ on HB 20 — including Rep. Sara Walsh of Ashland — gave various reasons for their vote. Many argued that, because of low turnout, the vote in favor of expansion was not representative of the general population.

Walsh called HB 20 “a massive expansion of welfare” in a Tweet she posted after the vote. “We must make wise decisions today so we don’t leave a nightmare for future generations of Missourians.”

Rep. Doug Richey, R-Excelsior Springs, said funds should not be diverted from disabled and elderly Missourians in order to provide health care to “able-bodied adults.”

Democrats on the committee took issue with this characterization, saying that in the long-run, federal dollars would allow the program to pay for itself.

“I am flabbergasted by the idea that we have to rob Peter to pay Paul here,” said Nurrenbern.

Rep. Peter Merideth, D-St. Louis, went a step further by suggesting that his colleagues were lying about the finances of expansion.

“Stop acting like we don’t have money because you don’t want to provide health care to our people because you don’t want to follow our constitution,” Meredith said. “It is a lie.”

Soon after, committee chair Rep. Cody Smith, R-Carthage, reminded members not to openly question the motives of their colleagues.

“We will maintain decorum, and anything less will not be tolerated,” Smith said.

Richey disagreed with the notion that expansion would pay for itself.

“I think it is foolish to say we have temporary revenue available,” Richey said, adding that short-term federal COVID-relief money does not mean “we have no reason to be concerned about the fiscal health of our state.”

Smith sponsored the bill and was in the rare position of voting against his own legislation. On the budget committee, all bills are brought forward by the chair. Even though Smith did not support funding expansion, he felt it was important for the committee to consider it.

Despite the bill’s failure, Smith said the debate over expansion will “spill out onto the House floor next week.” It is unclear what may come of such debates.

Merideth said in a Twitter post that options include adding the money back during the House floor debate or in the Senate, the Department of Health and Human Services proceeding to expand Medicaid despite the vote, “or they try not to implement it and it goes to court.”

Smith also said that he will bring forward a new bill next week to spend the state portion of the money that would have been spent on Medicaid expansion.

  • State Government Reporter, Fall 2020 and Spring 2021. Reach me at, or in the newsroom at 573-882-5700

  • Mark Horvit is the state government editor. Call me at 817-726-1621 with story ideas, tips or complaints.

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