Missouri Capitol grinds to a halt as hard-right senators block billions for Medicaid

A protracted filibuster from a group of hard-right senators has ground the Missouri Senate to a halt, threatening to derail the General Assembly’s final weeks of session.

The state’s Medicaid program and a roughly $50 billion budget that funds state operations hang in the balance. The results could be devastating to Missouri.

Members of the hard-right Missouri Freedom Caucus have for more than 28 hours held the Senate floor hostage, halting all action until a laundry list of their demands are met. The hours-long filibuster has sparked chaos among lawmakers who fear that it could blow up the session with less than three weeks left.

A chorus of Missouri health care groups and the Missouri Chamber of Commerce and Industry on Wednesday also issued a stark warning: The Freedom Caucus is “endangering the well-being of millions of Missourians.”

The filibuster has blocked the Senate from taking up the renewal of a crucial series of taxes that would keep the state’s Medicaid program operating. The program provides health coverage to roughly 1 million residents. Failure to renew the taxes called the Federal Reimbursement Allowance or FRA, would result in a loss of billions in state and federal Medicaid funds.

Members of the Freedom Caucus have vowed to block the renewal until two of their priorities are completed: Republican Gov. Mike Parson must sign into law a bill to prohibit Planned Parenthood from Medicaid reimbursements and lawmakers must also pass a measure that would make it harder for Missourians to change the constitution.

One of the leaders of the Freedom Caucus, Sen. Bill Eigel, a Weldon Spring Republican, has chewed up a significant amount of floor time railing against the tax renewal. On Tuesday, he referred to it as a “pyramid scheme.”

“We feel like we have to stand today and hold up the renewal of one of Missouri’s largest health care taxes that is levied on our hospitals,” he said.

The push from Eigel and his colleagues follows months of infighting between members of the Freedom Caucus and Republicans aligned with Senate leadership. Some Republicans appear to be growing increasingly frustrated with the group’s tactics.

Sen. Lincoln Hough, a Springfield Republican who filed the bill to renew the FRA, said in an interview that the Freedom Caucus was blocking funding that would help rural hospitals stay afloat.

“I think they’re standing in the way of themselves at this point,” said Hough, who is running for lieutenant governor. “This idea that we have to stop everything and do something else right now, it’s kind of counterintuitive to actually getting anything done.”

If lawmakers fail to renew the FRA this session, Republican Gov. Mike Parson would almost certainly call them back into a special session — which is what happened the last time the taxes were up for renewal in 2021.

The filibuster has also prevented the Senate from taking action on the state’s budget for the next fiscal year, which lawmakers are required by the Missouri Constitution to complete.

Parson spokesperson Johnathan Shiflett in an email declined comment on the filibuster but said the governor could have a statement by the end of the day on Wednesday.

In the meantime, Missouri health care groups are sounding the alarm. The Missouri Hospital Association, the Missouri Pharmacy Association, the Missouri Ambulance Association, and the Missouri Chamber of Commerce and Industry released a joint statement criticizing the Freedom Caucus’ tactics on Wednesday.

The groups called on Eigel and the Freedom Caucus to “immediately cease their destructive filibuster.”

Failure to renew the taxes would hurt children with chronic illnesses, force nursing homes to close, shut down rural hospitals, collapse mental health care services, and jeopardize pharmacy and emergency services, the groups said.

“These are not mere warnings; they are the grim realities we face if Senator Eigel and his colleagues continue to prioritize political spectacle over practical governance,” the statement said.

The FRA is levied on hospitals, ambulance companies, and pharmacies, which have voluntarily contributed to the system since 1992. The taxes are a critical funding source for the entire state budget.

Not renewing the FRA would lead to an estimated loss of $4.3 billion in state and federal Medicaid funds in fiscal year 2026, according to an analysis by the Missouri Budget Project, a nonprofit that analyzes fiscal policy.

The filibuster in the Senate has also halted most action across the Capitol building in the House, effectively derailing the entire General Assembly.

“All eyes are on the Senate,” House Majority Leader Jonathan Patterson, a Lee’s Summit Republican, told reporters earlier this week. “Our focus is on really getting the budget and the FRA done and we kind of have to wait on the Senate for that.”

House Speaker Dean Plocher, a St. Louis-area Republican, went a step further on Tuesday and appeared to align himself ideologically with one of the Freedom Caucus’ demands. However, he told reporters that he was not endorsing the group’s tactics.

Plocher, in a letter to Senate Majority Leader Cindy O’Laughlin, a Shelbina Republican, requested that Senate leaders pass the measure that would make it harder to amend the constitution before they take up the FRA and the budget.

The push by hard-right Republicans comes as abortion rights supporters are expected to turn in more than 171,000 signatures this week to get an amendment that would overturn the state’s abortion ban on the ballot. Some Republicans feel that making it harder to change the constitution through the state’s initiative petition or IP process could block that potential vote.

Sen. Nick Schroer, a Freedom Caucus member from St. Charles County, on Wednesday, described the petition to legalize abortion as a “doomsday” scenario.

“I have been vocal that yes, this issue, the IP issue, the FRA issue and arguably even the budget are all right to life, pro-life issues in different ways,” Schroer added.

Democrats in both the Senate and the House also appear to be growing increasingly concerned about the General Assembly’s tight deadline to renew the taxes and pass the budget.

Senate Minority Leader John Rizzo, an Independence Democrat, said the filibuster could have been avoided if the bill had been brought up earlier in the session.

“It was a situation that we all knew how important this was,” Rizzo said. “Every senator from the top senator to the last senator understood this was essential to passing a balanced budget, to keeping rural hospitals open, to keeping nursing homes open, Medicaid, all these things.”

And as the clock continues to tick, House Minority Minority Leader Crystal Quade, a Springfield Democrat, has filed her own bill to renew the taxes. She took to social media on Wednesday to attack the Freedom Caucus.

“The stakes are too high to let extremists hold Missouri hostage for their campaign ads,” said Quade, who is running for governor. “Let’s get it done and keep more of our hospitals from closing.”