Senate filibuster of taxes that fund Missouri Medicaid approaches record at 39-hour mark

State Sen. Rick Brattin speaks to an empty chamber Wednesday as the filibuster blocking renewal of provider taxes needed to finance Missouri's Medicaid program approached its 24th hour (Rudi Keller/Missouri Independent).

A filibuster blocking renewal of taxes essential to funding Medicaid passed 39 hours early this morning as a small group of Republicans held the Missouri Senate floor demanding action on other bills.

Five members of the Missouri Freedom Caucus have tried four times to amend the bill, failing each time when their proposals were tabled during overnight action. As the 39-hour mark passed at 1:30 a.m., state Sen. Rick Brattin of Harrisonville  was holding the floor on the fourth amendment to the fifth attempt to change the bill, to shorten the sunset when taxes would expire.

The stakes are enormous. 

The first is the $1.4 billion generated by the taxes on hospitals, pharmacies, nursing homes and ambulance services, which is used to match approximately $2.8 billion of federal funds in the Medicaid program.

The second, and more importantly, the filibuster is delaying debate on the $53 billion budget proposal approved last week in the Senate Appropriations Committee. All spending bills must pass by May 10 or lawmakers will have to return for  a special session to finish the budget before the fiscal year ends on June 30.

“This is pathetic political gamesmanship out here,” state Sen. Lincoln Hough, a Springfield Republican and chairman of the appropriations committee, said in an interview.

Depending on how it is counted, the filibuster is breaking the 39-hour record set in 2016 when Democrats blocked a proposed constitutional amendment to allow businesses and clergy members to refuse services to same-sex couples. The first eight hours of this year’s filibuster were on procedural motions, leaving the issue of the record length in question.

Freedom Caucus members are demanding action on two bills — one barring Planned Parenthood from receiving state payments as a medical provider and another that would change the majority needed to pass constitutional amendments proposed by initiative petition. The Freedom Caucus has been at war with the chamber’s GOP leadership since the session started, a stance that has cost them chairmanships and parking spots.

Sen. Rick Brattin, a Harrisonville Republican, ended his shift in the filibuster about 10 a.m. and argued he was holding up the Senate  as a principled stand to preserve Missouri’s ban on abortions for most women.

“That is why I stood here all night long and why I will continue to stand here to protect life,” Brattin said.

The bill on Planned Parenthood is awaiting Gov. Mike Parson’s signature, and his actions are out of the control of the Senate GOP leadership. On Tuesday, Parson’s office told a reporter for Nexstar Media Group that he would decide when to sign the bill.

“This deliberate dysfunction in the Senate is unfortunate for the people of Missouri and senators trying to do good work for the people back home,” Parson’s office told the reporter.

Sen. Lincoln Hough, left, chats with Senate staff Wednesday morning as he endures a filibuster of his bill renewing medical provider taxes that finance Missouri’s Medicaid program (Rudi Keller/Missouri Independent).

The bill to change the majorities for initiative proposals is awaiting a final Senate vote that would send it to a ballot later this year. But because the version sent from the House includes other provisions Democrats oppose, GOP leaders are reluctant to bring it to a vote before the budget is complete.

Under the constitution, the deadline for budget bills is set one week before the final date for consideration of other bills.

The provider taxes, in place since 1991, have been renewed 17 times in the past. On 16 occasions, the renewal occurred during the regular session and with little controversy. 

The 2021 renewal was the first time anti-abortion lawmakers sought to use the taxes as leverage to pass provisions that would otherwise be defeated. No resolution could be found during the regular session and lawmakers returned in late June to complete the job.

The taxes, known as the federal reimbursement allowance, are paid by hospitals, pharmacies, nursing homes and ambulance services “for the privilege of engaging in the business of providing” medical services within the state. Each entity pays the tax in a different way and the rates are adjusted every year to meet the financial needs of Medicaid. This year, pharmacies pay 0.52% of receipts and hospitals pay 4.8%. Nursing homes pay $12.93 per patient day, and ambulance services pay about $1.50 per mile.

The taxes aren’t mandated by federal law, but allow less general revenue funds to be needed for the Medicaid program. While the federal government requires Missouri to put up about 35% of the cost of most Medicaid services, general revenue accounts for only about 20% of the current cost.

The budget proposal awaiting Senate debate is $2.3 billion more than the House-passed version. The changes, including higher Medicaid payments to nursing homes and dozens of local projects, need a close look, said state Rep. Mike Haffner, a Raymore Republican challenging Brattin in this year’s 31st District primary..

“We just had a caucus meeting where we discussed this: these ongoing filibusters year after year after year, especially during budget time,” Haffner said. “We don’t have an opportunity to adequately review what the Senate position is on every one of these aspects of the budget and we’re forced to do a quick review where we don’t have a comprehensive analysis taking place.”

Associations representing hospitals, nursing homes, pharmacies and ambulance services back the provider tax renewal and on Wednesday morning issued a news release jointly with the Missouri Chamber of Commerce calling for an end to the filibuster.

Cuts to the Medicaid program would endanger rural hospitals and nursing homes, the organizations said, and reduce the availability of emergency services.

“We urge you to set aside personal political ambitions and bring the FRA bill to a vote,” the release stated. “Your refusal to act responsibly is crafting a scenario that will devastate Missouri’s health care system and cause irreparable damage to countless lives.”

The proposal to change the majority needed to pass constitutional amendments has taken on a new urgency for Republicans afraid that a proposal to legalize abortion will make the ballot this year.

The inability of the Senate to bring any of the issues to a resolution is frustrating to Missouri House members, Speaker Dean Plocher said Tuesday. At a news conference backed by dozens of GOP members, Plocher said he wanted the Senate to pass the proposal to require a concurrent majority in congressional districts along with a statewide majority on initiative proposals.

“During the winter caucus, there was a residual animosity and House members were reticent to take up senate bills this session,” Plocher wrote in a letter to Senate leaders. “This year I strongly urge the Senate to take (initiative petition) reform up now and avoid the situation where IP reform dies on the floor of the Senate again.”

At the news conference, Plocher said he was not endorsing the Freedom Caucus tactics.

“I am advocating on behalf of the members of my house,” Plocher said. “I am not here to tell the senate what to do, per se, That is their sandbox.”

The Independent’s Allison Kite contributed to this report. This article will be updated.

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