Missouri GOP likely to include ban on birth control coverage in Medicaid tax compromise

Missouri Republicans are still weighing a ban on Medicaid coverage of Plan B and other contraceptives as part of a compromise on renewing a crucial tax that funds the health program.

Efforts to approve the renewal fell apart in the Senate last month at the end of the regular session. GOP leaders were caught between conservative colleagues demanding the birth control provisions and Democrats, who said they were promised a tax renewal without them.

Republicans now appear ready to negotiate an agreement on their own and haven’t sought the support of Democratic leadership. Including some form of a coverage ban would signal that top GOP officials hope to win over the most conservative and vocally anti-abortion senators.

Gov. Mike Parson, a Republican, met with several GOP senators on Tuesday afternoon to discuss the tax, called the Federal Reimbursement Allowance. Parson said last week he won’t call a special session on the tax until a deal is on the table.

But budget cuts loom without one. Failure to renew the tax, which expires Sept. 30, would deprive Medicaid of $1 billion in state funds and billions more in federal dollars. Parson has threatened to withhold funds from the budget beginning July 1 to make up for the potential shortfall.

Senate Minority Leader John Rizzo told The Star on Wednesday that Senate Majority Leader Caleb Rowden, following the meeting between Parson and GOP senators, told him that Republicans are working on a proposal that includes a Medicaid coverage ban on specific contraceptives.

In a text message, Rowden, a Columbia Republican, told The Star the Democrats “have the language in front of them.”

“We will continue those discussions in the coming days,” Rowden said.

Rizzo, an Independence Democrat, said the only language he had seen came from a newsletter distributed by Missouri Times publisher Scott Faughn, which included a proposed coverage ban on the emergency contraceptives Plan B and Ella, and intrauterine devices (IUDs). The proposal also includes a ban on the abortion pill. Rizzo said Rowden told him the language in the newsletter is, in fact, what Republicans are considering.

Staff for Sen. Dan Hegeman, a Cosby Republican who chairs the Senate Appropriations Committee, said Wednesday that Hegeman has reviewed the language and supports it. Hegeman will likely file a bill to renew the tax with that language, a spokesperson said.

Rowden didn’t respond to a call for comment. Parson spokeswoman Kelli Jones did not respond to a request for comment on the language on Wednesday afternoon but said, “At this time, a special session has not been confirmed.”

Before meeting with the senators on Tuesday, Parson told reporters that he was going into the meeting with “what we believe is language that we can all deal with.”

Parson said he was willing to consider the inclusion of contraceptive language “if we can find a medium in there that doesn’t jeopardize” the provider tax. Some legislators and advocates have raised concerns that the bans could endanger federal funding for Medicaid.

The federal government requires states to cover family planning services, and it requires all insurance plans to cover birth control.

But a group of hard-right senators, led by Sen. Paul Wieland, an Imperial Republican, have insisted on including the ban as a condition of supporting a renewal of the provider tax. Before 2021, the General Assembly had never failed to renew the tax during its regular session.

Wieland did not respond to a request for comment.

“You want to force people who have a moral objection to that, you want to force them to have their taxpayer money pay for it? That’s the question,” said Sen. Eric Burlison, a Battlefield Republican.

During the legislative session, Sen. Bob Onder, a Lake St. Louis Republican, also pushed to include a ban on dollars going toward Planned Parenthood. The compromise language under consideration doesn’t appear to include the provision.

“There are some that are promoting a narrative that we’re all in agreement on everything,” Onder said. “I, both in our meeting with the governor and in our caucus meeting following, I was very clear to anyone who was listening that although we’re, I believe, very close on the abortion drug language ... we are miles apart on the issue of funding of abortion providers.”

House Budget Chair Cody Smith, a Carthage Republican, said last week some form of the ban would likely be part of the tax renewal. But lawmakers were struggling to determine the potential consequences of including such a ban in the Medicaid program.

Not all states cover all forms of birth control — some have waivers with the federal Centers for Medicare and Medicaid Services to not to cover Plan B — but lawmakers didn’t know which “hard and fast rules” would apply to Missouri, Smith said.

“If we choose not to offer some drugs inside our Medicaid programs there are potential ramifications for the entirety of our pharmacy program and specifically referring to the federal funding we rely very heavily on for our Medicaid pharmacy program,” he said. “So we have to be careful about keeping our Medicaid program intact while we are seeking to address some of these pro-life issues.”

Democrats appear unlikely to support a ban on Medicaid coverage of Plan B and other contraceptives, but Rizzo said they are researching the possible effects of the bill. Being in a special session gives minority party members less opportunity to fight a bill they don’t like, he said.

“At first glance the language seems problematic, we’re doing a deep dive into the language right now,” Rizzo said. “It seems like it appeases the extremists in their caucus who want to deny women birth control.”