Highlight on Missouri: Sharp Divisions Between Governor and Legislature

The nations battles over health care issues, including abortion and implementation of the Affordable Care Act, continue to play out in Missouri. In the latest development, women will not have to wait 72 hours for an abortion because Governor Jay Nixon (D) vetoed  HB 1307, which would have imposed the requirement. The bill did not include any exception to the 72-hour wait even in cases of rape or incest.   Governor Nixon stated that the bill was “disrespectful” and “would unnecessarily prolong the suffering of rape and incest victims and jeopardize the health and well-being of women.”

The bill would have tripled the current minimum waiting period. Even if it had contained exceptions for rape and incest, Nixon said, the bill would still have been unacceptable because the delay:

  • served “no demonstrable purpose” other than to add to the emotional and financial hardships attendant to unplanned pregnancy;
  • presupposed that women were not capable of making difficult decisions for themselves; and
  • made the procedure more dangerous, thereby endangering women’s health.

Nixon noted that Missouri law currently requires the following to be given to the woman, in person, and in print, at least 24 hours before an abortion:

  • a detailed explanation of the procedure, risks, and contraindications;
  • counseling concerning the available alternatives to abortion;
  • a list of agencies that provide alternative services;
  • advice about the obligation of the father to support the child;
  • a detailed description of the anatomical and physiological characteristics of the fetus at each stage of development, in two-week increments, accompanied by color photographs or images;
  • the opportunity to view an “active ultrasound” and hear the fetal heartbeat;
  • on each page of the material described above, prominently displayed, the statement: “The life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being.”

Missouri law requires the physician to have admitting privileges at a hospital that offers obstetrical or gynecological services within 30 miles of the location where the abortion is performed and to inform the woman that the physician will be available to provide follow-up care at that hospital if complications arise.

Affordable Care Act Implementation

The Missouri legislature has steadfastly resisted the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). In July 2010, it barred any future Health Insurance Exchange from offering policies that would cover abortion, even via an optional rider. In the fall of 2012, the voters prohibited the establishment of a state-based Exchange without explicit approval of the legislature or of the people by referendum. The law barred state agencies and employees from providing assistance to any federally managed Exchange. In July 2013, the legislature passed (and Governor Nixon signed) a law requiring Navigators, trained individuals who assist consumers with enrollment through the Health Insurance Exchange, to be licensed. The law also prohibited Navigators from advising on the advantages or disadvantages of a particular policy without an insurance license.

Nixon and the legislature have never reached agreement to expand Medicaid under the ACA. Even a private option waiver like Arkansas’ was unacceptable to the Republican  majority.

Medicaid Enrollment

Seventeen of the 26 states that did not expand Medicaid by March 31, 2014 saw increases in enrollment as eligible individuals came “out of the woodwork.” According to CMS’ enrollment figures and an analysis by Avalere Health, Missouri’s Medicaid enrollment has declined, however, along with six other states. CMS and Avalere compared Medicaid enrollment during the three months preceding open enrollment, i.e., July through September 2013, to enrollment at the end of each month in 2014. Enrollment dropped from  an average of 863,417  to 829,585 in March 2014.  According to the St. Louis Post-Dispatch, state officials attribute the drop to “people getting jobs” in an improved economy.

According to the Bureau of Labor Statistics, however, about 200,362 individuals, 6.6 percent of Missouri’s labor force, were unemployed in August 2013; the preliminary numbers for March 2014 were 204,209 unemployed individuals, about 6.6 percent of the state’s work force.