Author: Daniel Landon, Senior Vice President of Governmental Relations
The 2016 election resulted in Republicans retaining control of the
Missouri and U.S. House of Representatives and Senate, and winning the Missouri
governorship and U.S. presidency.
The Missouri congressional delegation will have the same seven
Republicans and three Democrats. Overall, Republicans have 241 seats in the
U.S. House and Democrats have 194. In the U.S. Senate,
Republicans have 52 seats and Democrats 46 seats, with two Independents who
caucus with the Democrats.
Partisan control of the Missouri General Assembly essentially
stayed the same, with 117 Republicans and 46 Democrats in the House of
Representatives, and 25 Republicans and nine Democrats in the 34-member Senate.
A Republican senator was elected Lieutenant Governor; his reliably Republican
seat will become vacant and be filled by a special election.
The election of Republican Eric Greitens as Missouri’s next
governor enhances the likelihood that Republican legislative priorities will be
signed into law. They include “right to work” legislation to prohibit mandatory
participation in a labor union and tort reform legislation to revise standards
for liability lawsuits. The General Assembly previously enacted these bills,
but they were vetoed by Democratic Gov. Jay Nixon and the General Assembly
failed to override the vetoes. The alignment of a Republican state legislature
and governor also is expected to favor new laws to revamp executive branch
The new federal and Missouri political landscape means that an
expansion of Missouri Medicaid eligibility as authorized by the federal Patient
Protection and Affordable Care Act of 2010 is improbable. Already disinclined
to support Medicaid expansion, Missouri Republican politicians know
President-elect Donald Trump is expressing support for legislation to repeal
significant components of the ACA. With a supportive president, a congressional
enactment to repeal all or much of the ACA will be signed into law. There were,
and are, insufficient votes in Congress to override a presidential veto of an
ACA repeal. The November election makes a partial repeal of the ACA very
likely, if not a certainty.
Missouri Republicans will watch carefully to see how Congress and
the new president reshape the health policy landscape. The mantra of those
supporting repeal of the ACA has been “repeal and replace.” However, at present
it is unclear what will be put forward as a replacement. President-elect
Trump’s website describing the transition to his inauguration includes brief
references promoting high-risk health insurance pools, health savings accounts
coupled with health insurance coverage, new regulatory standards for interstate
sale of health insurance, and modernization of Medicare.
The details of legislation to define the Republicans’ health
policy landscape likely will be crafted by Congress in consultation with the
White House. For example, U.S. House Speaker Paul Ryan previously developed a
Medicare reform proposal based on a premium support model.
The prospect of federal Medicaid financing being converted to
state “block grants” is being discussed, with few details of design or
implementation. In general, Medicaid block grants would award each state a
capped amount of federal funding, with greater flexibility to design and
implement its Medicaid program.
It is unclear how Congress will revamp the Medicaid program, but
all indications point to a concerted effort to do so. However, passing the
federal laws to accomplish the change will require some bipartisan engagement.
Current U.S. Senate procedures dictate that complex or controversial
legislation must receive 60 affirmative votes at key points in the legislative
process. The Senate is expected to retain those procedures.
If significant portions of the ACA are repealed and
replaced with new laws and programs, MHA will be working to ensure that
Missouri is treated equitably and in a way that recognizes the state’s
innovative approach to financing its Medicaid program.