A bipartisan proposal to extend postpartum care for low-income women in Missouri to a full year after they've given birth is "hanging on a thread," its sponsor said, due to resistance from a Republican state senator in the legislative session's final days.
The provision, which would expand health care coverage from 60 days to a year after pregnancy, has emerged as a rare point of agreement for groups on both sides of the abortion debate.
However, on Monday, a House lawmaker moved to have it stripped, along with other provisions, from a bill it had been added to because of "difficulties on the other side of the building."
The House ultimately voted to keep postpartum care expansion in the bill, which also included provisions to decriminalize needle-exchange programs, establish a prison nursery program and require school districts to print the national suicide prevention hotline number on student IDs.
However, supporters of the postpartum legislation said it will likely be stripped out in the end.
"I hate that we will have to remove it," said Sen. Holly Thompson Rehder, R-Sikeston and the sponsor of the underlying bill. "But we have seen that that isn't getting anywhere in the Senate right at this moment, so we definitely won't kill the underlying bill along with all the amendments."
Sen. Jill Schupp, D-Creve Coeur, said the primary opposition has been from Sen. Bob Onder, a Lake St. Louis Republican who has been vocal in his opposition.
A standalone bill's chances were already derailed earlier this year when Onder attempted to attach language that would bar abortion providers and their affiliates from the state's Medicaid program.
Onder later said in March if he were allowed to attach his language, he would vote for the bill expanding postpartum coverage, "a bill that I otherwise have some significant concerns about -- about its cost, about its ability to accomplish its stated objectives.
"And I have a long history of opposing Medicaid expansion," Onder said previously.
The proposal to extend postpartum care has since been amended onto a handful of separate bills. Onder challenged one of those bills Monday afternoon and signaled last week that postpartum care would be among the amendments that "probably need to come out" of the bill.
By Tuesday morning, the provision was removed.
Sen. Denny Hoskins, R-Warrensburg, said he supported postpartum care being available to women and children, but he would like to see it paired with reforms to Missouri's Medicaid program.
"It needs to be a mixture of both," Hoskins said. "We can't just continue to expand, in what my opinion, is a broken system."
Sen. Elaine Gannon, R-De Soto and the sponsor of the bill to expand postpartum care, said it may come down to the session's final day to see if it will ultimately pass. The legislative session ends at 6 p.m. Friday.
"It's really sad that one of the priority bills, that is truly a priority bill for the women in the state of Missouri," Gannon said, "there's a strong chance that it's not going to make it across the finish line, for reasons that should have never even happened."
The bill would also take advantage of a provision within the American Rescue Plan Act passed by Congress that allows for states to extend postpartum coverage for the next five years.
Lawmakers also included funding in the state budget to cover costs of extending postpartum coverage to a year for women on Medicaid. State officials estimate approximately 4,565 patients would be eligible for the expanded benefits, with costs expected to rise to $10.6 million in general revenue by fiscal year 2025, according to a fiscal analysis of the bill.
The Senate and House versions of the bill faced no opposition in committee, with organizations like Planned Parenthood, Missouri Right to Life and Kids Win Missouri all testifying in support.
Schupp said the legislation was especially needed to help curb Missouri's dismal maternal mortality rate. A state board of experts studying the issue released a report last year that found Missouri women on Medicaid are four times more likely to die within a year of pregnancy compared to those with private health insurance. Black women are also four times more likely to die within one year of pregnancy than white women.
"It's really such a travesty," Schupp said of the legislation languishing. "This is such important legislation for the families of the state of Missouri."
If the postpartum provisions aren't removed, they could doom Rehder's underlying bill, which would decriminalize needle-exchange programs that allow drug users to swap out used syringes with clean, new ones in an effort to decrease the chances of contracting or spreading diseases like HIV or hepatitis C from using a contaminated syringe.
Needle-exchange programs have been found to reduce the transmission of infections, and participants have also been found to be more likely to seek treatment for their addictions. Programs in Kansas City and St. Louis have operated for years in a "gray area" of the law, in a state where the Centers for Disease Control and Prevention identified 13 counties that were most at-risk or experiencing an HIV outbreak.
Rehder has filed a version of the needle-exchange bill since 2016, and while it came close to passage last year, it ultimately failed in the session's final week when language to renew an essential tax on hospitals, nursing homes and pharmacies, known as the federal reimbursement allowance, was added.
The legislation may be on the same path this session.
"Year after year after year that program dies, and it dies because it gets loaded up with a whole bunch of controversial amendments," said Rep. Phil Christofanelli, R-St. Peters and the bill's House handler, "which means that dangerous blood-borne diseases are spreading throughout our public and killing people."
In the House, lawmakers loaded the bill with over a dozen amendments, ranging from barring COVID-19 vaccinations for organ transplants to preventing the type of visitor restrictions healthcare facilities imposed during the pandemic.
"I'm hopeful, but being realistic as well," Rehder said of the needle-exchange bill's passage. "Our rural counties need this."
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.
Click the link below to read the full bill:
• SB 690: Modifies provisions of law relating to health care
Sponsor: Sen. Holly Thompson Rehder