Missourians with disabilities and seniors could lose at-home care under new eligibility algorithm

by Clara Bates, Missouri Independent
October 2, 2024

Nearly 8,000 seniors and Missourians with disabilities could lose at-home care over the next year after a new eligibility algorithm went into effect this week, a spokesperson for the state health department told The Independent.

Starting Oct. 1, Missouri’s Department of Health and Senior Services implemented a change in the scoring algorithm they use to determine eligibility during annual reviews and enrollment for those receiving help with everyday tasks like going to the bathroom, getting dressed and taking their prescriptions. The assistance is part of a Medicaid-funded program called home and community based services designed to provide an alternative to those who would otherwise need to receive institutional care. 

That change, according to the department, is designed to help ensure those who truly need the services receive them, and those who don’t — for instance, because their conditions have improved or they’re not severe enough to qualify — are removed.

“We want to ensure those with higher acuity needs are receiving the care they need,” said DHSS spokesperson Lisa Cox. “That is what this transformation is about—to ensure we are providing the right services, in the right setting, at the right time to those who would go into a facility placement if not for [home and community based services].”    

But advocates are raising alarm that certain people who still need services will lose them, causing their health to decline or forcing them into institutional settings like nursing homes. 

Jennifer Gundy, who runs a center for independent living in southwest Missouri, which provides in-home care support for 370 people, estimates 18% of her clients will fall off the rolls.

And most of them will still be in need of services, she said, including cases of those with severe diabetes, mobility issues, complicated medication regimes and other issues that are eased by current assistance but will worsen without it.

“So that’s our concern,” she said. “And we’ve been voicing that concern with the state for probably the last two years,” she said.

Joel Ferber, director of advocacy at Legal Services of Eastern Missouri, said there are “truly needy folks who are going to lose services.” 

Legal Services of Eastern Missouri has been working with national advocacy groups to analyze the new algorithm and its effects, and provide guidance. One client they identified, a 70-year-old woman who receives 40 hours of weekly paid help, won’t be eligible after her review, according to LSEM. She weighs under 100 pounds and has had a stroke.

Without a caretaker, she won’t be able to make herself meals or bathe, and has no family in the area. She may have to be hospitalized or go to a nursing home.

State Rep. Deb Lavender, a Democrat of Manchester, said thousands will lose services, “without any support from the state” to fill in the gap.

“They’re going to be people who have received services for years,” she said, “and we have provided that for them — to then drop them because they don’t meet the new algorithm doesn’t seem right.”

(Getty Images)

Cox said 7,818 people are at risk of losing services, but she didn’t provide an estimate of any possible net change, saying the program will “continue to add more participants every month due to the increase in needs of our population.” New people will also qualify based on the new algorithm, adding to the population, she said.

From 2021 to last month, the department used both the new and old algorithm, so that anyone who qualified on either basis could qualify for the program. Cox said thousands of people have gained access to services under the new algorithm who wouldn’t have qualified on the old calculation: She said 7,708 people have gained eligibility under the new algorithm since it was introduced in Nov. 2021.

There were around 68,000 people monthly on the program last fiscal year, Cox said.

The new algorithm has been years in the making. 

The legislature in 2017 grew concerned with the home and community based services program “just blossoming” in participation and cost, said Jessica Schaefer, program director for home and community based services in a recent training. 

To cut the budget, the legislature in 2017 raised the threshold for eligibility. It also capped costs for services at a lower level. 

The program is jointly funded by the state and federal government, and states vary widely in how they run the programs.

The department found those changes weren’t entirely effective, Schafer said — that some people who needed services most didn’t qualify anymore — so they launched a “transformation” of the eligibility criteria. It was designed to be more accurate at directing limited services to the correct people.

The “transformation is about ensuring those most in need of care receive the services needed to remain independent in their community,” Cox said.

There have been several delays in implementing the new algorithm — most recently because of federal rules tied to accepting American Rescue Plan Act funds. 

The state has generally characterized those who will lose coverage as people who don’t have needs significant enough to qualify in the first place.

In a slideshow for providers during a recent training, the state recommended when delivering the news of ineligibility to individuals, that they “exude confidence” and “put a positive spin on ineligibility,” along with connecting them to other resources and expressing sympathy.

Because the department has been providing two scores, advocates can see which clients will not qualify under the new algorithm and have been able to track it.

Advocates say they’ve repeatedly brought up concerns with the state based on clients they see are desperately in need of services who will no longer qualify.

“The only thing that we can do is just go ahead and allow them to do this, and then if there’s enough people that fall off the services and end up going to the nursing home, going in the hospital, having lots of problems because they’re not getting the services, then we can look at doing a class action lawsuit,” said Gundy, the southwest Missouri advocate.

“Which is really sad, because those people have to get hurt or have really bad health problems for something to get done.”

States across the country have made similar cuts to the program, based on automated decisions, including in Arkansas, where the algorithm was successfully challenged in court.

Legal Services of Eastern Missouri and a group of national advocates published a toolkit for providers and participants to understand the changes and track those who lose services.

Emily Paul, project director at Upturn, a national organization that advocates for equity and justice in technology, has been involved in that analysis.

“What we understand in general is that automation is a tool that states are using to deal with inadequate funding for these programs, and to create a rationale for who doesn’t get services,” Paul said.

“Underfunding really drives the need to have this whole rationale for trying to distribute the resources and trying to make claims to fairness and objectivity within a system that is not really set up to actually meet people’s needs,” she said. “And so that’s the fundamental issue. States can still try to make better or worse choices about how they allocate the resources.”

This story was updated at 9:10 A.M. with additional comment from the Department of Health and Senior Services.

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Half of Missourians have faced recent medical debt, survey finds

by Clara Bates, Missouri Independent
September 25, 2024

Two of every five Missouri adults owe money to medical providers, according to a survey published Tuesday by the nonprofit Missouri Foundation for Health.

Those debts include unpaid fees for services ranging from lab tests and doctors’ visits to emergency treatment and dental care. Often, the bills are from one-time or short-term medical expenses, the report states.

One in ten Missouri residents have more than $5,000 in medical debt.

The result is that Missourians with medical debt commonly cut back on spending for basic needs, exhaust their savings and increase other forms of debt, like credit card debt.

“When people struggle to access affordable health care, the effects ripple through our economy,” said Sheldon Weisgrau, foundation vice president of Health Policy and Advocacy, in a press release.

“It’s not just about health; it’s about financial stability, workforce productivity, and the ability of families to thrive,” he added.

The foundation commissioned a statewide survey of over 2,000 adults last spring, conducted by the research firm SSRS. Data were weighted to be representative of the population.

The survey found Hispanic and Black Missourians are more likely to have medical debt compared to white adults. 

Those in rural areas are also more likely to have current or recent medical debt, as are those with disabilities.

Half of Missouri adults have held medical debt at some point in the last five years, according to the report. Most of them — 78% of those under age 65 — had health insurance at the time they received the care that sent them into debt.

One reason those with coverage are incurring debt, the report notes, is that many have unaffordable deductibles — meaning out-of-pocket costs they must pay before the insurance company starts to pay. Cost-sharing measures, like copays, can also be high.

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In 2023, the average family deductible in Missouri was $3,783, according to the nonprofit KFF. The average deductible for single coverage in Missouri was $2,340.

Yet many Missourians live paycheck to paycheck. 

Four in ten Missourians don’t have the money to pay for an unexpected $500 bill, the Missouri Foundation for Health survey found. 

“The burden of medical debt is not only financially devastating but also demoralizing for families,” said Samantha Schrage Bunk, MFH health policy strategist, in the press release.

The results in the survey were similar to the national average found in a 2022 survey conducted by the nonprofit KFF.

The states with the worst rates of medical debt haven’t expanded Medicaid, KFF has found. Missouri implemented Medicaid expansion in October 2021.

There has been increasing attention to medical debt at the state and federal level in the last few years. At least 17 states this year proposed legislation related to consumer relief for medical debt, though not Missouri, according to LexisNexis’ state legislative tracker.

The Missourians surveyed widely support policies that would require greater price transparency, limits for hospital charges and uniform criteria for financial assistance programs.

“Missourians are clear – they want policy changes that make health care affordable and accessible, and they’re looking for government and health care systems to listen to them and take action today,” Schrage Bunk said.

In an earlier report, published in March, Missouri Foundation for Health interviewed focus groups.

“[Medical debt is] something that I will have to pay for the rest of my life,” one low-income woman, who has between $1,000 and $2,500 in debt is quoted as saying.

Others quoted needed to declare bankruptcy due to medical debt, or took hits to their credit that hurt their ability to find housing and employment.

One rural farmer needed to take on odd jobs in town to try to pay off thousands in debt. A man with disabilities needed to pay hundreds each month for years, instead of saving for retirement. A young mother needed to cut back on spending for food and clothes for her kids to pay hospital bills. 

Another described the “vicious cycle” of taking out credit card debt to try to pay off medical debt. 

“Honestly, if you’re middle class or low class,” one interviewee asked, “how can you afford $2,000 a ride in an ambulance?” 

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Missouri tax revenues declining in first months of fiscal year, raising concerns

by Rudi Keller, Missouri Independent
September 17, 2024

Missouri’s general revenue has lagged behind inflation for two years in a row. And with that gap widening, the next few months could determine whether state revenue will see a year-over-year decline for the first time in more than a decade. 

“September is a good sort of bellwether one for us, because that’s where we get quarterly payments from both individuals and corporations,” Dan Haug, Gov. Mike Parson’s budget director, said in an interview with The Independent last week. “There’s not a lot of significant due dates in July and August, so we try not to even really look at what trends are until we get through the end of September.”

Through Friday, general revenue receipts are down more than 3% compared to the same period in fiscal 2024.

Revenue grew 2.74% in fiscal 2023, while inflation was calculated at 3% by the federal Bureau of Labor Statistics. In fiscal 2024, which ended June 30, revenue grew 1.47%, while inflation was again pegged at 3%.

Missouri isn’t the only state suffering from sluggish revenue growth, according to a recent report from Pew Charitable Trusts. During the COVID-19 pandemic, many states — including Missouri — enjoyed a surge of revenue that drove new spending and tax cuts.

Missouri enjoyed double-digit revenue growth for two years, a trend that ended in early 2023. Nationally since the start of fiscal 2023, the report states, state government revenues have fallen below inflation rates and below the growth trend seen before the pandemic. That is the first time in 40 years that has happened outside of an economic recession.

“There’s less fiscal flexibility, but it’s unclear whether states will be really under strain or not, but it’s going to be more difficult than before,” said Alexandre Fall, a senior associate with Pew who was the main author of the report.

As they wrote this year’s budget in the spring, the Republican-led legislature tried to limit ongoing general revenue spending to the anticipated revenue of $13.2 billion. But even after Gov. Mike Parson vetoed $1 billion, the budget anticipates spending $15.1 billion in general revenue, dipping into surpluses accumulated during the surge in 2021 and 2022.

House Budget Committee Vice Chairman Dirk Deaton, a Republican from Noel, said lawmakers must continue to limit ongoing spending to new revenue.

“If revenue is lower in the future we will have to look carefully at core spending items to make sure the state budget is on a sustainable path and Missouri is well positioned to balance the budget year after year,” Deaton said.

State revenue was down in the early part of fiscal 2024 but ended up with modest growth, Deaton noted.

State Rep. Peter Merideth of St. Louis, the ranking Democrat on the Budget Committee, said future legislatures should commit to meeting state needs instead of hanging on to surpluses. Merideth is not returning to the House due to term limits.

Any spending cuts tied to the flow of revenue, rather than to the state’s total available resources, will fall heavily on education programs, Merideth predicted.

“We will cut education further,” he said. “Maybe it’s on the transportation line, or maybe it’s somewhere else, and we will cut higher education because those are about the only two slightly discretionary places that the legislature has to cut with large sums of money.”

Sitting on a surplus

On June 30, the general revenue fund held $4.8 billion, down $960 million from the balance a year earlier. That is still the third-highest year-end balance in state history.

Some of that money is committed to multi-year building projects, such as a $300 million mental health hospital in Kansas City, but most of it is unencumbered.

Other surplus money was stashed elsewhere. The state is holding $2.4 billion transferred from general revenue for major projects including rebuilding Interstate 70 and expanding the state Capitol Building. 

Another $1.8 billion was held in accounts that can be spent like general revenue.

The question for lawmakers and state officials is how to spend from surplus funds without exhausting them, said Liz Farmer, a fiscal policy writer at Pew.

“States are spending down balance dollars at a rapid rate,” Farmer said. 

The budget presented by Parson in January anticipated an unencumbered general revenue balance of $1.9 billion on June 30, 2025. 

Along with major projects, in the past two years lawmakers have used the surplus to fund smaller items in their districts. Parson has vetoed many of those items as he cut $550 million from the budget in 2023 and $1 billion approved this year. 

Future lawmakers need to resist the urge to earmark funds for their district, Merideth said. Stagnant or declining state revenue should mean extra funds are reserved for filling shortfalls in important programs.

“We have a surplus to work with in the short term but we haven’t hit an economic crash, which at some point will happen in the future,” Merideth said. “That’s when we’re going to be in real trouble.”

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During the recession that began in 2008, revenues fell from about $8 billion annual to $6.7 billion a few years later. Haug, who has worked for both the legislature and the executive branch, said the state is in good shape in case of a recession.

“We’ve got a very healthy fund balance to help us get through a minor downturn, if there is one, although I’m not sure that there even will be one,” Haug said. “We’re in a lot better spot to weather this kind of stuff than we’ve been probably in any of the time I’ve been here.”

There are structural changes in the cost of state government that are permanent, thanks to the surge of revenue. 

The pay of every state worker hired before the beginning of 2022 has increased at least 20.7% under pay raise plans proposed by Parson. Some workers have received much larger percentage boosts, from a longevity pay plan approved this year, increases in night pay for workers in prisons, mental health hospitals and other custodial institutions and approval of a minimum salary of $15 an hour for all state jobs.

With state agency staff vacancy rates averaging more than 10%, the cost of running the state will go up as workers are added.

“Increased state employee pay and salaries, as well as permanent tax cuts, were two very popular policy choices that were made across states and were made in Missouri,” Fall said. “But now that we’re seeing all this excess revenue kind of pull back, and states are seeing decreased flexibility, it’s unclear what comes next.”

Missouri has passed two large permanent tax cuts, with income tax rate cuts enacted in a special session in 2022, and a bill exempting Social Security benefits from state income tax in 2023.

Together, that legislation will reduce state revenue by $1 billion or more annually. The next step in the phased-in tax cut passed in 2022 will take effect on Jan. 1, cutting the top income tax rate to 4.7%.

Those cuts will generate economic activity that will sustain revenues, Deaton said.

“Missouri has made very clear through our tax policy we are more interested in growing the bank accounts of the people as opposed to growing the amount of monies coming to Jefferson City,” he said.

With a new governor coming into office in January and new legislative leadership, tapping the surplus could be a temptation.

“Whoever is sitting in that governor’s mansion and whoever is sitting in the budget committee chair will make a significant difference and it’s hard to predict,” Merideth said.

Revenue picture

In the last full fiscal year before the pandemic, the Missouri general revenue fund took in $9.6 billion. In the fiscal year that ended June 30, the total was $13.4 billion, 1.47% more than in the previous year.

Two of the main sources of state revenue — personal and corporate income taxes — saw a decline in collections in fiscal 2024. So far this year, the decline in revenue received so far has extended to sales tax collections.

The surge in revenue coincided with the highest inflation rates in 40 years and sales tax growth led the way, thanks to consumers spending federal pandemic relief aid along with higher wages and prices.

There is no evidence in the Missouri economy that would show the current decline in sales tax collections is anything but temporary, Haug said.

“People may be pulling back a little bit temporarily to pay off debt and things like that, but eventually the fundamentals are what’s going to drive it,” Haug said. 

Missouri added 62,400 jobs from July 2023 to July 2024 and personal income grew at an annual rate of 6.7% in the first quarter of the year. State GDP is up 1.6% on an annual basis and inflation, while slowing, continues, with prices nationally about 2.5% higher than a year ago.

“Long term, that’s what’s going to drive our revenues, and I think that’s still what’s going to drive our revenues,” Haug said.

With the end of pandemic restrictions, consumers are spending more on non-taxed services and travel, Farmer said, as well as substituting cheaper goods when they make purchases.

Missouri estimates its revenue each December for the remainder of the fiscal year and the coming year. A longer horizon for budget outlooks would make the state better prepared for possible trouble, she said.

“That is one of our key benchmarks for state fiscal health, and something that could be really helpful for assessing what these impacts on personal income tax and those cuts look like for the state down the line for revenue,” she said.

A longer-term outlook may be helpful, Deaton said, but experience shows that the short-term estimates aren’t particularly accurate.

“There have been times they were very close and other years when estimates missed badly,” Deaton said. “The further you extend out, the greater the margin of error.”

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GOP legislator’s son asks Supreme Court to order inquiry into donations to Missouri AG

by Allison Kite, Missouri Independent
September 11, 2024

Eight months into his term as Missouri’s attorney general, Andrew Bailey withdrew his office from defending a state agency being sued by a legislator’s son for disability discrimination.

A few months earlier, his campaign and an affiliated political action committee accepted more than $150,000 in donations connected to a witness in the case.

Incensed by what he saw as the state’s top attorney using his office for political benefit, Lucas Cierpiot — whose brother Patrick filed the original lawsuit and whose father is GOP Sen. Mike Cierpiot — filed a formal complaint accusing Bailey of violating attorney conduct rules.

Bailey’s spokeswoman, Madeline Sieren, noted in an email that the Office of Chief Disciplinary Counsel dismissed Cierpiot’s complaint without investigating. And legal experts interviewed by The Independent aren’t so sure taking money from a witness would warrant sanctions. 

But Cierpiot remains convinced the attorney general violated ethics rules. He’s now asking the Missouri Supreme Court to intervene and order an investigation. 

“No attorney can ever collect money from a case witness,” Cierpiot’s filing says. “The fact that there is not a rule spelling this out in-letter is due to the fact that it is so obvious.”

While Bailey’s office was still in charge of the case, his campaign for reelection launched. 

The first donor to his fledgling campaign committee was Michael Ketchmark, who gave $2,825, the maximum that an individual can donate. By the end of January 2023, Bailey would receive a combined $16,950 from individuals with the last name Ketchmark or employed by the law firm Ketchmark & McCreight P.C.

According to Patrick Cierpiot’s lawsuit, Ketchmark is a material witness in his case because he spoke to Gov. Mike Parson’s chief of staff in an attempt to keep Cierpiot from being fired from the Missouri Department of Economic Development. 

Ketchmark is a prominent attorney and donor in Missouri politics, including giving huge contributions to Parson. Patrick Cierpiot said he has known Ketchmark for 30 years.

In an email, Ketchmark said he has not been called as a witness by the state in Patrick Cierpiot’s or any other case. Court records in Kansas show Cierpiot called Ketchmark as a witness. Ketchmark did not respond to a question about whether he spoke to the governor’s staff on Cierpiot’s behalf. 

“I have no idea why Patrick was fired, and the fact that Patrick listed me as a witness does not stop me from supporting a political candidate,” said Ketchmark, whose law firm this year alone gave the PAC supporting Bailey $1.1 million.

Todd Graves gets high-powered help lobbying for University of Missouri curator position

Attorneys contacted by The Independent said there is not a specific rule in Missouri barring Bailey from accepting donations from a witness. But Peter Joy, who teaches legal ethics at Washington University in St. Louis, said it creates a public confidence issue.

“In terms of public perception,” Joy said, “it raises a lot of questions.”

When someone is running for prosecutor or attorney general, Joy said, it’s a “delicate balance” between being a lawyer and a politician.

“They still owe their primary obligation to the oath that they took to fulfill their elected office,” Joy said, “but…they have a campaign committee that’s soliciting people for contributions and they’re attending fundraisers and they’re speaking before groups where they’re hoping to generate funds to run their campaign and get votes, eventually, to retain their office.”  

Lucas Cierpiot’s filing is the latest in a series of accusations of unethical behavior by Bailey, who narrowly avoided being questioned under oath last month about his contact with a defendant in the state’s case against Jackson County. One of Bailey’s deputies lost his law license in that dispute, according to a filing from Jackson County’s attorneys. 

Last year, Bailey’s office withdrew from defending the Missouri State Highway Patrol in a lawsuit filed by companies that operate video game machines that offer cash prizes. The patrol investigated the machines, believing that they were illegal means of gambling. 

The withdrawal came after Bailey’s PAC accepted large campaign contributions from political action committees linked to a lobbyist for the two companies that brought the lawsuit against the state — Torch Electronics and Warrenton Oil.

It’s also the second time Bailey has been the focus of a formal complaint about the behavior of his office. Earlier this year, the Hazelwood School District lodged a formal complaint about Bailey after his office falsely blamed the school’s diversity, equity and inclusion program for the off-campus assault of a student. 

Patrick Cierpiot sued the Missouri Department of Economic Development two years after he was fired from the department. He said he requested accommodations after breaking his wrist in a bicycle wreck because he was struggling to write and type to keep up with his workload but was fired instead. In its response, the state accused Cierpiot of fraud.

In Cierpiot’s amended lawsuit in May 2022, he named Ketchmark as having urged a Parson staffer not to fire him. 

The following January brought the Ketchmark-affiliated donations to Bailey’s campaign. Later in the spring of 2023, Ketchmark’s law firm donated $125,000 to the pro-Bailey Liberty and Justice PAC. 

A few weeks after that, Liberty and Justice received an in-kind donation from the firm totaling $9,216.53. Bailey helped raise money for Liberty and Justice PAC, which, in turn, supported his successful GOP primary run for a full term as attorney general. 

Bailey’s campaign and the PAC received a combined $151,166.53 in cash and in-kind donations from Ketchmark, his relatives and his law firm and associates while Bailey was defending the state in the Cierpiot lawsuit.

Missouri AG drops out of gambling case after taking donations from companies suing state

In August 2023, Bailey’s office withdrew from the case and allowed the department to hire a private law firm to handle it. At that time, Sieren told the St. Louis Post-Dispatch that Bailey didn’t have a conflict of interest and his office was looking to outside firms to handle “complex cases.” 

Lucas Cierpiot filed his complaint four months later in December 2023. It was dismissed by the Office of Chief Disciplinary Counsel in March. Cierpiot asked for further review, but the case was dismissed again in May.

In response, Cierpiot filed a motion with the state Supreme Court last month asking that it order an investigation. 

The Office of Chief Disciplinary Counsel responded to Lucas Cierpiot’s filing with the Missouri Supreme Court, saying he could not insist on an investigation. It went on to say Cierpiot’s complaint didn’t allege a violation of the rules of professional conduct because it outlined donations from Ketchmark’s firm to the PAC, not from Ketchmark himself to Bailey’s campaign committee.

“Corporations are legal entities separate and distinct from their officers and shareholders,” the response filing says. 

The filing, signed by Chief Disciplinary Counsel Laura Elsbury, claims that before declining to investigate Cierpiot’s allegations, officials “independently verified that (Ketchmark) had not contributed to (Bailey’s) campaign committee.”

But that was wrong. Ketchmark did contribute to Bailey’s campaign committee.

Elsbury said in an email she could not comment on the pending issue. Lucas Cierpiot did not immediately return a  request for comment.

In an interview, Patrick Cierpiot said he doesn’t think it is right for an attorney to take money from a witness.

“If it’s okay for Andrew Bailey to solicit and accept money from a case witness,” Patrick Cierpiot said, “then the Missouri courts are completely blown open for corruption.”

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Missouri judge hears arguments challenging ‘fair ballot language’ for abortion amendment

by Anna Spoerre, Missouri Independent
September 4, 2024

A judge could decide as early as Thursday whether Missouri Secretary of State Jay Ashcroft’s “fair ballot language” summary for an abortion-rights amendment is truly fair. 

Missouri voters will be asked on Nov. 5 whether they support Amendment 3, which would establish a constitutional right to an abortion up until fetal viability and protect other reproductive rights, including access to in-vitro fertilization and birth control. Abortion became illegal in Missouri in June 2022, with limited exceptions for the life and health of the mother.

Posted at every polling station around the state, next to sample ballots, is “fair ballot language” that summarizes the questions that voters will be asked to decide on. State law requires that this language, written by the secretary of state, be “true and impartial.”

In a lawsuit filed two weeks ago, organizers behind Amendment 3 claimed that Ashcroft’s summary was “intentionally argumentative” and could create confusion among voters. 

The same day Ashcroft certified the measure for the November ballot, his office also published to its website a “fair ballot language” summary statement for the amendment which reads: 

“A ‘yes’ vote will enshrine the right to abortion at any time of pregnancy in the Missouri Constitution. Additionally, it will prohibit any regulation of abortion, including regulations designed to protect women undergoing abortions and prohibit any civil or criminal recourse against anyone who performs an abortion and hurts or kills the pregnant women.” 

Missouri voters will decide whether to legalize abortion in November 

The abortion rights campaign is asking the court to issue new “fair ballot language” and order that Ashcroft remove his current language from his government website.

A brief bench trial Wednesday afternoon in Cole County Circuit Court focused in particular on the last sentence of Ashcroft’s summary, and how a court could interpret subsection 5 of the amendment, which reads: “No person shall be penalized, prosecuted, or otherwise subjected to adverse action based on their actual, potential, perceived, or alleged pregnancy outcomes, including but not limited to miscarriage, stillbirth, or abortion. Nor shall any person assisting a person in exercising their right to reproductive freedom with that person’s consent be penalized, prosecuted, or otherwise subjected to adverse action for doing so.”

Andrew Crane, representing Ashcroft on behalf of the Missouri Attorney General’s Office, argued Wednesday that this subsection would result in “effectively neutering the government’s ability to enforce any effective regulations” on abortion. 

Tori Schafer, an attorney with the ACLU of Missouri, which is representing the plaintiff, called this claim “politically-charged” and unfounded, as it fails to take into account other language in the amendment protecting patients.

“The amendment will provide greater independence from the government,” she told the court. “But it does not create the boundless, limitless, unregulated right the secretary continues to make it to be.” 

Schafer said Ashcroft in the latest language “resurrects his false claims” that have already been denounced by the Missouri Court of Appeals.

Ashcroft was sued last year by the abortion-rights campaign over the initial ballot summary he drafted, which would have asked Missourians, in part, if they wanted to “allow for dangerous, unregulated, and unrestricted abortions, from conception to live birth.” 

Cole County Circuit Judge Jon Beetem ruled a year ago that Ashcroft’s language was “problematic” and inaccurate. 

An appeals court agreed, ruling that it is “not a probable effect” that the amendment would allow unrestricted abortion in all nine months of pregnancy or that it would toss aside health and safety regulations, “including requirements that physicians perform abortions and that they maintain medical malpractice insurance.”

However, Crane on Wednesday argued that the appeals court ruling didn’t specifically address the immunity provisions of subsection 5.

Ashcroft, who recently lost a bid for the GOP candidate for governor, has been open about his opposition to abortion. 

During the Midwest March for Life outside in May, he told The Independent of the abortion initiative petition: “I just want to make sure that people know what this amendment will actually do. That it’s abortion from conception until the very last second that the last toenail leaves the birth canal.”

Cole County Circuit Judge Cotton Walker, who is overseeing the current case, said he intends to rule on Thursday. 

Walker recently upheld the “fair ballot language” summary written by Ashcroft for a proposed constitutional amendment that would ban ranked-choice voting after two voters sued over the language. The voters called the language imprecise, in part because it doesn’t state that it’s currently illegal for non-citizens to vote in Missouri. 

The Amendment 3 lawsuit was filed by retired physician Dr. Anna Fitz-James, who initially filed the abortion rights initiative petition in spring 2023 on behalf of Missourians for Constitutional Freedom, the campaign behind the amendment. 

The campaign has raised millions of dollars this election cycle, and recent polling by St. Louis University/YouGov showed 52% of Missouri voters supported Amendment 3. The poll surveyed 900 voters across nine days in August.

Meanwhile, a second lawsuit regarding Amendment 3 is also pending in Cole County after a number of anti-abortion activists and lawmakers asked a judge to block the amendment from the Nov. 5 ballot. Their lawsuit claims Amendment 3 violates the state constitution by including more than one subject and fails to specify which laws and constitutional provisions would be repealed if it was approved.

A bench trial in that lawsuit is scheduled for Friday.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.

Poll shows Missouri voters back Trump, Hawley, abortion rights and minimum wage hike

by Rudi Keller, Missouri Independent
August 29, 2024

Missourians seem poised to legalize abortion and increase the minimum wage in November but are unlikely to embrace the Democratic statewide candidates who are among the ballot measures’ most ardent supporters, a new poll shows.

The proposal to enshrine the right to abortion up until the point of fetal viability in the Missouri Constitution drew support from 52% of people surveyed between Aug. 8 and 16 for the St. Louis University/YouGov poll. The minimum wage increase, to $15 an hour by Jan. 1, 2026, had even stronger backing, with 57% of those surveyed saying they support it.

The poll also found majorities supporting every Republican running statewide, who each held at least a 10-percentage point lead over Democratic opponents. Former President Donald Trump was selected by 54% of respondents, with 41% backing Vice President Kamala Harris. The poll gives Lt. Gov. Mike Kehoe a 51% to 41% advantage over House Minority Leader Crystal Quade in the governor’s race.

The best-funded Democratic statewide candidate, Lucas Kunce, was 11 percentage points behind incumbent Republican U.S. Sen. Josh Hawley, with the poll showing Hawley with a 53% to 42% edge.

“I’d be very surprised if any Democrat won a statewide race this year,” poll director Steven Rogers said. “It’s not breaking news that Democrats struggle in statewide races in Missouri.”

The poll surveyed 900 voters and has a 3.8% margin of error. It included 69 questions, seeking views on major issues facing the state in addition to tracking approval ratings for politicians and testing election contests.

The results showed:

The economy is the biggest concern for voters, listed as the No. 1 issue by 47%. The survey also showed 69% view the national economy as fair or poor and 71% give that rating to the state economy. Health care, at 18%, and education, 16%, are the second and third issues listed as top concerns.A plurality of voters, 42%, oppose four-day school weeks, but those aged 18 to 29 support it by a 44% to 35% margin. Voters 65 years old or older had the strongest opposition. A new law requiring a public vote to adopt a four-day week in districts in charter counties and cities larger than 30,000 people had overwhelming support at 77%, which was consistent across all demographic, income and partisan groups.Laws to require a background check for gun sales and banning minors from carrying guns on public property without adult supervision also had overwhelming support, 79% and 85% respectively. But voters oppose other measures to control firearms, including allowing local ordinances that are stronger than state law.

Polling by SLU/YouGov began in 2020, making this the second presidential election year for the project. Its last poll before the 2020 election pointed correctly to the outcome, but Republican candidates generally did better than the poll indicated.

Gov. Mike Parson was shown with a 50% to 44% lead over Democratic State Auditor Nicole Galloway and ended up winning by a 57-41 margin. That poll showed then-President Donald Trump with a 52% to 43% advantage over Joe Biden, with the final result a Trump win, also by a 57-41 margin.

Democrats are banking heavily on voter support for ballot measures, especially the abortion rights proposal, to help overcome some of the other disadvantages they face. No Democrat has won a statewide race since 2018.

Historically, however, ballot measures have only a marginal impact on candidate races, said Rogers, an associate professor of political science at St. Louis University.

“A presidential election year is probably the least effective time to have something else to boost turnout,” he said.

Republican U.S. Sen. Josh Hawley, left, confronts his Democratic challenger, Lucas Kunce, over who is ducking debates during a meeting Thursday, Aug. 15, 2024, at the Governor’s Ham Breakfast at the Missouri State Fair in Sedalia (Rudi Keller/Missouri Independent).

Ballot measures can drive turnout. Three of the most high-profile Missouri ballot measures this century — same-sex marriage in 2004, right to work in 2018 and Medicaid expansion in 2020 — were placed on the August primary ballot by governors worried about the impact of ballot-measure voters on November campaigns.

In 2004, the issue coincided with a titanic battle for the Democratic nomination for governor and 847,000 Democrats voted. In 2018, with no significant primary, 607,577 votes were tallied in the Democratic primary for U.S. Senate and in 2020, where there again was no hotly contested primary, 537,000 Democrats voted in the gubernatorial race.

In years with no high-profile ballot measures, Democrats since 2000 have averaged about 350,000 voters in statewide primaries for governor and U.S. Senate.

Republicans also showed an increase in primary voters in the years with ballot measures, but not by the same degree. In years without controversial ballot measures, the GOP has averaged about 530,000 voters in statewide contests for governor and U.S. Senate. The average for 2004, 2018 and 2020 was about 640,000 votes.

That data shows that ballot measures can impact low-turnout elections, Rogers said. Presidential election years traditionally have the highest turnout.

“Those voters may already be turning out, and so the difference that you’re making is probably going to be marginal,” Rogers said.

The poll found very few voters are undecided, so the target for Democrats will have to be voters who support the ballot measures but intend to vote for Republican candidates. The poll shows that about one-third of voters who said they will vote for Trump, Kehoe and Hawley will also support the abortion rights amendment and minimum wage propositions.

Democrats will have a tough time switching voters, Rogers said.

“There isn’t much evidence of what we would call reverse coattails for ballot measures,” he said. 

The only Democrat already airing television ads in advance of the November election is Kunce, who has spent $2.7 million through Tuesday, according to FCC records reviewed by The Independent. Hawley has spent $1.2 million on television ads in defense of the seat he won in 2018.

Hawley is in the best position he has been in any of the previous SLU/YouGov polls. His approval rating is 53%, which is 14 percentage points higher than his negative rating. That is the best overall number recorded, Rogers said.

He also had a 14-point net positive rating in July 2021 in the first SLU/YouGov poll after the Jan. 6 attempt to overturn the 2020 election.

Hawley’s lowest net positive was two points in an August 2022 poll taken just after video of him running away from the Senate chamber during the Jan. 6 riot was included in hearings of the House Select Committee on the January 6 Attack. In that survey, Hawley had a 46% favorable rating and a 44% unfavorable rating.

State Sen. Denny Hoskins, right, speaks with Barbara Coan, center, and Mark Coan, during a July 2 campaign stop in Springfield (Rudi Keller/Missouri Independent).

The only Republican statewide candidate who equals Hawley’s support is state Sen. Denny Hoskins of Warrensburg, shown with a 54-36 lead in the secretary of state race over state Rep. Barbara Phifer, the Democratic nominee.

Hoskins ran in the primary as a team with state Sen. Bill Eigel, who finished second in the primary for governor. Eigel’s combative style found an enthusiastic audience in some areas and that is likely helping Hoskins, Rogers said.

Hawley also has a reputation for being combative and that may explain why he is doing so well, Rogers said.

“Hawley is not Eigel, but he sometimes acts Eigel-like,” he said.

The poll found support for the abortion rights initiative, which is slated to appear on the November ballot as Amendment 3, is increasing. It is eight percentage points higher than found in a February poll, Rogers said. 

Amendment 3 has a plurality or majority of voters in most demographic, income and education subgroups, with only Republicans, as a group, and voters in rural areas of northeast and southern Missouri showing more opposition than support.

The abortion measure would overturn a Missouri law that took effect in June 2022 after the U.S. Supreme Court overturned the 1973 Roe v. Wade decision that provided federal constitutional protection for abortion. Under current Missouri law, abortions are only allowed to save the life of the mother or when “a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function.”

Exactly how many initiative proposals will be on the Nov. 5 ballot remains uncertain. 

The abortion rights measure and the proposal to legalize sports wagering must survive court challenges, and backers of a proposal to allow a new casino near the Lake of the Ozarks are trying to overturn the decision that they fell short of the required signatures in one congressional district.

No hearing had been set as of Wednesday afternoon for the challenge to the abortion rights amendment. Attorneys will be in court Sept. 5 for arguments over the sports wagering proposal, which would be Amendment 2 on the ballot, and on Friday for the casino proposal.

With no legal challenge, the campaign committee for increasing the minimum wage, known as Missourians for Healthy Families and Fair Wages, has already begun reserving television ad time for the final three weeks of the campaign. Through Tuesday, the committee had spent $904,000, according to FCC records.

The minimum wage proposal, which also includes a requirement for businesses to provide paid time off to full-time employees, is supported across all regional, demographic, income, and education subgroups. Only Republicans, as a group, showed more opposition than support. On another question, pollsters surveyed what voters thought the minimum wage should be in Missouri and the median was $15, the level targeted in the initiative.

Support for sports wagering, seen in 50% of those polled, was also widespread. Only one subgroup, voters in southeast Missouri, showed more opposition to sports wagering than support.

Each of the initiative campaigns is poised to spend millions to hold and expand the support shown in the polls. Rogers said he’s confident that effort will pay dividends.

“My anticipation,” he said, “is that as the campaigns become more active, and based off our previous polling, that support will only go up.”

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Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.

Deadline for Missouri’s new marijuana plain packaging is Sept. 1

by Rebecca Rivas, Missouri Independent
August 26, 2024

Marijuana companies face a hard deadline to meet Missouri’s new plain packaging requirements on Sept. 1 — more than a year after the rule was initially put in place. 

For decades, there’s been a global movement urging “plain packaging” on tobacco products — or packaging with limited colors and frills — after numerous studies found it makes cigarettes less appealing to young people. 

Missouri is now atesting ground to see if plain packaging has the same impact for recreational marijuana.

When voters passed the constitutional amendment to legalize recreational marijuana in 2022, it included a provision that labels and packaging for marijuana-related products, “shall not be made to be attractive to children.”

Now under new state rules, packaging can only be one primary color, and it can have up to two logos or symbols that can be a different color or several different colors.

On June 6, 2023, the Missouri Department of Health and Senior Services released more guidance, specifying the main packaging should be a primary color, and it can have up to two logos or symbols that can be a different color or a few colors (photo submitted).

“This approach to packaging is familiar to all of us,” said Amy Moore, director of Missouri’s Division of Cannabis Regulation, during a legislative committee hearing last year. “You think about the cereal aisle versus tobacco packaging or over-the-counter medicines.”

The initial deadline for compliance was May 1, but regulators heard from licensees that potential delays in global shipping could impact their ability to receive the packaging in time. 

Now starting on Sept. 1, marijuana manufacturers must package and label all products in division-approved designs before sending them to a dispensary. 

Dispensaries can continue to sell non-compliant products they already have in the store until Nov. 1.

The new rules also require the division to pre-approve the labels, a process that didn’t exist under medical marijuana rules. 

Nick Rinella, CEO of Hippos Cannabis, said companies have seen delays in the state’s approval of their submitted designs.

“The state just doesn’t have the manpower to go through and approve them,” Rinella said. “And until they’re approved, they can’t go onto the shelves in their new packaging.”

Since the approval process opened on Sept. 1, 2023, the division has received nearly 150,000 submissions, said Lisa Cox, spokeswoman for the division.

Half of those were submitted within the last 60 days.

“Licensees have had a year to submit applications for approval,” Cox said, “and five months’ notice that they should not expect another extension.”

Cox said all applications are being processed within 60 days.

The constitution says that no marijuana facility can sell edible marijuana-infused candy in shapes or packages that are attractive to children or that are easily confused with commercially sold candy that does not contain marijuana. Penalties include fines of up to $5,000 and a loss of a business license. 

The packaging requirements are part of Missouri’s new cannabis regulation rules that went into effect on July 30, 2023. 

In the division’s first draft of proposed rules last year, it required companies to have only one color on the label. 

That caused an uproar from the Missouri Cannabis Trade Association, which argued in a letter to lawmakers that marijuana businesses had already invested “many millions” in packaging designs. And companies did so, the trade association contends, because “attractive, interesting, and attention-grabbing packaging is essential to effectively advertise and promote marijuana product sales.”

After the pushback from both MoCann Trade and some legislators, the agency changed the rule to allow “limited colors.” Another compromise, Moore told lawmakers, was allowing for QR codes on the labels to send consumers to their website for more information. 

Missouri becomes one of few states that require plain packaging in the adult-use cannabis market, according to the Network for Public Health Law. The others include Connecticut, Massachusetts and New Jersey. 

Moore said the rules align with what voters asked for in the constitutional amendment. The requirements regarding children’s safety are more stringent than what was included in the constitutional amendment legalizing medical marijuana in 2018.

“We have to notice that,” she said, “and say, ‘Apparently we’re to do more, we’re to do better for children and for health.”

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.

Missourians average 1 year in jail waiting for court-ordered mental health treatment

by Clara Bates, Missouri Independent
August 21, 2024

The number of people languishing in Missouri jails in need of court-ordered mental health treatment currently stands at 344 — and the wait time for a hospital bed averages one year. 

That’s up from 254 people this time last year, according to Missouri Department of Mental Health data provided to The Independent. A spokeswoman for the department said that because the agency’s inpatient beds are at capacity, the number of people waiting in jails for treatment will continue to rise.

Debra Walker, the department’s spokeswoman, said February was the first month the number of individuals waiting ever exceeded 300.

None of the people on the waitlist have been convicted of a crime. They were arrested, found incompetent to stand trial and ordered by the court into mental health treatment, designed to allow them to stand trial, a process called competency restoration that generally includes therapy and medication. 

“We do want to increase the number of individuals who are getting competency restoration,” said Jeanette Simmons, deputy division director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a mental health commission meeting earlier this month. â€œWe have a growing number of individuals who are waiting for those services.”
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Missouri has faced a years-long struggle with this issue, due to increasing numbers of court referrals for competency restoration, staffing issues and limited psychiatric hospital capacity. It’s worsened over the last year.

The legislature appropriated $300 million this year for Department of Mental Health to open a new hospital in Kansas City, but it could be around five years before construction is complete.

State officials are also working to implement the “jail-based competency restoration” program approved by the legislature this year in response to the issue. This year’s budget set aside $2.5 million for the jail-based competency programs to be established in jails in St. Louis, St. Louis County, Jackson County, Clay County and Greene County.

Services in jail-based competency restoration will include room and board, along with medical care for 10 slots at each jail, contracted staff from a local behavioral health organization, and psychiatric care from “mobile team practitioners.”

The department is currently training two agencies in Kansas City that will be going into county jails to provide jail-based treatment. Clay County has a “tentative go live date” for September, Simmons said.

“So we're really looking forward to that and getting that launched, because we do believe that it's going to take a multifaceted approach to target those numbers,” she said.

Simmons said the agency has mobile teams of doctors going into county jails prescribing medications “to try and get folks started on those medications that they need to stabilize their mental illness.” The department is working with community behavioral health liaisons as well as jail mental health or medical staff, she said, to get people services.

The Department of Mental Health is also working on trying to get information to the courts about outpatient restoration, for those who can be safely treated in the community and don't require hospital-level care. A law passed this year gives the agency the authority to treat certain arrested people on an outpatient basis.

“Sometimes I think the courts don’t really consider that as an option,” Simmons said of outpatient treatment. “It’s something very new.”

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In other states, including some bordering Missouri, lawsuits have been filed over similar wait times, alleging they violate individuals’ rights to due process and the Americans with Disabilities Act.

A federal lawsuit filed last year in Oklahoma alleged jails are holding patients for three months to one year. A proposed settlement set a benchmark of a 60 day maximum wait and ultimately a goal of 21 days, but it has faced opposition from the governor.

A lawsuit filed in Kansas in 2022 alleged that individuals are detained for longer waiting for a psychiatric bed than they would be if they had been convicted. Many of the charges are for low-level crimes, national investigations have found.

County sheriffs and jail administrators in Missouri have raised the alarm about challenges caring for individuals who are being detained pretrial. And state officials have acknowledged the long waits contribute to mental deterioration.

The Missouri Sheriffs’ Association recently published an issue of their ‘Missouri Jails’ magazine focused on managing mental health challenges in county jails, which shared several examples of local issues, including that one county spent $30,000 to provide around-the-clock guarding over a suspect for two months, because the secure medical centers didn’t have any openings.

Some county sheriffs are looking to build or expand jails to combat the issue, according to the magazine, including by increasing the number of solitary cells to keep those with mental health diagnoses out of the general population. Others have contracted with private health provider Turn Key Health Clinics to provide increased mental health care while people are awaiting transfer. 

“As mental health professionals and legislators struggle to find solutions to the crisis,” magazine contributor Michael Feeback wrote, “sheriffs and other agencies are looking for answers on their own.” 

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Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.

US credit card debt continues to rise as housing and other costs remain high for the lowest earners

by Casey Quinlan, Missouri Independent
August 22, 2024

Americans are racking up credit card debt as they struggle to keep up with the cost of living, and experts say those who earn the least are the hardest hit.

Total credit card balances rose 5.8% from a year ago, to $1.14 trillion, according to a recent New York Fed report. Equifax credit files through June show that credit card delinquency is still rising but that delinquency on consumer finance loans and retail cards fell and auto loan delinquency was flat.

People use credit cards for all kinds of purchases, and despite the stereotype of consumers getting themselves into too much credit card debt so that they could buy a few extra flashy clothes or vacations, many of them are for necessities.

So what does it mean for the economy that the average rate for people with a credit card balance was 22.76% in May, that there is an expansion of financial tech products like “buy now, pay later,” and that many Americans find themselves unable to pay off that debt? It depends on your role in the economy, financial experts and economists say.

“If you’re in that half who’s paying your cards in full and taking full advantage of rewards and buyer protections, life is great for you. That’s a very different story from someone who’s trapped in that expensive cycle of 20 to 25 to 30% interest month after month,” said Ted Rossman, Bankrate senior industry analyst.

Still, the rate of growth in credit card debt has accelerated, which Rossman calls “potentially troublesome.”

It’s impossible to look at rising credit card debt without acknowledging the high cost of living, such as housing prices. The Consumer Price Index, a measure of inflation, showed that in July, shelter increased 0.4% and made up 90% of that month’s rise in the all items index.

“Inflation is definitely contributing to higher balances. Even if it’s a category like rent, which most people are not putting on a credit card, if you’re getting squeezed on rent, you have less money to go around for groceries and gas and other things that maybe you are putting on a credit card now,” he said.

The Federal Reserve’s campaign to raise interest rates to bring down inflation also affects credit card debt and some economists say it is fueling economic inequality. Although the Fed paused rates last year, they are still fairly high and influence credit card rates. The Fed may cut rates in its September meeting if it continues to see cooling inflation data.

“People who rely on credit cards and other forms of borrowing to finance all sorts of things in their lives, whether that’s food or purchases for investments in their education or purchases for their home or their children, disproportionately folks who are poor – they’re really hurting because interest rates are really high,” said Rakeen Mabud, chief economist and a senior fellow at Groundwork Collaborative, a progressive think tank. “These interest rates are really taking a toll on people’s day-to-day ability to live and finance their lives. It looks to me that the high interest rates at this point are actually causing more pain than the inflation that it is trying to combat.”

In addition to the impact of the federal funds rate on credit cards, consumers are facing high annual percentage rate margins, or APR margins, which the Consumer Financial Protection Bureau said were an all-time high in a February report. The agency said rising APR margins are driving people into persistent debt and delinquency.

“Credit card companies are gouging consumers with record high APR margins, which sit on top of the Fed’s already high interest rates. Profiteering by credit card companies cost people an extra $25 billion last year and is yet another example of corporations using inflation as a cover to rip people off,” Mabud said.

A lack of competition in the credit industry doesn’t help matters for those struggling with credit card debt, added Mark Zandi, chief economist of Moody’s Analytics, which provides financial intelligence products.

“There is some evidence that there’s less competition in that market and that’s allowing credit card lenders to enjoy wide margins,” he said.

Mitria Wilson-Spotser, vice president and federal policy director at the Center for Responsible Lending, said she partly attributes the rise in credit card debt to some major credit card companies not reporting payment data, which does not make it to their credit reports, hurting their credit score and leaving them with higher credit card rates or extending credit without basing it on an ability to repay.

Consumers also have access to more financial tech products, like earned wage access programs, which let employees access their pay earlier for a fee, and buy now pay later products, said Wilson-Spotser. These products are not regulated in the same way as credit cards. The Consumer Financial Protection Bureau issued a rule in May to apply the same regulations to “buy now pay later” lenders as traditional credit cards.

“There’s no obligation to ensure an ability to repay for the consumer, so that debt, which is kind of this phantom in the room, is combining with credit card debt, which I think is probably one of the reasons why we’re seeing an increase in delinquency among some consumers,” she said.

Zandi said the people most likely to suffer financially from their credit card debt, lower-income people, only account for a sliver of the consumer spending driving the economy.

“[High interest rates] is adding to the pressure on households who have revolving debt, that aren’t paying off their cards and are using the card as a way to borrow money and have outstanding debt. So that’s a real problem for those households,” he said. “… The economy can move forward and be just fine even if the folks in the bottom third are struggling. The economy can’t flourish but it can do what it’s doing.”

That doesn’t mean the impact of the harms of high credit card rates and inflation, which is cooling but has done damage to households, will go unnoticed, however, Zandi said, alluding to building political pressure to improve people’s economic well-being.

“But the political and social implications are enormous. You can see it in our fracture of politics and what’s going on in terms of the presidential election,” he said. “… Politics has been affected by the fact that lower-income households have seen their share of the economic pie decline from where it was when it was at its peak back in the late 70s, early 80s.”

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.

Missouri voters will decide whether to legalize abortion in November 

by Anna Spoerre, Missouri Independent
August 13, 2024

Abortion will be on Missouri’s statewide ballot in November.

An initiative petition to enshrine the right to abortion up until the point of fetal viability received final approval Tuesday, securing a place on the general election ballot. If the measure receives a majority of votes, Missouri could become the first state to overturn an abortion ban through a citizen-led measure.

The Missouri Secretary of State’s Office had until 5 p.m. to certify all ballot measures that received enough verified signatures to qualify. It certified the measures as sufficient hours before that deadline. Also certified to be on the November ballot were proposals to legalize sports wagering and raise the minimum wage. 

Leaders with Missourians for Constitutional Freedom, the coalition behind the ballot measure, gathered at a press conference Tuesday to encourage Missourians to get out to vote. The coalition is headed by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates. 

“Politicians have tied doctors’ hands and the stakes could not be higher,” said Mallory Schwarz, executive director of Abortion Action Missouri. “ … With a yes vote on amendment 3 this November, we are taking back what’s ours.”

In Missouri, the first state to ban abortion after the U.S. Supreme Court overturned the constitutional right to the procedure two years ago, abortion is expected to be a focal point of the general election campaign.

Missouri is among 18 states with an abortion ban, and among several states working to put abortion on the ballot. In each state that put the issue on the ballot, citizens ultimately choose to protect the procedure.

“The measure takes away the right from every person who loses a child or a loved one because of negligence during pregnancy, labor or delivery the freedom to sue for malpractice and obtain compensation,” Stephanie Bell, a spokeswoman with Missouri Stands with Women, said in a statement Tuesday.

Tori Schafer, director for policy and campaigns for the ACLU of Missouri, responded to the comment, saying the statement is “fully false” and that the amendment doesn’t impact malpractice laws already in place.

What would the amendment do?

Abortion is illegal in Missouri, with limited exceptions only in cases of medical emergencies. There are no exceptions for survivors of rape or incest.

If the amendment receives more than 50% of votes in approval, the measure would legalize abortion up until the point of fetal viability, an undefined period of time generally seen as the point in which the fetus could survive outside the womb on its own, generally around 24 weeks, according to the American College of Obstetricians and Gynecologists. 

Such an amendment would return Missouri to the standard of the 1973 Roe v. Wade decision, which also legalized abortion up to the point of fetal viability. Missouri’s amendment also includes exceptions after viability “to protect the life or physical or mental health of the pregnant person.”

Missouri’s amendment also states that women and those performing or assisting in abortions cannot be prosecuted. Under current Missouri law, doctors who perform abortions deemed unnecessary can be charged with a class B felony and face up to 15 years in prison. Their medical license can also be suspended or revoked.

Dr. Selina Sandoval, associate medical director for Planned Parenthood Great Plains Votes, said the right to make decisions about abortion is personal and she sees each day the barriers and hardships bans cause.

“In Kansas right now, we are serving mostly out-of-state patients, including Missourians, who’ve had to flee their home states in order to simply access abortion care,” Sandoval said Tuesday.

Missourians for Constitutional Freedom, the coalition leading the reproductive-rights campaigns, is headed by Abortion Action Missouri, the ACLU of Missouri and the state’s Planned Parenthood affiliates. 

A decade ago, when abortion was still legal with fewer limitations, more than 5,000 abortions were performed in the state, according to data from the Missouri Department of Health and Senior Services. But by 2020, that number dropped to 167 due to a series of “targeted regulation of abortion providers” laws passed, including a mandatory 72-hour waiting period between the initial appointment and a surgical abortion and mandatory pelvic exams for medication abortions.

2 years after Missouri banned abortion, navigating access still involves fear, confusion

Since the Supreme Court decision in June 2022 through March 2024, there were 64 abortions performed in Missouri under the state’s emergency exemption, according to data from the Missouri Department of Health and Senior Services. 

A recent study by the Guttmacher Institute, a reproductive rights research group, showed that in 2023 alone, 8,710 Missourians traveled to Illinois and 2,860 Missourians went to Kansas for the procedure, which remains legal in both states. 

Despite the relative proximity to clinics in the Illinois suburbs of St. Louis and the Kansas suburbs of Kansas City, abortion access for Missourians has remained precarious at best.

Missourians hoping for abortions have increasingly found themselves competing for limited resources — including abortion funds and clinic appointment openings — especially as more southern states have outlawed the procedure, making Illinois and Kansas critical access points for women in states like Florida, Oklahoma and Texas. 

This has led many Missourians to increasingly rely on self-managed medication abortions. Rather than traveling across state lines, it’s estimated that thousands of Missourians received Mifepristone and Misoprostol to end their pregnancies at home in the past two years according to JAMA, the American Medical Association’s journal.

On Tuesday, members of Missourians for Constitutional Freedom continued to return to their continued fears for women’s health care in Missouri if a ban remains in place. Missouri already has stark maternal health care deserts, high maternal mortality rates, and recently saw adecrease in applicants to OB-GYN residency programs.

Schafer, with the ACLU, said the coalition plans to start rebuilding access to abortion on day one, if the measure passes.

“We know that after passage, constitutional amendments take 30 days to go into effect in the state of Missouri,” she said. “And we are hopeful that clinics will be open and our teams will be working toward that as our goal.”

Schwarz said they’ve been in contact with abortion providers about coming back to Missouri.

“After we win this in November, the impact will be regional and across the country,” she said. “And and from abortion providers that we are in close regular relationship and contact with, people are thinking all the time about where the next clinic can be, where the next opportunity is for them to grow and be able to support more and more patients.”

Wide support despite initial delays

The initial attempt to place abortion on the ballot began in March 2023. 

Legal fights with Republican state officials over the ballot language and internal disagreements on whether to include a viability ban stalled signature gathering attempts until January. 

As a result, the coalition had just 90 days to fundraise and collect signatures across the state.  

Meanwhile, Republican lawmakers were prioritizing an attempt to raise the threshold for approving citizen-led ballot measures. After a series of Senate filibusters, including one thatbroke records at 41 hours, the legislation failed on the final day of session. 

Missouri House Speaker Dean Plocher on the day of adjournment said that if abortion made it to the ballot and then passed in November under the current initiative petition guidelines, “the burden of abortion falls squarely on the Senate and its leadership.”

Despite these obstacles, the initiative petition garnered wide support across the state. 

As of July, the campaign raised nearly $7.3 million in donations, according to filings with the Missouri Ethics Commission.

Missourians for Constitutional Freedom turned in 380,000 signatures by their May deadline, including from each of Missouri’s 114 counties. To qualify for the ballot, they had to get signatures from 8% of registered voters in six of Missouri’s eight congressional districts, which equates to about 171,000 signatures.  

As of mid-July, the campaign had turned in more than enough valid signatures to land on the ballot, according to preliminary records from Missouri election authorities.

Once all verified signatures were turned in by election authorities in late July, the secretary of state’s office had two weeks to determine whether there were any final issues, like duplicate pages or missing affidavits signed by circulators. 

On Tuesday, the secretary of state’s office also certified ballot measures hoping to raise the state’s minimum wage and mandate paid sick leave and legalize sports wagering. A third proposal to authorize construction of a new casino near Lake of the Ozarks fell short of the needed signatures.  

This story was updated at 2:30 p.m. to include reactions from those supportive of and opposed to the amendment.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected]. Follow Missouri Independent on Facebook and X.