The Medicaid 23’s sham trial could finally give Missouri health care its day in court

Shortly before police in the Missouri Capitol politely arrested 23 faith leaders and escorted them out of the Senate galleries in 2014, the group had treated lawmakers to a melodious version of “Amazing Grace.”

Two years later, Missouri has crafted an amazing disgrace — the spectacle of nearly two dozen mostly older, mostly black pastors put on trial and convicted of “trespassing.” In a public building. For demanding access to health care.

The prosecution of the Medicaid 23, as the defendants are now known in social media, was racist and intolerant and reflected badly on Missouri. Does anyone think a group of white activists would be put on trial for visiting the Senate chambers and boisterously calling for an expansion of gun rights?

But here’s the bright side: By dragging the pastors into court more than two years after they were arrested, Senate Republican leaders and Cole County Prosecuting Attorney Mark A. Richardson have unwittingly reinvigorated the push for Medicaid expansion in Missouri.

Missouri is one of 19 states that continue to deny low-income citizens access to health insurance by refusing to expand Medicaid eligibility to the limits called for in the federal Affordable Care Act. The issue was front and center in 2014, with powerful business groups like the state hospital association and the Missouri Chamber of Commerce joining forces with social justice advocates. Medicaid expansion, they understood, would not only bring financial and medical security to thousands of low-income working families; it also would enable the state to access millions of federal health care dollars.

Advocates were optimistic that a vote to expand eligibility would pass the House. But in the Senate, Republicans such as Kurt Schaefer of Columbia and Rob Schaaf of St. Joseph vowed to block any attempt to broaden access.

“Why is this somehow our problem?” Schaefer asked, when discussing health care for poor people.

So two weeks before the 2014 session ended, about 300 persons traveled to the Capitol to try to convince senators that the denial of health care to fellow Missourians was indeed their problem. Twenty-three of them set out to disrupt the Senate.

The Missouri Legislature has a strange set of values. Lawmakers won’t even think about capping campaign contributions because that, they say, would limit the free speech of multimillionaires like Rex Sinquefield. But ministers singing in the Senate gallery constitutes trespassing. Go figure.

That 2014 effort to forge legislation to expand Medicaid sputtered out, and the cause has barely received a mention in the last two legislative sessions. Meanwhile, thousands of Missourians, most of them in working families, go without antibiotics, postpone surgeries or limp along on bad joints because they fall into a coverage gap and can’t afford to see a doctor.

Now, though, the Medicaid 23’s song is charting again. Medicaid expansion is back in the conversation. The trial has given supporters new motivation.

“From my perspective, as an organizer and a faith leader, this is a good thing,” says Cassandra Gould, a Jefferson City pastor who is executive director of Missouri Faith Voices. “I think it will lead to some new troops in the fight.”

Why Richardson, in his second term as prosecuting attorney, insisted on pursuing the case is a mystery. He never managed to produce anyone at trial who said they felt victimized by the protest.

It seems likely that Richardson acted with the consent of Senate President Ron Richard and others in the GOP leadership. The Pitch contacted Lauren Hieger, communications director for the Senate’s majority caucus, for clarification on that point. She said she would look into the matter but did not get back with an answer.

In any case, the trial produced pleasant evidence that the General Assembly’s oversize GOP majority doesn’t walk in lockstep on Medicaid expansion or free speech.

Jay Barnes, a lawyer and GOP lawmaker from Jefferson City, represented the defendants in court. He is one of the few Republican legislators who has tried to find a way to get more Missourians insured.

Even Schaefer — shifting into unlikely good-guy mode after his bad-guy act earned him a humiliating defeat in the Republican primary for Missouri attorney general — denounced the case. “I don’t think anyone broke the law,” he said from the witness stand.

Schaefer may simply have been retaliating against Richardson for supporting his opponent in the attorney general primary. But Gould believes his presence was significant. “Having Kurt Schaefer come to stand with the Medicaid 23 really helps,” she says.

Health care advocates already are strategizing on how to use the sympathy and anger generated by the trial to kickstart another run at Medicaid expansion when the General Assembly convenes in January. Missouri will have a new governor by that time. Democratic candidate Chris Koster supports expansion of Medicaid eligibility and may do a better job of convincing lawmakers to go along with him than the current governor, Jay Nixon, has. The Republican candidate, Eric Greitens, is on record opposing expansion; he hasn’t said what he would do about the approximately 11 percent of Missourians who are uninsured.

Schaefer’s exit from the Senate due to term limits removes a significant roadblock. Of the most strident opponents two years ago, only Schaaf will still be in office next year. While many of the GOP senators say they oppose Medicaid expansion, some are open to at least talking about finding a way to get more people access to insurance.

To be clear, the majority of Missouri lawmakers won’t be upset that a group of mostly black, urban ministers faces fines for trespassing. But they understand that Richardson’s trial has made the state look bad. And lawmakers in rural areas are hearing from constituents and hospitals about the challenges posed by lack of access to insurance.

Time to crank up the lobbying apparatus and start singing in the gallery again. To squander the opportunity presented by the prosecution of the Medicaid 23 would be an amazing waste.