Did the Missouri AG approve the ballot summary for Gerald Peterson's petition 2020-027 expanding Medicaid and family-planning funding?

Plain-English summary

Gerald Peterson's initiative petition 2020-027 was a Medicaid-expansion package combined with explicit funding for contraception, family planning, and Planned Parenthood, with a hospital-tax backstop. It targeted Chapter 208 of the Revised Statutes of Missouri (the state's public-assistance and Medicaid statute). The petition's four elements were:

1. Adopt Medicaid Expansion under the Affordable Care Act for adults aged 19 to 64.
2. Require the state to fund birth control and family-planning services (including emergency contraception, identified by the summary as the "morning-after pill") for all state residents at least 13 years old.
3. Require the state to fund Planned Parenthood if federal funding for it were discontinued.
4. Impose a hospital tax to pay for Medicaid Expansion and the contraception/family-planning services if the state chose not to fund Medicaid Expansion through other means.

This 2019 opinion is the AG's § 116.334 approval of the Secretary of State's summary statement. The summary uses a four-bullet list to present those elements to voters. The AG approved the form of the statement and added the standard disclaimer that approval is not an endorsement.

The 2020-027 petition was one of several Medicaid-expansion vehicles circulating in Missouri before the 2020 election. (Missouri voters ultimately approved a Medicaid-expansion constitutional amendment in 2020 via a separate measure, Amendment 2.) The 2020-027 petition combined the expansion question with politically more controversial elements (state Planned Parenthood funding, contraception for minors aged 13 and up, hospital tax), which likely affected its political prospects.

Currency note

This opinion was issued in 2019. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

What is Medicaid Expansion under the ACA?

The Affordable Care Act gave states the option to expand Medicaid eligibility to adults at or below 138 percent of the federal poverty level, with the federal government picking up most of the cost. Missouri had not adopted expansion as of 2019. Petition 2020-027 was one of several initiative vehicles trying to mandate expansion through the ballot.

Why pair Medicaid Expansion with contraception and Planned Parenthood funding?

Likely a policy choice by the proponents to bundle several aligned reproductive-health and access-to-care priorities into one petition. Bundling can broaden the coalition of supporters but also gives opponents more vectors of attack.

Why "13 years old" as the contraception age threshold?

The petition would have made state-funded birth control and family planning available to all state residents at least 13 years old. This was a deliberate policy choice by the proponents to extend access to adolescents, and a politically controversial one in Missouri's 2019 environment.

What is the hospital-tax backstop?

A common structure in Medicaid-expansion proposals. Hospitals benefit financially from Medicaid Expansion (more insured patients, less uncompensated care), so a hospital tax to fund the expansion lets the state collect from the entities that gain the most. The petition's backstop activated the hospital tax only if the state chose not to fund expansion otherwise.

Did this petition reach the 2020 ballot?

This particular petition (2020-027) did not. Missouri voters approved a separate Medicaid-expansion constitutional amendment (Amendment 2) in August 2020. The two were unrelated petition vehicles, though they addressed overlapping policy goals.

Background and statutory framework

Missouri's initiative process runs through Chapter 116. § 116.334 directs AG review of summary statements. The substantive subject is Chapter 208 of RSMo (public assistance and Medicaid). The federal framework is the Patient Protection and Affordable Care Act, Pub. L. 111-148 (2010), which created the Medicaid Expansion option.

Citations

• § 116.334, RSMo (AG review of summary statement)
• Chapter 208, RSMo (Missouri public assistance and Medicaid)
• Affordable Care Act, Pub. L. 111-148 (2010) (Medicaid Expansion option)
• Mo. Const. art. III, §§ 49 to 53 (initiative and referendum process)
• Initiative Petition 2020-027 (Peterson, Chapter 208 Medicaid expansion and family planning)

Source

• Landing page: https://ago.mo.gov/other-resources/ag-opinions/
• Original PDF: https://ago.mo.gov/wp-content/uploads/attachments/44-2019.pdf?sfvrsn=2

Original opinion text

ATTORNEY GENERAL OF MISSOURI
ERIC SCHMITT
JEFFERSON CITY
P.O. Box 899
ATTORNEY GENERAL
65102
(573) 751-3321

February 7, 2019

OPINION LETTER NO. 44-2019

The Honorable John R. Ashcroft
Missouri Secretary of State
James C. Kirkpatrick State Information Center
600 West Main Street
Jefferson City, MO 65101

Dear Secretary Ashcroft:

This opinion letter responds to your request dated January 28, 2019, for our review under § 116.334, RSMo, of a proposed summary statement prepared for the petition submitted by Gerald Peterson regarding a proposed amendment to amend Chapter 208, Revised Statutes of Missouri (2020-027). The proposed summary statement is as follows:

Do you want to amend Missouri law to:

• adopt Medicaid Expansion for certain people 19 to 64 years old as set forth in the Affordable Care Act;
• require the state to pay for all birth control and family planning services (including the morning-after pill) for all state residents at least 13 years old;
• require the state to fund Planned Parenthood if federal funding is discontinued; and
• impose a tax on hospitals to pay for Medicaid Expansion and free birth control and family planning services if the state does not fund Medicaid Expansion?

Pursuant to § 116.334, RSMo, we approve the legal content and form of the proposed statement. Because our review of the statement is mandated by statute, no action that we take with respect to such review should be construed as an endorsement of the petition, nor as the expression of any view regarding the objectives of its proponents.

Very truly yours,

ERIC S. SCHMITT
Attorney General

OP-2019-0034