Is Josh Hawley Progressive?

Missouri’s Medicaid program is a massive engine that keeps health care running for over a million residents, from children of low-income households and seniors to people with disabilities and working families. The program, known as MO HealthNet, is jointly funded by the federal government and the state. In traditional Medicaid, the feds pick up about two-thirds of the tab. However, for those covered under “Medicaid expansion,” consisting of working-age adults who earn just above the poverty line, the federal government pays 90% of the expenses. This means that Missouri only has to cover 10% of the costs for Medicaid expansion.

The 90% federal match rate makes Medicaid expansion affordable for Missouri. However, the proposed "Big Beautiful Bill" threatens to reduce this rate by 10%, potentially doubling the state's share of Medicaid expansion costs. If this occurs, lawmakers would need to find hundreds of millions of dollars to maintain current coverage. (Some Republican lawmakers have discussed reducing the rate to 66%, but so far, that’s not in the bill.) Missouri lawmakers’ options would be limited: raise taxes, cut services, or risk rural hospitals shutting down—none of which are favorable for a state with a Republican supermajority that supposedly values low taxes and limited government.

Here’s what makes things especially difficult for Missouri. In 2020, voters passed a constitutional amendment to implement Medicaid expansion. Republican lawmakers attempted to disregard the will of the people by ignoring it, but after months of legal disputes, the Missouri Supreme Court made it clear: the state must provide Medicaid expansion, even if the federal dollars were reduced or no longer available. Consequently, Missouri’s Republican legislators found themselves in a challenging position. They were now obligated to fund a program that they couldn’t legally withdraw from.

Enter Missouri Senator Josh Hawley. Known for his conservative views and anti-federal statements, he now advocates for federal Medicaid funding. What? Why would he do this? It’s unlikely that he suddenly cares about the health of his constituents; rather, it’s more likely he understands basic math. If Missouri cuts federal funding for Medicaid expansion, it won’t just affect the poor; it will impact hospitals, jobs, and entire rural communities. Consider that one in two children in Missouri receives Medicaid benefits. The political repercussions of cutting these benefits would be severe. Many of Hawley’s supporters wouldn’t easily forgive the damage to their lives. While Republicans might try to pin the blame on Democrats, it would be difficult to escape the reality that Republicans have controlled the Missouri legislature for almost 25 years, and they’ve pushed the Big Beautiful Bill at the federal level. 

So yes, Josh Hawley is breaking with the far right on this issue, not out of compassion, but out of cold, heartless calculation. Missouri simply can’t afford to lose Medicaid funding, and he can’t afford a political bloodbath.