Rebecca Payne McClanahan, Chair of MONA-PAC and Jack Seigel, MONA Outreach Manager

The 2022 election cycle has been a good one for Missouri Nurses Association Political Action Committee (MONA-PAC). We have been working for months to elect pro-nursing candidates to the Missouri legislature and election day, November 8, 2022, gave us that opportunity. We celebrate our successes. Based on our endorsed candidates that won their election, MONA-PAC had a 98.7% winning percentage in the general election. These results would not have been possible without activism from nurses. Members donated money, attended events, made phone calls, reached out to friends and family, posted on social media and more – and nurses voted. All of these activities helped MONA-PAC support our nursing champion candidates through their successful elections.

In the State Senate MONA-PAC made 15 general election endorsements and all 15 of our candidates were successful. Of the 17 senators up for reelection, nine of those elected were incumbents and eight are newly elected, although six of those newly elected to the Senate had served in the House giving them a voting record regarding issues of interest to nurses. Half of the senators are elected each election cycle, with this year being the 17 even-numbered districts. We took a particular interest in ensuring Senators-elect Nick Schroer (R-O’Fallon) and Tracy McCreery (D-St. Louis) won their elections to the State Senate. Both will continue their staunch support for Missouri nurses.

In the House, we made 64 general election endorsements and 63 of our candidates won election. All 163 seats in the House are elected every two years and 43 House members were termed out, the seat was vacant, or the incumbent did not run for re-election in 2022. One hundred seventeen incumbents were re-elected, and seven incumbents were defeated in the primary election while two incumbents were defeated in the general election. Fifty new House members will assume office in January and nurses must work hard to educate them on nursing issues and assure they are aware of the concerns of their nurse-constituents. Republicans continue to maintain a veto-proof majority in both chambers (111 to 52 in the house, 24 to 10 in the senate). We should note that Rep. Patty Lewis (D-Kansas City) was re-elected in the 25th district so we will continue to have a RN in the Missouri Legislature. Biographies and contact information for all legislators will be available on the Senate and House websites at the start of the legislative session in January 2023.

House And Senate Leadership Elections

In addition to general election results, the MONA-PAC also follows the leadership elections in the House and Senate within the party caucuses. Those elected to leadership are especially influential in the legislative chambers as well as within their respective caucuses. The Majority Floor Leader races are crucial as this position decides which bills are brought up for debate and how much time is devoted to legislation, which is especially impactful in the Senate due to the filibuster. The winners of these closely watched races will shape which issues are prioritized next year and the final outcome of major legislation. Official Committee appointments will not be made until after the start of the 2023 session which begins at noon, on Wednesday, January 4, 2023. We will focus particular attention on Committees to which our legislation is likely to be assigned. Missouri Nurses Association (MONA) lobbyist, Kyna Iman, has been working hard to build relationship with each of the presumed leaders to assure they are aware of nurses’ legislative priorities, and she has received a very positive response.

Senate Leadership

Republicans:

President – Lieutenant Governor Michael Kehoe (by virtue of his office)

President Pro Tem – Senator Caleb Rowden (R-Columbia) A vote in the full Senate will be taken to ratify the election of the President Pro Tem. It is possible an additional nomination will be made but since Republicans hold a supermajority in the Senate, Rowden is expected to be elected President Pro Tem.

Majority Floor Leader – Senator Cindy O’Laughlin (R-Shelbina)

Assistant Majority Floor Leader – Senator Jason Bean (R-Pemiscot)

Majority Caucus Whip – Senator Karla Eslinger (R-Wasola)

Majority Caucus Chairman – Senator Tony Luetkemeyer

Majority Caucus Secretary – Senator Sandy Crawford (R-Buffalo)

Democrats: 

Minority Floor Leader – Senator John Rizzo (D-Kansas City)

Assistant Minority Floor Leader – Senator Doug Beck (D-St. Louis)

Minority Caucus Chairwoman – Senator Angela Mosley (D-Florissant)

Minority Caucus Whip – Senator Steven Roberts (D-St. Louis)

House Leadership:

Republicans

Speaker of the House – Representative Dean Plocher (R-St. Louis). A vote in the full House will be taken to ratify the election of the Speaker. It is possible an additional nomination will be made but since Republicans hold a supermajority in the House, Plocher is expected to be elected Speaker.

Speaker Pro Tem – Representative Mike Henderson (R-Bonne Terre)

Floor Leader – Representative Jon Patterson (R-Lee’s Summit)

Assistant Floor Leader – Representative Jamie Burger (R-Scott)

Caucus Chair – Representative Chris Dinkins (R-Lesterville)

Majority Whip – Representative Hardy Billington (R-Poplar Bluff)

Majority Secretary – Representative Ann Kelley (R-Lamar)

Democrats

Minority Floor Leader – Rep. Crystal Quade (D-Springfield)

Assistant Minority Floor Leader – Rep Richard Brown (D-Kansas City)

Minority Caucus Whip – Representative Ashley Aune (D-Kansas City)

Minority Caucus Chair – Ingrid Burnett (D-Kansas City)

Minority Caucus Vice-Chair – Representative Emily Weber (D-Kansas City)

Minority Caucus Secretary – Representative Gretchen Bangert (D-Florissant)

Minority Caucus Policy Chair – Representative Jamie Johnson (D-Kansas City)

Ballot Initiatives

MONA-PAC did not take a stand on any of the the Constitutional ballot measures. Amendment 1 was defeated but would have granted the General Assembly statutory authority to invest state funds and expand the state treasurer’s investment options. Amendment 3 was approved and legalizes recreational marijuana in Missouri after voters had approved medical marijuana in 2018. Amendment 4 was passed and allows the General Assembly by law to increase the minimum funding for a police force established by the state board of police commissioners and currently affects Kansas City Police Department. Amendment 5 was approved and creates a new state department known as the Missouri Department of the National Guard rather than remaining under the auspices of Department of Public Safety. The question of a Constitutional Convention was defeated.

Federal Senate and Congressional Races

MONA-PAC monitors federal elections and is especially interested in those representing Missouri at the federal level. Although we rarely endorse federal candidates, we are sometimes consulted by the American Nurses Association in their endorsement process. In 2022, we made an unusual decision to endorse Trudy Busch Valentine for US Senate because of the compelling reasons to do so. Valentine is a Registered Nurse and a long-time member of Missouri Nurses Association. She made her role as a nurse and her understanding of the health care system as central to her campaign. She emphasized the nursing skills of understanding and prioritizing issues and effective problem-solving as important to her potential service in the Senate. If she were elected to the Senate, she would have been the first nurse ever to serve in that body. We announced our endorsement of her early in the primary election cycle and she touted our endorsement proudly, although she eventually lost the general election race to Missouri Attorney General, now US Senator-elect Eric Schmitt. Missouri congressional incumbents that were reelected include Representatives Cori Bush (D-01), Ann Wagner (R-02, Blaine Luetkemeyer (R-03), Emmanuel Cleaver II (D-05), Sam Graves (R-06) and Jason Smith (R-08). Newly elected to the Congress are Mark Alford (R-04) and Eric Burlison (R-07) who was a consistent champion for nurses during in his service in the Missouri House and Senate.

Missouri congressional delegation includes:

Senator Josh Hawley (R)
Senator-elect Eric Schmitt (R)

Representative Cori Bush (D – District 1), a Registered Nurse.
Representative Ann Wagner (R – District 2)
Representative Blaine Luetkemeyer (R – District 3)
Representative-elect Mark Alford (R – District 4)
Representative Emanuel Cleaver (D – District 5)
Representative Sam Graves (R – District 6)
Representative-elect Eric Burlison (R – District 7)
Representative Jason Smith (R – District 8)

Two Key State Senate Races in 2022

The configuration of the Missouri Senate makes or breaks our agenda. Historically, we have seen a single senator shepherd legislation through the process while under relentless attack from the opposition and, conversely, we have repeatedly witnessed a single senator halt the process entirely despite overwhelming support by majorities in the House and Senate. Currently, a very high proportion of legislators in the House and in the Senate support the policy agenda of Missouri nurses. During the last few years, our legislation has passed the House with wide margins, only to be stopped in the senate – often by ONE opposition senator – often a physician. In the 2022 midterms, THIS election cycle, we had a real opportunity to influence senate races that could make all the difference in our future endeavors – and we DID!

Senator-elect, Tracy McCreery (Senate District 24) was elected in tight race against a well funded, physician-leader that directly opposed nurses’ priorities and had received large contributions from a PAC specifically organized to oppose changes to the practice authority of APRNs. MONA-PAC endorsed McCreery early in the primary election cycle to maximize nurses’ influence in that race, even though she did not have a primary opponent at that time. Our early endorsement allowed her campaign to tout our support while building early support for her general election race. We gave monetary contributions to her campaign, knocked doors and made phone calls on her behalf, as well as mailing a letter of endorsement to nurses in the area. Many nurses in the district were publicly supportive of her campaign. MONA Outreach Manager, Jack Seigel, presented virtual campaign training for members interested in doing campaign work and coordinated our efforts with Missouri Association of Nurse Anesthetists to phone-bank to assure that voters in Senate District 24 knew why McCreery was endorsed by nurses and nursing groups. McCreery believes that our support was significant in her election which she won by a margin of 8.5 points (53.3-48.8) and we look forward to working closely with her in the 2023 legislative session.

Another race to watch was the open state senate seat in St. Charles County. MONA-PAC knew how important it was to ensure Representative Schroer won a competitive primary and then general election so he could continue his advocacy for nurses as a state senator. Early in the primary campaign, Missouri Nurses Association members were invited to join a candidate “virtual meet and greet” organized by our sister organization, Missouri Association of Nurse Practitioners, where Schroer shared his plan to build a strong bipartisan effort in support of full practice authority (FPA) for APRNs. The MONA-PAC endorsed Schroer in the primary election because of his dedicated support for Missouri Nurses Association policy agenda and the competitiveness of the race. After winning the primary, Senator-elect Schroer won the general election with an impressive 26-point vote margin. When referring to Schroer’s service in the House for the last few years, we would commonly use the term “champion for nurses” because of his tireless work at the Committee level and beyond. He is well-grounded in the issues and an effective spokesperson in Committee and during legislative debate. We look forward to a continued partnership with Senator-elect Schroer.

We know the opposition is organizing and raising money specifically targeted to stop our efforts toward APRN full practice authority and other priority issues for the nursing profession. A new Political Action Committee (PAC) was established in 2021 by those opposed to full practice authority for Missouri APRNs and they were able to raise several times the resources of MONA-PAC within a short period of time. That PAC made donations to candidates at the maximum allowed by Missouri election law. That PAC, funded by the Missouri Medical Association PAC, Anesthesiology groups, and others received large donations of $5,000 or $10,000. That enabled them to donate $2,400 to Bill White, Lincoln Hough, Justin Brown and $2,000 to incoming Speaker of the House, Dean Plocher. They later donated $2,400 to George Hruza, opponent of Tracy McCreery, ahead of the general election. Missouri Nurses Association is fighting back! In 2022, MONA targeted unprecedented funding toward hiring an Outreach Manager, Jack Seigel, who is focusing on engagement of members by training and supporting members to build relationships with state level elected officials and participate in legislative advocacy. In the last three months prior to the general election, Seigel assisted all seven MONA Regions in planning a series of legislative picnics giving nurses an opportunity to interact with elected officials and candidates in their home regions. The addition of this position to the MONA staff improves our capacity to shape health policy in Missouri to support nursing care for the betterment of all Missourians.

What is the MONA-PAC and What Does it Do?

The Missouri Nurses Association Political Action Committee (MONA-PAC) is the only political action committee representing the interests of all professional nurses in Missouri. It was established to elect candidates that will advance MONA’s legislative and regulatory agendas. MONA-PAC was founded in 1985 in accordance with Missouri law. All contributions and expenditures of the MONA-PAC are in compliance with Missouri state law and governed by the Missouri Ethics Commission. The MONA-PAC reports to the Missouri Ethics Commission on a regular basis and all transactions are transparent and publicly available. It is important to note that no Missouri Nurses Association membership funds are used for political purposes.

Since that time of its founding the MONA-PAC has interviewed and endorsed hundreds of candidates for elected office in the Missouri legislative and executive branches. In addition to influencing elections, MONA-PAC scans the environment for opportunities and barriers to enacting the mission of the Missouri Nurses Association, including monitoring the process and the outcomes of Rules and Regulations promulgated by all state agencies. Missouri Nurses Association members and staff monitor hearings, provide testimony, attend meetings and represent nurses in collaboration with many nurse and non-nurse groups to assure the voice of nurses is heard and that all opportunities to influence legislative and regulatory processes are realized on behalf of Missouri nurses and in the interest of the health of all Missourians.

Candidate Endorsement Process

The MONA-PAC endorses legislative candidates from both political parties on their RECORD related to the legislative priorities of concern to nurses, the nursing profession and public health. We analyze the voting record of each incumbent and if their record has been favorable, we will tend to endorse them, recognizing that incumbents have a political advantage and are more likely to win reelection. Also, we are more likely to endorse an incumbent if they are or will be in a leadership position within their chamber or within their caucus. Those affiliated with the majority party, especially in the situation when one political party has a supermajority within a chamber, are more likely to receive our endorsement. Since 2004, Republicans hold a majority in both the House and Senate and currently hold a supermajority, a two thirds majority. A super majority is sometimes referred to as a veto-proof majority, meaning they are able to garner enough votes to override a veto by the Governor giving them primacy in policy decisions. The reality of the current balance of power in the Missouri General Assembly means the MONA-PAC will endorse more Republican candidates/legislators because they will have the authority to set the agenda for the legislative session and to appoint Committee chairs and other leadership positions. If the majority shifts in the legislature, our endorsements will reflect that reality. The MONA-PAC endorses candidates believed to help advance the legislative agenda of the entire nursing profession, not necessarily a person for whom all nurses would cast their vote. The PAC sincerely appreciates any and all feedback regarding endorsements and we attempt to respond to comments regarding our actions.

Why are there so few endorsements in support of health care access?

A particularly challenging topic, access to health care, especially expansion of MOHealth Net (Missouri Medicaid) is a deeply decisive issue that falls mainly along partisan lines. Although Missouri Nurses Association’s mission and legislative priorities have often included expansion of Medicaid, we rarely have the opportunity to endorse candidates based on that issue alone. Eventually, in 2020, when the legislature failed to act for almost a decade, the voters of Missouri passed a ballot measure directing the expansion of MO HealthNet to be in effect July 1, 2021. Still, full implementation was delayed through court cases and administrative decisions by the Governor and state agencies. Fortunately, recent enrollment in MO HealthNet has accelerated dramatically with special funding incentives from the federal government. Missouri Nurses Association continues to participate in a collaborative effort with many organizations that work to influence state agencies to increase health care access for Missouri’s most vulnerable citizens, clearly an important motivation to enable RNs and APRNs to practice to the full extent of their preparation. We will continue to support legislative and regulatory efforts that enhance the practice of nursing and improve the health of Missourians.

Each election cycle, a MONA-PAC Legislative Candidate Survey is sent to all candidates on the ballot for the general election. The electronic survey is updated each election cycle to reflect current legislative priorities and to assure it functions as an educational tool for candidates. The Committee was very pleased with the rate and the content of responses in 2022, with an overwhelming majority of candidates indicating strong support for our legislative priorities and specifically stating their support of legislative measures resulting in Full Practice Authority for APRNs. Candidates were selected for endorsement by MONA-PAC based on their survey responses and on their voting record, for incumbents, and other interactions with the candidates in order to identify potential legislative allies. This year, we endorsed an unusual number of primary candidates because of the numerous contested races that had implications for several of our legislative champions. After the primary election we reviewed and expanded the list to include all candidates with strong indicators they would be effective in the legislature relative to our priorities. MONA-PAC’s endorsement is widely sought, and many candidates released a public statement and posted on their websites/social media almost immediately after they were notified.

Several virtual meetings of the PAC were held to identify candidates for endorsement and to identify targets for monetary donations. We will hope to seek additional and ongoing donations to the PAC to enable us to provide support for unexpected winners of legislative seats. For example, we may identify the benefit of a contribution to a person that won the election after we endorsed their opponent, favored an incumbent that was defeated or stayed out of a race entirely because of no clear difference between the candidates on support for nurses. It would be desirable to make periodic contributions or sponsorships for legislator fundraising events for our legislative allies and champions. After the election we will plan to make contributions to the funds of House & Senate leadership, as they are important decision-makers in moving legislation forward.

This year communication to MONA leaders and members regarding the PAC was ramped up with multiple requests for donations in response to our updated our 2022 Work Plan and Fundraising Plan with specific goals and target dates. Our methods included published letters in The Missouri Nurse, multiple general membership emails and targeted phone calls to previous PAC contributors. In particular, Association leaders were encouraged to make a commitment to recurring monthly donations to the PAC. Our intent is to continue to grow the PAC into a more influential group reflective of the significance of the nursing profession to the state of Missouri. Nurses have untapped power in numbers as the largest health care professions group in Missouri and the nation. We may not have deep pockets, but we have lots of pockets. For example, if every member of MONA were to give the cost of a premium coffee each month it would yield more than $180,000 making us one of the premier professional PACs and would exceed funds raised by the opposition. This goal is doable! To take it a step further, if the more than 110,000 RNs in the state of Missouri were to contribute $1 each month the PAC, a mere $12 each year, we would become a 7-figure powerhouse that would exceed funds raised by PACs of all other health professions combined. Nurses would be unstoppable! Unfortunately, despite enhanced fundraising efforts we have not seen commensurate increases is funds raised, likely related to fewer in-person events during the pandemic, external issues such as economic uncertainty and nurses lack of awareness of their potential power. Until we can reach EVERY nurse in Missouri, you and I will need to give more.

The Future: What Can You Do?

  • Become a sustaining member of Missouri Nurses Association. Renew every year, or better yet, set up an automatic renewal process to avoid a lapse in your membership.
  • Register to vote. Vote in EVERY election – enhance your record as a regular voter. Legislators can confirm if you are a constituent of theirs and if you are an active voter (they do not have access to how you voted).
  • Attend MONA sponsored events: Nurse Advocacy Day, Schedule a Nurses Day-in-the-Capitol with mentoring from MONA staff (some events will be pre-planned), Advocacy in Action Conference and others.
  • Establish and maintain contact with legislators. Prior to the legislative session would be an excellent opportunity for each and every nurse to send a congratulatory note to their own legislators and to members of leadership to reinforce that we will expect to work closely with them in the upcoming legislative session. Offer yourself to them as a consultant on issues related to nursing and health care and, if needed, we will back up your claims. Attend in-district events sponsored by the legislator. It can be surprising how few voters attend a kitchen-table-talk or a regular coffee hour – you will likely have the opportunity to have in-depth discussion with your legislator and to have direct influence on their perceptions of nurses and of proposed legislation.
  • Volunteer to become a member of the MONA-PAC. Several members of the current PAC have stepped down after many years of outstanding service. We will need to rebuild a core group moving forward. The following members have served during this cycle: Val Bader, Maryann Coletti, Katie Foster, Lucy Hood, Glenna Mahoney, Rebecca McClanahan (Chair), Terry Reece and Scott Sullivan. Ex Officio members include State Director Heidi Lucas, Outreach Manager Jack Seigel. MONA President Caryl Goodyear, VP for Advocacy Sarah Oerther and Lobbyist Kyna Iman.

Donate to MONA-PAC. There has never been a better time for nurses to unite through the MONA-PAC to impact the future of our profession on issues such as workplace violence, staffing levels, patient safety, and removing constraints in the practice environment so RNs and APRNs can practice to their full potential. If we are to have influence in the policy arena, we must be active in the political arena. It is imperative that we are able to continue to influence important races. We need YOUR help now!

2023 Legislative Priorities:

APRN – The Missouri Nurses Association urges Missouri legislators to join our surrounding states and other states in our nation to remove unnecessary mileage restrictions, untimely and unnecessary chart and patient reviews by the collaborating physician, as well as other unnecessary restrictions

Public Health – We work on topics that are in the best interest of Missouri’s citizens health and welfare; such as Medicaid Expansion, a PDMP, Needle Exchange programs, and Immunizations

Workplace Safety – The Missouri Nurses Association supports initiatives to address safety in the workplace for all nurses.

Mental Health – MONA believes that everyone deserves mental health services that are comprehensive, affordable, and without stigma

Additional Resources

MONA-PAC endorsements for the 2022 general election here: https://missourinursespac.org

Identify the senate/house district in which you live: https://www.senate.mo.gov/legislator-lookup/

Biographies and contact information for all legislators available at the start of the legislative session in January 2023 [www.house.mo.gov and www.senate.mo.gov].

MONA-PAC reports to Missouri Ethics Commission: https://mec.mo.gov/MEC/Campaign_Finance/CommInfo.aspx?MECID=C000596

SCOPE PAC reports to Missouri Ethics Commission: https://mec.mo.gov/MEC/Campaign_Finance/CommInfo.aspx?MECID=C211572