COMMITTEE ON LEGISLATIVE RESEARCH OVERSIGHT DIVISION FISCAL NOTE L.R. No.:1890H.01I Bill No.:HJR 54 Subject:Abortion; Health Care Professionals Type:Original Date:February 3, 2025Bill Summary:This joint resolution proposes a constitutional amendment establishing provisions relating to reproductive health care. FISCAL SUMMARY ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028 General Revenue* $0 or (More than $8,000,000) Total Estimated Net Effect on General Revenue $0 or (More than $8,000,000)$0$0 *The potential fiscal impact of “(More than $8,000,000)” would be realized only if a special election were called by the Governor to submit this joint resolution to voters. ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net Effect on Other State Funds $0$0$0 Numbers within parentheses: () indicate costs or losses. L.R. No. 1890H.01I Bill No. HJR 54 Page 2 of February 3, 2025 KP:LR:OD ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net Effect on All Federal Funds $0$0$0 ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net Effect on FTE 000 ☒ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any of the three fiscal years after implementation of the act or at full implementation of the act. ☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of the three fiscal years after implementation of the act or at full implementation of the act. ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Local Government*$0$0$0 *The potential fiscal impact to local election authorities (reimbursed by the state) would be realized only if a special election were called by the Governor to submit this joint resolution to voters. L.R. No. 1890H.01I Bill No. HJR 54 Page 3 of February 3, 2025 KP:LR:OD FISCAL ANALYSIS ASSUMPTION HJR - Provisions relating to reproductive health care Officials from Office of the Secretary of State assume, each year, a number of joint resolutions that would refer to a vote of the people a constitutional amendment and bills that would refer to a vote of the people the statutory issue in the legislation may be considered by the General Assembly. Unless a special election is called for the purpose, Joint Resolutions proposing a constitutional amendment are submitted to a vote of the people at the next general election. Article XII section 2(b) of the Missouri Constitution authorizes the governor to order a special election for constitutional amendments referred to the people. If a special election is called to submit a Joint Resolution to a vote of the people, section 115.063.2 RSMo requires the state to pay the costs. The cost of the special election has been estimated to be $8 million based on the cost of the 2022 primary and general election reimbursements. The Secretary of State’s office is required to pay for publishing in local newspapers the full text of each statewide ballot measure as directed by Article XII, Section 2(b) of the Missouri Constitution and Section 116.230-116.290, RSMo. Funding for this item is adjusted each year depending upon the election cycle. A new decision item is requested in odd numbered fiscal years and the amount requested is dependent upon the estimated number of ballot measures that will be approved by the General Assembly and the initiative petitions certified for the ballot. In FY 2014, the General Assembly changed the appropriation so that it was no longer an estimated appropriation. For the FY26 petitions cycle, the SOS estimates publication costs at $60,000 per page. This amount is subject to change based on number of petitions received, length of those petitions and rates charged by newspaper publishers. The Secretary of State’s office will continue to assume, for the purposes of this fiscal note, that it should have the full appropriation authority it needs to meet the publishing requirements. Because these requirements are mandatory, the SOS reserves the right to request funding to meet the cost of the publishing requirements if the Governor and the General Assembly again change the amount or continue to not designate it as an estimated appropriation. Oversight has reflected, in this fiscal note, the state potentially reimbursing local political subdivisions the cost of having this joint resolution voted on during a special election in fiscal year 2026. This reflects the decision made by the Joint Committee on Legislative Research that the cost of the elections should be shown in the fiscal note. The next scheduled statewide general L.R. No. 1890H.01I Bill No. HJR 54 Page 4 of February 3, 2025 KP:LR:OD election is in November 2026 (FY 2027). It is assumed the subject within this proposal could be on this ballot; however, it could also be on a special election called for by the Governor (a different date). Therefore, Oversight will reflect a potential election cost reimbursement to local political subdivisions in FY 2026. Officials from the Office of Attorney General (AGO) arising from this proposal can be absorbed with existing resources. However, the AGO may seek additional appropriations if the proposal results in a significant increase in litigation or investigation. Oversight does not have any information to the contrary. Therefore, Oversight assumes the AGO will be able to perform any additional duties required by this proposal with current staff and resources and will reflect no fiscal impact to the AGO for fiscal note purposes. Officials from the St. Louis City Board of Elections state there will be no fiscal impact unless a special election is called. The cost of a city-wide election is approximately $500,000. Oversight notes that officials from the SOS have included reimbursement costs to local election boards in their estimate of total costs for a special election. Therefore, Oversight will not reflect a separate special election cost for the St. Louis City Board of Elections. Officials from the Department of Commerce and Insurance, the Department of Health and Senior Services, the Department of Public Safety - Missouri Highway Patrol, the Department of Social Services, the Missouri Department of Conservation, the Missouri Department of Transportation, the Missouri Consolidated Health Care Plan, the Office of Administration - Administrative Hearing Commission, the Office of the Governor Jackson County Board of Election CommissionersKansas City Election Board, the Platte County Board of Elections and the St. Louis County Board of Elections, each assume the proposal will have no fiscal impact on their respective organizations. Oversight does not have any information to the contrary. Therefore, Oversight will reflect a zero impact in the fiscal note for these agencies. Officials from the Office of the State Courts Administrator did not respond to Oversight’s request for fiscal impact for this proposal. Oversight only reflects the responses received from state agencies and political subdivisions; however, other local election authorities and hospitals were requested to respond to this proposed legislation but did not. A listing of political subdivisions included in the Missouri Legislative Information System (MOLIS) database is available upon request. L.R. No. 1890H.01I Bill No. HJR 54 Page 5 of February 3, 2025 KP:LR:OD FISCAL IMPACT – State GovernmentFY 2026 (10 Mo.) FY 2027FY 2028GENERAL REVENUETransfer Out - SOS - reimbursement of local election authority election costs if a special election is called by the Governor $0 or (More than $8,000,000)$0$0 ESTIMATED NET EFFECT ON GENERAL REVENUE $0 or (More than $8,000,000)$0$0 *The potential fiscal impact of “(More than $8,000,000)” would be realized only if a special election were called by the Governor to submit this joint resolution to voters. FISCAL IMPACT – Local GovernmentFY 2026 (10 Mo.) FY 2027FY 2028LOCAL POLITICAL SUBDIVISIONS Transfer In – Local Election Authorities - reimbursement of election costs by the State for a special election $0 or More than $8,000,000$0$0 Costs – Local Election Authorities - cost of a special election if called for by the Governor $0 or (More than $8,000,000)$0$0 ESTIMATED NET EFFECT ON LOCAL POLITICAL SUBDIVISIONS$0$0$0 FISCAL IMPACT – Small Business No direct fiscal impact to small businesses would be expected as a result of this proposal. L.R. No. 1890H.01I Bill No. HJR 54 Page 6 of February 3, 2025 KP:LR:OD FISCAL DESCRIPTION Upon voter approval, this constitutional amendment prohibits abortions, except in cases of medical emergencies, fetal anomalies, rape, or incest. In the case of abortions performed or induced because of rape or incest, the abortion may be performed or induced no later than 12 weeks gestational age of the unborn child and only if documentation is presented to the attending physician that the rape or incest has been reported to a law enforcement agency that has jurisdiction to investigate the complaint at least 48 hours prior to the abortion. The amendment also prohibits public funds from being used to pay for abortions; prohibits the use of surgeries, hormones, or drugs to assist a child with a gender transition; and holds that any person who intentionally or negligently causes damage to another person relating to the provision of reproductive health care or the performance or inducement of an abortion is liable for damages and subject to suspension or revocation of his or her medical license. Under this constitutional amendment, a woman's right to reproductive freedom includes the right to health care in cases of miscarriages, ectopic pregnancies, and other medical emergencies. The General Assembly will have the authority to enact laws to carry out these provisions. This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space. L.R. No. 1890H.01I Bill No. HJR 54 Page 7 of February 3, 2025 KP:LR:OD SOURCES OF INFORMATION Attorney General’s Office Office of Administration - Administrative Hearing Commission Department of Commerce and Insurance Department of Health and Senior Services Department of Public Safety - Missouri Highway Patrol Department of Social Services Office of the Governor Missouri Consolidated Health Care Plan Missouri Department of Conservation Missouri Department of Transportation Office of the Secretary of State Jackson County Board of Election Commissioners Kansas City Election Board Platte County Board of Elections St. Louis City Board of Elections St. Louis County Board of Elections Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 3, 2025February 3, 2025