I began writing in support of Medicaid expansion for Mississippi in 2012, two years before the first states came online with the expansion encouraged and incentivized by the Affordable Care Act.
I have not changed my overall opinion in the dozen years since. As I wrote then, Medicaid expansion should be a no-brainer in a state with some of the highest rates of poverty, of uninsured adults and of health problems — all related, by the way.
Expansion would be good not just for the uninsured, many of whom are working but can’t afford coverage, but also for the hospitals that get stuck treating them in the emergency rooms but don’t get compensated for it. It would be good for the already insured, too, since their premiums are impacted by the uninsured.
Plus it’s a good investment for the state, better than the factory-chasing the Legislature has no qualms about bankrolling. For every $1 the state would put up for Medicaid expansion, it would get $9 from the feds, producing a billion dollars a year in funding that should create thousands of new jobs in the high-paying medical field.
Despite my longstanding conviction in favor of Medicaid expansion, I have tried to keep an open mind to all of the debate that has happened — in the Legislature and in the news media — this year, the first time that Mississippi lawmakers have seriously considered the question.
Unfortunately, most of the coverage in the two Mississippi news sources that have given the issue the most attention has been slanted by their own biases. Mississippi Today’s coverage has been heavily pro-expansion, giving short shrift to the other side. Magnolia Tribune has done just the opposite, mostly ignoring the cascading endorsements of full expansion coming from the medical, religious and business communities.
Both sources cite studies and statistics to back their case, but those also tend to have a spin, leaving anyone who may be on the fence in the Legislature and in the public uncertain whose analysis to believe.
The arguments against expansion have shifted over time, and even some during the current legislative session.
In 2012 and for several years afterward, the Republican majority in the Legislature said that Mississippi could not afford expansion nor could it trust Congress not to change the rules once it hooked a state into signing on.
The post-pandemic annual surpluses Mississippi has been running to the tune of hundreds of millions of dollars, though, have erased that first concern. And as for Congress changing the rules on Medicaid expansion, the only change it has made so far is to increase the incentives to try to encourage the few holdouts, such as Mississippi, to join the other 40 states that have expanded.
Earlier this session, it was argued that Mississippi’s health-care system could not handle such an influx of new Medicaid enrollees, estimated between 200,000 and 300,000, especially in rural areas that already don’t have enough physicians to treat the population. Then it was discovered that about half of the projected increase would be of adults who already have insurance but would be shifted to Medicaid from commercial plans on the federal exchange, which was also created by the Affordable Care Act.
Now the main argument is about what’s the best and most cost-effective way to deal with that segment of the expansion population — between 100% and 138% of the federal poverty level — that already qualifies for heavily subsidized commercial insurance plans.
Legislative negotiators appear to be moving toward a compromise in which this group would be left in the private market but the state would start picking up 10% of the cost, similar to what Arkansas has done with its Medicaid expansion.
The plus side of this is that more doctors take commercial insurance than accept Medicaid. The negatives are that it will cost the state more, and the coverage might not be as good for the insured, particularly when the federal subsidies that reduce the premiums to zero for this income bracket end next year.
Still to be worked out is the Senate’s insistence that there be a work requirement for the expansion population, which may make sense politically but no sense practically. Such a requirement is unlikely to be approved as long as a Democrat is in the White House, but even if it were approved, it’s based on a fallacious belief that Medicaid discourages people from working.
Mississippi is one of the most stingy states in providing government benefits to the poor. It also has the nation’s lowest labor-force participation rate. If skimping on welfare programs encourages people to work, it would have worked by now.
Nevertheless, in order to hold together enough votes on Medicaid expansion to overcome the expected veto by Gov. Tate Reeves, the Legislature may have to include some provisions that it will later drop when the federal government balks or when the setup proves more expensive or less workable than straightforward expansion would be.
That’s what most states that first tried to modify the original model for Medicaid expansion have wound up doing.
- Contact Tim Kalich at 662-581-7243 or tkalich@gwcommonwealth.com.
