By Bobby Harrison
Daily Journal Jackson Bureau
JACKSON – The Republican legislative leadership appears poised to enact Gov. Phil Bryant’s alternative to the Medicaid expansion allowed under the federal Affordable Care Act.
House Public Health Chair Sam Mims, R-McComb, is advocating legislation that would replace with state money a small fraction of federal funds that hospitals are losing by Mississippi political leaders opting not to expand Medicaid.
“We need our small-town hospitals and large hospitals to succeed,” Mims said, explaining the reason for the proposed state funding help.
On the Senate side, Public Health Chair Dean Kirby, R-Pearl, said he supports the effort.
But Kirby added, “If money (state revenue) becomes tight again and if the (federal) DSH cuts continue to grow, that might be a problem. But I am glad we can help the rural hospitals this year. It is really for all the hospitals, but especially the rural ones.”
DSH is short for a program known as the Disproportionate Share Hospital payments. Through a complex formula, the federal government under the program has reimbursed hospitals from two pots of money to partially offset their costs for treating people with no insurance or ability to pay.
Under the Affordable Care Act – popularly known as Obamacare – the DSH payments are scheduled to be cut under the assumption that hospitals will be treating far fewer people who do not have health care coverage. But the decision of about half the states, all led by Republican governors or legislatures, to not expand Medicaid as allowed under the act is leaving a large coverage gap.
The result is that hospitals still will be treating people with no ability to pay – especially in their emergency rooms – while the amount of federal funds for uncompensated care is being reduced, leaving a funding hole for Mississippi hospitals.
In his budget, Bryant proposes to offset the cut in federal funds by giving the hospitals an additional $4.4 million from state coffers. Mims’ bill would appropriate $4.5 million from reserves for that effort.
Mims concedes that the $4.5 million will not cover all the federal cuts to DSH and other programs. Mims said the other DSH cuts are related to the Medicare program for the elderly. He said the state plays no part in that program.
But “if the goal is to make hospitals whole, you have to look at the big picture,” said Ed Sivak, director of the Mississippi Policy Center. That isn’t happening by focusing on the Medicaid DSH cuts, which while small now, will continue to grow, Sivak said.
And for the current year, cuts to Mississippi hospitals from the other pot of federal money – Medicare DSH – will be $146.5 million and will continue to grow each year, according to information Sivak gleaned from the Mississippi Hospital Association.
House Minority Leader Bobby Moak, D-Bogue Chitto, agreed, the $4.5 million “would be only a small piece of the cuts to the hospitals.” He said the governor and legislative leadership are advocating for a limited amount of help for the hospitals while “turning down $3 million a day in federal funds” by not expanding Medicaid.
It has been estimated that up to 300,000 people – primarily the working poor – would be covered in Mississippi if Medicaid is expanded under the federal law to cover those earning up to 138 percent of the federal poverty level or about $15,000 annually for an individual or about $32,000 for a family of four.
One recent study estimated the expansion would cost the state $39 million the first year for $1.2 billion in federal funds and over a seven-year period will cost the state a cumulative $579 million while receiving $8.6 billion in federal funds.
Bryant and legislative leaders remain adamant that the state cannot afford the expansion.
Kirby said one reason he is reluctant to expand Medicaid is that there is no guarantee the federal government would continue to fund the program in future years.
“It appears Obamacare is a debacle,” House Speaker Philip Gunn, R-Clinton, said recently. “I cannot believe anybody would continue to advance it.”
Medicaid currently covers about 645,000 Mississippians – the elderly, disabled, poor pregnant women and poor children.
Mims said he also is supporting another proposal touted by the governor to improve access to health care in the state without expanding Medicaid. Mims is introducing legislation to increase the state funding to 21 community health centers from $4 million annually to a little less than $8 million so they can expand their operations. This would include longer hours of operation and potentially more services to patients.
Mims said the centers, which also receive federal funds and other grants, treat on a sliding financial scale people with no insurance, people on Medicaid and people with health insurance.
“They are such an asset to Mississippi,” Mims said. “They are seeing an underserved population.”
Sivak said his advocacy group supports expanding the scope of the clinics, but added, “Expanding Medicaid would do nothing but help them serve more patients.”