DEBATE STALLS MEDICAID BUDGET
By Bobby Harrison
Daily Journal Jackson Bureau
JACKSON – Sen. Vince Scoper, R-Laurel, took the podium of the state Senate Friday to say it amazed him how two groups of people elected by the same constituents could sometimes have such diverse views.
Those diverse views reared their ugly heads Friday during a debate on managed health care for Medicaid patients, throwing the seemingly uneventful 1996 legislative session into a state of flux.
As a result, the state’s $1.8 billion Medicaid budget has yet to be funded. After weeks of closed-door negotiations, the two houses of the state Legislature could not agree on whether to conduct a managed-care pilot program for Medicaid recipients in 22 counties.
Both the House and Senate members went home Friday with no plans to come back until next Friday, which is scheduled to be the last day of the session.
By next Friday, leaders of both chambers believe the impasse can be worked out. But at times during debate on the floors of the two chambers Friday, it appeared the divisions were deep.
“No one or two people on the other side of the hall is going to tell me how to vote,” said Sen. Bill Minor, D-Holly Springs, who did not want to agree to a compromise that yielded to the House position.
Actually, it was not one or two people in the House demanding that compromise. An astounding 107 House members refused an earlier compromise they felt yielded to the Senate. Only six members voted with Speaker Tim Ford, D-Tupelo, who was involved in the compromise, and Rep. Charlie Capps, D-Cleveland, who was the House’s lead negotiator. Another one of the negotiators, Rep Bobby Moody, D-Louisville, voted present.
It was obvious that the two chambers were miles apart. In the House chamber, Speaker Pro Tem Robert Clark, D-Lexington, took the floor to say some of the state senators who favored capitated health care (managed care) could not even pronounce it – much less know what it meant.
The issue that caused so much debate and trouble is whether to allow the state Division of Medicaid to contract with private health maintenance organizations to provide medical care in 22 Mississippi counties – mostly along the Gulf Coast and in the Delta. Under the plan, which would be voluntary, the health maintenance organization would be paid a certain amount of money to be responsible for the care of all Medicaid patients who signed up for the service.
The HMO would spend that money for the care of the patients and get to keep any leftover funds. In theory, supporters said, the HMOs would stress preventive care to protect their potential profit. Supporters also said managed care eventually would be required statewide because of federal changes in Medicaid funding. Medicaid recipients, generally speaking, are the poor and disabled.
Minor said if the state does not go to a managed care system for Medicaid patients, “we will have to raise taxes or we won’t be able to take care of the people.”
But members of the House disagreed. They said managed care would result in inferior medical services for the state’s most needy.
Recalling passages from the Bible on this Easter weekend, Rep. Steve Holland, D-Plantersville, said, “I think of when He said, What he has done to the least of thee, he has done to Me.”
Holland said the program had not received enough study to put in place. “We do not know what it will do to the least of thee.”
After the speeches of Holland and others, the House sent the bill back for additional negotiations with the Senate. In the end, two of the three Senate negotiators agreed to establish a committee to study the managed care issue instead of setting up the pilot program in the 22 counties.
But not all of the senators liked that notion.
“It is clear as it can be that the House is just wrong,” said Sen. Jim Bean, R-Hattiesburg, chairman of the Health and Welfare Committee. “How can you study something when you don’t have the facts?”
Sen. Tommy Robertson, R-Moss Point, agreed. He said most major companies force their employees to use health maintenance organizations. It should be required of Medicaid recipients, too, he said.
Before the Senate had a chance to vote on whether they agreed with Robertson, Sen. Alan Nunnelee, R-Tupelo, raised a point of order. He said the Medicaid appropriations bill violated the state Constitution because it set up the study committee. Under the state Constitution, setting up a study committee should have been done in regular legislation and not in an appropriations bill, which funds state government.
After a lengthy consultation with a Senate staff attorney, Lt. Gov. Ronnie Musgrove agreed with Nunnelee. This in effect sent the bill back for additional negotiations with the House. But the House already had approved the bill and left for the day.