Half of states balk at Medicaid expansion

By Bobby Harrison/NEMS Daily Journal

JACKSON – It appears Mississippi will join about half the states in not participating in Medicaid expansion during the 2014 calendar year, forfeiting at least one of three years where all health care costs from the expansion will be paid by the federal government.
But even though legislative Democrats were unsuccessful in expanding Medicaid during last month’s special session, the issue isn’t dead for good in Mississippi.
During debate in the June 28-29 special session, House Minority Leader Bobby Moak, D-Bogue Chitto, said he had been told by some Republican legislators the issue “will be revisited” during the 2014 regular session.
Democrats don’t plan to let the issue rest.
“We are going to pursue it,” said Rep. Steve Holland, D-Plantersville. “It is an active subject. It continues to be a work in progress.
“We will continue to make the case for the working people of Mississippi to have health insurance.”
It has been estimated that by expanding Medicaid to cover those earning up to 138 percent of the federal poverty level, as is allowed by the federal Affordable Care Act, health care would be provided to about 300,000 primarily working Mississippians.
The state’s Republican leaders – Gov. Phil Bryant, Lt. Gov. Tate Reeves and Speaker Philip Gunn – have been staunchly opposed to the program as an overreach of government and because of the expense to the state.
Democrats pointed out during the special session that according to the most recent numbers from Bryant’s Medicaid officials, the expansion will cost the state $7 million the first year for $70 million in federal funds and over a seven-year period will cost the state a cumulative $450 million while receiving $8.6 billion in federal funds.
But unless there is dramatic turnaround, Mississippi won’t participate in the first year of the program, starting in January, when the federal government pays 100 percent of the health care costs associated with the expansion. The $7 million in state costs for the first year, cited by the Division of Medicaid, are primarily administrative costs.
For the first three years of the program, the federal government pays 100 percent of the health care costs. It eventually stairsteps down to 90 percent of the health care costs associated with the expansion paid by the federal government in 2020. It is supposed to remain at that level.

No guarantee

Bryant and Republicans argue there is no guarantee the federal government will continue to pay 90 percent of the costs after 2020. Democrats counter that the same can be said for any joint program the state participates in with the feds, but the federal government has been consistent since the 1960s in meeting its commitment to the existing Medicaid program.
Recently, Mississippi’s matching requirement for the additional Medicaid program has risen slightly, but that has more to do with shifts in the formula that determines the matching rate for each state.
Mississippi, the poorest state in the nation, still has the best matching rate with the federal government providing about 73 cents of every $1 on health care for the 640,000 elderly, disabled, poor pregnant women, and poor children on the existing program. Nationwide, the average matching rate for the federal government is a little more than 57 percent, according to the Kaiser Family Foundation.
Also, according to Kaiser, Mississippi is hardly alone in opting not to participate in the expansion. According to the latest information provided by Kaiser, 21 states are not participating for at least the first year and debate is continuing in an additional six states.
In the Deep South, Arkansas is the only state participating with debate not finished in Tennessee.
In general, states under Republican control have opted not to participate in the expansion, while Democratic-controlled states are participating, but there are some exceptions. For instance, Arizona with a Republican governor and Legislature, is participating, while in Florida and Ohio, Republican governors wanted to participate but were blocked by Republican legislatures.
During the 2014 session, which begins in January, the Mississippi Legislature will again have to take up provisions of the existing Medicaid program dealing with continuing taxes on health care providers to fund the program. That will give Democrats a chance to again force debate on the subject and potentially a floor vote on expansion.
In the meantime, some leaders have said they intend to study the entire Medicaid program in the coming months before the start of the 2014 session.
“I support extending the agency for one year to study ways to reform the program, improve care and find efficiencies to save money,” Reeves said before the special session.
bobby.harrison@journalinc.com