By Bobby Harrison
Daily Journal Jackson Bureau
JACKSON – At a Senate Committee meeting last week, Tim Moore, the new chief executive officer of the Mississippi Hospital Association, was described as giving a “less than enthusiastic” endorsement of Medicaid expansion.
Last year, the Hospital Association was one of the chief and most powerful proponents of the Mississippi Legislature expanding Medicaid to cover those earning up to 138 percent of the federal poverty level.
Then-CEO Sam Cameron, who retired last year, was participating in news conferences urging Gov. Phil Bryant and the Legislature to expand Medicaid – a position staunchly opposed by the governor and the legislative leadership.
For the most part, Moore is quiet on the issue.
When asked recently for the position on Medicaid expansion, MHA spokeswoman Shawn Rossi replied, “The Mississippi Hospital Association supports any and all efforts to increase the number of covered lives in Mississippi, as our state has one of the highest rates of uninsured in the nation.
“Last year, our state’s leadership and Legislature rejected Medicaid expansion. MHA is committed to assisting in the development of the right health care model for Mississippi. We have a responsibility to all of those we serve to study as many options as possible.”
Rep. David Baria, D-Bay St. Louis, said, “My perception is they (Hospital Association members) made the decision that they do not think it is likely they can pass a bill expanding Medicaid in the current political environment… So they made the decision it is not a front-burner issue.”
Or to put it another way, many believe the Hospital Association made the calculated decision that it was not doing its more than 100 member hospitals across the state a service by being very publicly at odds with the Republican leadership of the state.
“I think that is a mistake,” Baria said of the Hospital Association’s suddenly lukewarm response on Medicaid expansion. “States all across the country that were against it are now expanding Medicaid.”
The MHA has been at odds with the Republican leadership of the state on more than one occasion. During the previous term under then-Gov. Haley Barbour, the Hospital Association was routinely cross swords with the governor’s Division of Medicaid on various issues and unsuccessfully fought Barbour’s efforts to place an additional tax on hospitals to help pay for the existing Medicaid program.
This session the Hospital Association has seemed more interested in blocking efforts to place inpatient care provided by hospitals to Medicaid recipients in a managed care system. The hospitals have voiced concerns that the managed care administrator would not give them a fair price for the services they provide.
Some, primarily legislative Democrats who favor expansion, said hospitals are losing far more money by the state not expanding Medicaid than by them being placed in a managed care program.
Some have even suggested that the hospitals are trying to make a tradeoff with the leadership – they will be quiet on Medicaid expansion if they are not placed in managed care.
Sen. Hob Bryan, D-Amory, who asked the question about Medicaid expansion that put MHA CEO Moore on the spot, said, “I don’t care about the politics of expansion. It is the right thing for the Hospital Association members and the right thing for the citizens of Mississippi, and they (Hospital Association officials) ought to speak up and say it (expansion) is the right thing regardless of who is on what side of the issue.”
In the past, the Hospital Association has argued the refusal to expand Medicaid places a financial strain on its member hospitals. Under the federal law, the amount of federal funds the hospitals receive to partially offset the costs of providing uncompensated care to people with no insurance or ability to pay is reduced over a period of time.
The assumption is that there will be fewer people with no ability to pay because of the expanded Medicaid program that would provide health coverage to an individual making up to about $15,000 per year or about $32,000 annually for a family of four. But if a state does not expand Medicaid, there is no way to offset the loss of federal money for uncompensated care.
The governor and legislative leadership have been adamant in their opposition to Medicaid expansion, saying the state cannot afford it.
“It appears Obamacare is a debacle,” Gunn said in December. “I cannot believe anybody would continue to advance it.”
For the first two years of the Medicaid expansion portion of the Affordable Care Act, known as Obamacare, the federal government pays 100 percent of the health care costs. It eventually stair-steps 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.
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.
Last year studies conducted on behalf of the state Division of Medicaid estimated that over a seven-year period the expansion would cost the state a cumulative $450 million while receiving $8.6 billion in federal funds.
Other studies have indicated that the program would be no cost or minimal cost to the state general fund when the jobs and other economic activities generated from the expansion are factored in.
It has been estimated that the expansion could provide coverage to as many as 300,000 people, mostly the working poor.