Key health officials quiet on Medicaid expansion

By Bobby Harrison/NEMS Daily Journal Jackson Bureau

JACKSON – Two state health officials have stopped short of endorsing for Mississippi a federal proposal to expand Medicaid to cover all residents earning up to 138 percent of the federal poverty level of about $15,000 annually.
During a recent news conference at the Capitol to report on the overall poor health of Mississippi citizens, state Health Officer Mary Currier and Mississippi Medical Association President Steve Demetropoulos said their organizations have not taken a position on the expansion of Medicaid.
Both said they thought it is important for people to have health insurance as a step to improve the state’s overall health rankings. In most categories, the state is ranked as the nation’s worst, including for obesity, cardiovascular deaths, infant mortality, teen births and physician access.
When asked if the Medical Association, which is comprised of nearly 5,000 physicians across the state, has taken a position on whether to participate in the Medicaid expansion, Demetropoulos said, the issue “is very complicated, very fluid. We feel like everybody deserves to have insurance.”
By the same token, he said he understands the issues concerning the cost of the expansion to the state.
He said the Medical Association is committed “to work with the Legislature and the governor to try to find something that makes sense.”
Currier said the state Board of Health, which hired her to serve as state health officer and to oversee the Department of Health, has not taken a stance on the issue.
Currier added, “Access to care often depends on whether you have insurance and we support citizens having insurance some way, but again it is very costly trying to do that.”
Gov. Phil Bryant has voiced strong opposition to opting into the program, which is part of the federal Patient Protection and Affordable Care Act.
Several bills have been filed this session to opt into the expansion, but the Republican leaders of the Legislature have indicated they are not likely to tackle the issue this session.
Many poor adults do not qualify for Mississippi’s existing Medicaid program. Currently in Mississippi about 640,000 poor pregnant women, poor children, the disabled and a segment of the elderly population are on the Medicaid program. The federal government provides Mississippi about 74 cents of each dollar spent on Medicaid.
For the Medicaid expansion, the first three years, starting in 2014, the federal government will provide 100 percent of the costs. After that, the federal share will stair-step down each year to 90 percent in 2020 where it will remain.
It is estimated that more than 300,000 people would be added to the Medicaid rolls under the expansion. Various conflicting studies have been done on how much the expansion would cost the state.
While the Medical Association has yet to take a stance, the Mississippi Hospital Association has joined the Mississippi Health Access Coalition, which promotes the Medicaid expansion.
Demetropoulos concedes that the Medical Association is concerned about the impact on hospitals if the state does not participate in the expansion.
Mississippi hospitals currently receive more than $210 million annually in federal funds that cover the cost of about 40 percent of the uncompensated care they deliver. Under the federal law, those payments are supposed to be phased out under the assumption people would have coverage through the Affordable Care Act and hospitals would be treating far fewer people with no insurance.
But if Mississippi does not participate in the Medicaid expansion and the payments for uncompensated care are lost, Demetropoulos, a Pascagoula physician, said it could have a devastating impact on many of the state’s hospitals and communities where hospitals are the largest employer.
House Appropriations Chair Herb Frierson, R-Poplarville, who has been an outspoken opponent of the federal health care law, said he would be watching the hospital issue.
“I am refining my position,” said Frierson, who said he wanted to see what the final federal rules are and how they will impact Mississippi hospitals.
In the meantime, Rep. Steve Holland, D-Plantersville, said if the Legislature does not act this year the state stands to miss participating in the expansion in 2014 when the federal government will pay all the costs.
“If the state does not expand Medicaid, those taxes paid by Mississippians will be used to expand Medicaid in Arkansas, California, Minnesota and any other state wise enough to embrace it,” Holland wrote recently.
bobby.harrison@journalinc.com