Medicaid chief: Expansion won’t mean better health

By Bobby Harrison/NEMS Daily Journal Jackson Bureau

JACKSON – Mississippi Medicaid Executive Director David Dzielak declined Monday to affirm a link between an expansion of Medicaid coverage and improved health for the state’s citizens.
Dzielak, speaking to Senate committees about the state’s possible expansion of Medicaid as part of the new federal health care law, said during the past decades as Medicaid expenditures have risen, the state’s health has deteriorated.
His remarks came in a joint meeting of the Senate Public Health and Insurance committees and brought rebuttal from others.
Sen. Hob Bryan, D-Amory, said it stood to reason that a person who had a way to pay for health care and was more likely to see a doctor and receive preventive care would be healthier.
Ed Sivak, executive director of the Mississippi Economic Policy Center, said studies by the New England Journal of Medicine indicate that states that provide Medicaid coverage to a greater percentage of their populations have better health care outcomes.
Kimberly Hughes, director of government relations for the American Cancer Society Cancer Action Network, said expanding Medicaid coverage to those earning 138 percent of the federal poverty level or about $14,000 annually would enable many “hard-working” Mississippians to “see a doctor regularly, access preventive services. … Access to these critical services enhances the likelihood of detecting cancer at an earlier, more curable and much less expensive stage.”
The federal legislation gives states the option to participate in the expanded Medicaid coverage that begins in 2014. During the onset, the federal government will pay 100 percent of expansion costs. By 2020, the federal share will be reduced to 90 percent.
If Mississippi wants to participate in the expansion from the onset, the Legislature will have to act in 2013.
“My personal opinion is that the chairmen are not in a great hurry to do anything right now,” said Public Health Chair Dean Kirby, R-Pearl, as Monday’s meeting began.
Gov. Phil Bryant has repeatedly said the state cannot afford the expansion. Currently, poor pregnant women, poor children, the disabled and certain segments of the elderly population are covered by Medicaid in Mississippi with the federal government paying about 74 percent of those costs.
Dzielak cited a study done by Milliman, a private provider of actuarial services, placing total Medicaid expansion costs to the state of between $609 and $1 billion from 2014 to 2020. But Sivak pointed out that Milliman acknowledges some of those costs will be incurred even if the state does not participate in the expansion because people currently eligible for Medicaid but who aren’t in the program will likely sign up because of the federal law’s mandate for everyone to have health insurance.
State Sen. David Blount, D-Jackson, cited a study by the state Institutions of Higher Learning indicating the expansion costs would be much less than Milliman indicated and would help generate 9,000 jobs and tax revenue. Milliman did not consider the economic benefits of the expansion.
On Monday, Dzielak also discussed the possibility of a partial expansion to 100 percent of the federal poverty level, but federal officials have refused that option.
bobby.harrison@journalinc.com