Medicaid hearing airs woes of hospitals, uninsured

By Bobby Harrison/NEMS Daily Journal

JACKSON – Mississippi has one of the nation’s highest rates of preventable hospitalizations, members of the state House Medicaid Committee were told Monday.
Theresa Hannah, executive director of the Center for Mississippi Health Policy, also told the House Medicaid Committee that the state leads the nation in the number of amputations caused because of complications from diabetes, and while the state is 38th in instances of breast cancer it is fourth in the number of breast cancer deaths.
The problem, the committee was told, is that the state has a high percentage of the working poor who do not receive treatment until their illness has advanced to the point where expensive hospitalization and treatments are the only option.
“In general, uninsured people tend to seek (health care) services less often,” Hannah said.
The Medicaid Committee conducted a hearing on whether to expand Medicaid to those earning up to 138 percent of the federal poverty level or about $15,000 for an individual. The expansion is allowed as part of the federal Affordable Care Act.
The nearly three-hour hearing took place in a room filled with hospital administrators, other health care providers and numerous advocates wearing stickers in support of expansion.
Gov. Phil Bryant has voiced opposition to the expansion, saying the state cannot afford it. On Monday, his chief of staff, Lucien Smith, reiterated Bryant’s position, saying “It is not in the long-term best interest of the state” to provide health insurance to more Mississippians through Medicaid.
Yet Mississippi hospitals have expressed concerns about how they could be affected if the state does not expand Medicaid. The Mississippi Hospital Association, which was not asked to participate in the hearing, has pointed out that as part of the federal law a major reduction in federal reimbursements for uncompensated care will be enacted because it assumes people will have health insurance through Medicaid and other alternatives.
But Smith and others told the Medicaid Committee that those rules are still being developed.
Rep. Cecil Brown, D-Jackson, asked if it would make sense to enact a legislative trigger where the expansion would go into effect if the cuts in uncompensated care go into effect.
In a news conference before the hearing, Claude Harbarger, chair of the Board of Governors of the Hospital Association and president of St. Dominic Health Services in Jackson, said Bryant had agreed to work with them on a solution to the problem.
“We must arrive at solutions in this calendar year or face significant reductions in health care services in the state of Mississippi,” Harbarger said. “We look forward to working with Gov. Bryant and his team in the days ahead.”
Bryant said, “I recognize the situation facing our hospitals and my administration is committed to helping resolve those issues. While I oppose the expansion of Medicaid in our state, I appreciate the hospitals’ willingness to sit down with me and my team to discuss alternatives to solving these issues.”
According to Hannah, about 40 percent of adults below 138 percent of the federal poverty level have no health insurance. She said these are primarily low-wage workers, including more than 14,400 cashiers, 8,700 cooks, 6,800 construction workers and various other categories of laborers.
She said only 26 percent of businesses employing 50 people or less in Mississippi provide health insurance.
It’s estimated that as many as 300,000 additional people could sign up for Medicaid under the expansion. Currently, it serves about 640,000 elderly, disabled, poor pregnant women and poor children.
Under the proposed expansion, the federal government will pay 100 percent of the costs for the first three years, starting in calendar year 2014. By 2020, the federal share will be 90 percent.
But Smith argued that while the federal government is paying the bulk of the costs the state’s share of the expansion would take funds from other areas, such as education and law enforcement.
Currently there is no bill alive in the 2013 session to deal with Medicaid expansion, and the Republican leadership of the Legislature and the governor have given no indication of wanting to pass something.
But a reduction in federal uncompensated care could put many hospitals in a tough situation if the state does not act.
bobby.harrison@journalinc.com