State Medicaid had unlikely start

By Bobby Harrison/NEMS Daily Journal Jackson Bureau

JACKSON – State leaders have been adamant in their opposition to President Barack Obama’s Affordable Care Act with Gov. Phil Bryant calling it “an assault on the liberty of American citizens.”
Bryant has said he opposes the act’s Medicaid expansion that would provide health insurance to an additional 250,000 to 400,000 Mississippians because the state can’t afford it.
But this is not the first time state leaders have grappled with whether to take federal funds to expand health care.
In 1965, there were cries of socialism if legislation was passed to create Medicare to provide health insurance to the elderly and Medicaid for certain segments of the poor population.
As today, Mississippi politicians were among the most vocal in opposition. Yet, in 1969, one of those politicians – then-Gov. John Bell Williams – called a special session where he urged legislators to create a state Medicaid program.
In a historic special session, which ran from July 22 until Oct. 11, including an interruption by Hurricane Camille and legislation to deal with that disaster, lawmakers did opt into the Medicaid program and Williams signed the bill into law on Oct. 7.
As a Democratic congressman, Williams had endorsed Republican Sen. Barry Goldwater instead of incumbent Democrat Lyndon Johnson for president in 1964. After that endorsement, the Democratic leadership of the U.S. House stripped Williams of his seniority.
Williams, like all but one member of Mississippi’s seven U.S. House members and senators, voted against the Medicaid/Medicare legislation. William Colmer of Pascagoula did not vote.
In 1967, Williams returned home to run for governor. Like most Mississippi political leaders of the day, Williams ran against the intrusive federal government that was forcing the state to integrate its schools. He had bolstered his standing on those issues by supporting Goldwater, who opposed forced integration, and by opposing much of Johnson’s agenda, including the creation of Medicare, which was purely a federal program, and Medicaid, which included state matching funds, so the states had the option not to participate.
Yet, on July 22, 1969, in a joint address to the House and Senate on the opening day of a special session he called, Williams urged legislators to enact a Medicaid program.
“Let us not delude ourselves into the false notion that we can – or will – evade the burden of caring for these unfortunate people,” Williams said. “Our society, through the instrument of government, has always shouldered this responsibility, and I am sure it always will.”
Williams went on to say the state could not afford to turn down a federal health care program that would require the state to provide only 20 percent of the matching funds. He spoke of the economic impact it would have on the state.
“The simple fact is that someone pays for health services, and we must decide, who will do it and how,” he explained.
Former U.S. Rep. David Bowen of Jackson, who served as director of Federal-State Programs for Williams, said the governor did not enter office with the intent of enacting the Medicaid law in Mississippi.
“He was negative about it to begin with,” Bowen said. “But I convinced him he was obligated to hold public hearings.”
Williams took federal funds to form a Public Health Advisory Committee and tabbed Dr. Alton Cobb, a physician with the state Department of Health, to chair the panel. The panel held hearings throughout the state, including Tupelo.
Bowen said Williams attended each of the hearings where he heard from providers and the general public about health care needs in the state.
“He listened,” said Cobb, who would become the first director of the state’s Medicaid program and later served as state health officer. “The more he listened, the more it generated his interest.”
Ed Perry of Oxford was a 27-year-old freshman House member in 1969. He said the issue was dealt with during a special session because at the time the Legislature met only every other year.
“It was brand new,” Perry said. “It was something we felt we had to do, but be very cautious.”
After the legislation passed both chambers in differing forms, conferees were selected to hammer out a compromise. That compromise passed the House by a surprisingly comfortable 72-33 margin the first time on Oct. 1. But on the same day, the Senate voted by a 24-23 margin to send it back to a new conference committee for additional negotiations.
The second compromise, which passed the Senate 30-16 and again comfortably passed the House, had language saying that if the costs of the program exceeded $11 million, it would stand repealed.
Rep. Steve Holland, D-Plantersville, said when he was elected to the Legislature in 1984, similar language still was in the law saying the program would be repealed if costs exceeded $80 million. The repeal language was removed in the 1980s.
This past session the Legislature appropriated $821.7 million to pull down $4.16 billion in federal funds to provide health care to poor pregnant women, poor children, the disabled and certain segments of the elderly population. Since its inception, Medicaid has been expanded to the point that more than 90 percent of nursing home residents in the state are covered by it.
When the program was created, Williams estimated it would cover a little less than 100,000 Mississippians. Now the program covers more than 600,000.
Funding for the program has risen because of the explosion in health care costs through the years. Now the state’s share is about 24 cents of each dollar spent on Medicaid.
Mississippi received the best matching rate when the program was created in the 1960s because of its high poverty rate, and it still does.
The federal government would pay 100 percent of the costs for people covered through the pending expansion for three years, starting in 2014. By 2020, the state would be responsible for 10 percent of the costs.

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