BILL MINOR: Crack appears in GOP’s anti-Medicaid expansion wall

By Bill Minor

House Appropriations Chairman Herb Frierson scared education advocates out of their shoes two weeks ago by circulating a letter with dire numbers on how Medicaid has drained tight revenues from their pet program the past decade and would worsen if Medicaid is expanded.
The Poplarville Republican’s spending figures went unchallenged until last week when Rep. Cecil Brown, D-Jackson, recognized as the Legislature’s most knowledgeable fiscal authority, weighed in with a letter debunking Frierson’s figures and conclusions.
The tete-a-tete came as legislators stood by awaiting Gov. Phil Bryant’s call for a special session to deal with Medicaid on two fonts. One is to reenact the longstanding federal-state program which was blocked by Democrats at the 2013 regular session in a strategic move to force consideration of expanding of the program under the new Affordable Care Act. Second is the issue of expansion, which could add some 300,000 working poor to the rolls. Bryant and other top state Republican leaders oppose expansion as too costly though the U.S. would pick up all or most of the tab until 2020.
Constant pressure for Medicaid expansion from public hospitals last week produced a key break in the once-solid Republican opposition ranks. GOP Sen. Billy Hudson of Hattiesburg publicly dropped his opposition to expansion and said he would vote for it after meeting with the board of Forest General Hospital, one of the largest publicly owned health facilities in Mississippi. Public hospitals see ACA as a vital source to stem multi-million dollar losses they now experience from uncompensated emergency care.
Brown, a nationally-recognized CPA and financial consultant, had served as Mississippi’s fiscal officer in the 1990s before being elected to the Legislature. In his letter to fellow lawmakers, he pointedly dismantled Frierson’s figures on how much Medicaid cost has risen since FY 2004. The Jackson lawmaker contended Frierson had inflated both the total 10-year increase in Medicaid spending as well as its annual percentage increase.
“The actual average annual rate of increase in Medicaid spending is 6.4 percent, not the 13.6 percent Herb claims in his letter,” Brown wrote. Frierson miscalculated the annual rate of increase over the 10 year period by failing to compound the annual rate of growth.
Besides, Frierson began his 10 year spending period in FY 2004 with a significantly flawed figure, Brown points out. Because of an anomaly in federal matching funds that year, Brown shows that $95 million more in federal money was injected into Mississippi’s program. As a result, he adds, the state was able to reduce its matching funds. “Therefore,” the Jackson lawmaker wrote, “the state dollars were artificially reduced.” When Frierson used that low state appropriation as his base figure, Brown says, the Poplarville legislator automatically overstated the Medicaid increase from 2004 to 2014.
Brown, a longtime staunch education advocate, charged Frierson made a flawed contention when he wrote that education spending has been adversely affected by Medicaid increases. “His (Frierson’s) letter makes no mention of tax cuts for businesses that have decreased general fund receipts … nor does he mention some $400 million that has been socked away in various reserve funds that could have been spent to fund education,” Brown says.
The Jackson lawmaker concedes that Medicaid funding in recent years has grown, but attributes much of the program’s growth from an increased patient load resulting from the state’s job loss following the 2008 Recession. Added to that is substantially higher medical costs. In a sidewise jab at former Gov. Haley Barbour, Brown pointed to Barbour’s unfunded expansion of home and community based waivers as one additional cause of higher Medicaid spending.
The Fierson-Brown dueling letters aside, basic issues remain regarding Medicaid’s future in Mississippi, the nation’s poorest state where 625,000 needy citizens now have no other health insurance program. Not only are those on the rolls left hanging in space by a political game of chicken, but so are a quarter million others, most of whom now hold minimum wage jobs. In a state that prides itself on following what the “Good Book” says, this dilemma is difficult to comprehend.
Syndicated columnist BILL MINOR has covered Mississippi politics since 1947. Contact him through Ed Inman at edinman@earthlink.net.