BOBBY HARRISON: 2012 ruling helps make health care access unequal



In 1954, the U.S. Supreme Court ruled that it was unconstitutional for states to operate separate school systems for whites and blacks.

In 2012, the Supreme Court ruled, it could be argued, that the nation could operate an unequal system of health care for its citizens.

The 2012 Supreme Court decision, of course, was the highly anticipated or highly feared (depending on one’s political and philosophical beliefs) ruling on the Patient Protection and Affordable Care Act, better known as Obamacare.

There was an effort by those opposed to the law to have the Supreme Court rule it unconstitutional. Most of the focus of the legal challenge centered on the law’s individual mandate, which requires people fitting into certain income categories to purchase health insurance, often with the aid of what can be substantial federal subsidies.

The court, much to the chagrin of many, upheld the constitutionality of the individual mandate.

But in the same ruling, the nation’s highest court said that the federal government, through the law, could not require states to expand its Medicaid enrollment in order to continue to receive federal funds for its existing Medicaid program.

The court said it was up to each individual state to decide whether to expand Medicaid to cover those earning up to 138 percent of the federal poverty level – individuals earning up to about $15,000 per year, or $32,000 for a family of four.

The result of that Supreme Court ruling is that a person working at a fast-food restaurant in California, Arkansas, Kentucky, New York or a host of other states would be eligible for the Medicaid expansion and thus eligible for health care insurance coverage. The same fast food worker in Mississippi or most other Southern states would not be.

Expansion has been approved in 27 states, plus the District of Columbia. And it appears Republican governors, in such places as Pennsylvania, Wyoming and others, are now having a change of heart and considering expansion options, progressive news blog Talking Points Memo has reported in recent days.

But other Republican leaders, such as Mississippi Gov. Phil Bryant, are holding firm in their opposition to expansion.

Bryant says Mississippi cannot afford the expansion.

For the first three years of the Medicaid expansion portion of the Affordable Care Act, the federal government pays 100 percent of the health care costs. It eventually stair-steps down to 90 percent of the health care costs associated with the expansion paid by the federal government in 2020. It is supposed to remain at that level.

Bryant and Republicans argue there is no guarantee the federal government will continue to pay 90 percent of the costs after 2020. Democrats counter that the same can be said for any joint program the state participates in with the feds, but the federal government has been consistent since the 1960s in meeting its commitment to the existing Medicaid program.

Previous studies conducted on behalf of the state Division of Medicaid estimated that over a seven-year period the expansion would cost the state a cumulative $450 million while receiving $8.6 billion in federal funds.

Other studies have indicated that the program would be no cost or minimal cost to the state general fund when the jobs and other economic activities generated from the expansion are factored in.

It has been estimated that the expansion could provide coverage to as many as 300,000 Mississippians, mostly the working poor.

As Talking Points Memo pointed out, a study by the Kaiser Family Foundation conducted last year found that 79 percent of the about 5 million people who are not eligible for the Medicaid expansion because their state leaders were opting out reside in the South. Talking Points surmised that percentage will only grow as more leaders from other parts of the nation are beginning to look at some form of Medicaid expansion.

And, of course, Talking Points and others have pointed out a large percentage of poor residents in the South are African-American.

Bobby Harrison is the Daily Journal’s Capitol Bureau chief. Contact him at or call (601) 946-9931.

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    It’s rather amazing to me that a group of mostly lawyers ( politicians ) can manage to pull the wool over the eyes of their constituency on the rules of a basic contract. Two such rules are (1) the four corners rule saying if it’s not within these 4 corners its not a contract and (2) if one party fails to live up to the contract the contract is broken. In other words, if the Federal Government fails to pay the 90% of Medicaid Expansion cost beyond 2020 it has broken the contract and MS would be off the hook at that point. Correct?

    So, can MS prove that it is incapable of paying the 10% cost of Medicaid expansion.. That would be the better argument – the reason not to enter into the contract.

  • Thile

    So the state’s strategy is to “hang on” until 2020. But what exactly would our healthcare landscape look like by then? Failure to do anything could result in a lowered credit/bond rating for Mississippi. According to a study by the Robert Wood Johnson Foundation (can’t post links as the DJ would nuke them), Mississippi would lose nearly $5B in hospital reimbursements by then, along with $14.5M in Medicaid funding. With hospitals already closing, reducing or nixing services altogether, and laying off personnel, can we “afford” to hold out?