BOBBY HARRISON: Chambers’ differences define the Medicaid debate

By Bobby Harrison/NEMS Daily Journal

JACKSON – The differences in how the House and Senate are handling Medicaid this session provide a glimpse into the contrasting leadership style of the two presiding officers and also of the relationships between the members of the two chambers.
Bickering and the gnashing of teeth in the House have led to the killing this session of legislation that would in essence reauthorize the Division of Medicaid after June 30. It is important to note that all agree that Medicaid will be reauthorized, but at this point in the session, because of the House action, it will take extraordinary measures to revive legislation to keep the health care agency going.
In the Senate, the issue has not been nearly as controversial. The Senate leadership introduced a Medicaid technical amendment bill, as is done most sessions, with the code section dealing with eligibility. Having that section of the law in the bill means it a member could offer an amendment to expand eligibility to cover those making up to 138 percent of the federal poverty level or about $15,000 annually.
The federal Affordable Care Act gives states the option to expand Medicaid with the U.S. government paying all costs for the first three years and eventually paying 90 percent.
Most Mississippi Republicans say they oppose the expansion in part because the state cannot afford it, though there are conflicting studies.
Senate Public Health Chair Dean Kirby, R-Pearl, who said he opposes the expansion, opted to leave the code section to allow the expansion in the Medicaid technical amendments bill. Kirby reasoned that it is important to leave all options on the table throughout the session to learn more about the consequences of not participating in the expansion.
For instance, a decision not to participate in the expansion could result in layoffs and possible closures at many Mississippi hospitals. They currently receive hundreds of millions of dollars from the federal government to reimburse them for a portion of the uncompensated care they deliver.
But those federal payments could go away or at least be dramatically reduced under the assumption that people will have insurance through Medicaid so there will be much less uncompensated care.
During the process of the Senate passing its bill, it appears that Republican Lt. Gov. Tate Reeves, who presides over the Senate, quietly went to key Democrats and said let’s not fight at this point over whether to expand Medicaid. Instead, let’s keep the bill alive until more is known about how the decision to expand Medicaid or not will impact the state.
The result is that the Medicaid bill passed with almost nary a squeak.
Meanwhile, over in the House, the leadership introduced its technical amendments bill in a manner that would prevent the opportunity to offer an expansion amendment.
The minority Democrats were able to kill that bill, which needed a three-fifths majority to pass, saying they would rather deal with the Senate bill.
At that point, Speaker Philip Gunn, R-Clinton, took the unusual step of sending the aforementioned Senate Medicaid bill to his Rules Committee to kill it.
Gunn said he wanted to kill the Senate bill because there are not enough votes on the House floor to pass an expansion amendment, which Democrats surely would offer, and thus lengthy and divisive debate on the issue would be pointless.
There have been numerous lengthy debates during Gunn’s short tenure as speaker on issues ranging from charter schools to immigration. Last session he had the House in session well past midnight to debate a immigration bill that died uneventfully in the Senate.
As the minority leader during the previous term, it seemed at times Gunn’s primary mission was to engage the House in lengthy and divisive debate.
The House’s current minority leader, Bobby Moak, D-Bogue Chitto, said in reality Gunn went to such extreme measures to kill the Senate bill because if the legislation reaches the House floor many Republican, feeling pressure from their local hospitals, will cross party lines to vote for expansion.
Whatever the reason, how the issue has been handled by the two chambers is as different as night and day. Part of that is that because the Senate is smaller – 52 members compared to 122 – it is more congenial and there is less contentious debate.
But the flip side is that debate – even lengthy debate – often is part of legislative process. The result is at this point there is no legislation alive to re-authorize the Division of Medicaid.
Bobby Harrison is the Daily Journal’s Capitol Bureau Chief. Contact him at bobby.harrison@journalinc.com or call (601) 353-3119.