BOBBY HARRISON: Evening the payout with Medicaid expansion

By Bobby Harrison/NEMS Daily Journal

By refusing to expand Medicaid, perhaps, Mississippi and other so-called red states – or Republican-leaning states – can kind of even the playing field.
Currently, numerous studies show that the most federal spending goes to red states like Mississippi where the political leadership is opposed to expanding Medicaid to cover those earning up to 138 percent of the federal poverty level as is allowed under the federal Patient Protection and Affordable Care Act.
Roughly half of the states currently are expanding or leaning toward expanding Medicaid to provide coverage to an individual earning up to $15,000 per year. Generally speaking, the other half – the states rejecting expansion – are states where Republicans win national elections and have control of the statehouse.
There are some exceptions, such as that Tennessee and Arkansas are looking at federally approved programs to expand health care coverage to the working poor through the Affordable Care Act. Tennessee is considering expanding health care coverage even thought it is such a staunch Republican state that it voted against its native son – Al Gore – in 2000 when he ran for president.
In Mississippi, Republican Gov. Phil Bryant and other leaders say the state cannot afford the expansion. His critics argue the federal government is committed to paying 100 percent of the costs related to actual health care expenses for the first three years of the expansion and will pay at least 90 percent of the costs after that.
While Bryant says the state cannot afford the expansion, others ask how can the state afford not to participate in the expansion.
Interestingly, many of those states where Medicaid expansion is being rejected already receive more in federal taxes than they pay in. Mississippi is routinely near the top of that list, receiving about $2.50 in federal taxes for each $1 it contributes to the national treasury.
To be fair, the District of Columbia, though not a state, and New Mexico normally receive more than Mississippi does. Both New Mexico and the District of Columbia are reliably blue or Democratic in national elections.
The other reliably Democratic states normally at the top of the list – for receiving more than they pay in – are Hawaii and Maine. It should be pointed out, though, that Maine for years had two Republican U.S. senators. For the most part, the other states at the top of the list are predictable – Louisiana, Alabama, South Carolina, West Virginia. They are states with high levels of poverty and routinely vote Republican in national elections. With the exception of West Virginia, their leaders currently have no plans to participate in the Medicaid expansion.
The states that are net contributors to the federal government in terms of paying more in taxes than they receive generally speaking are Northeastern states, Midwestern states and surprisingly – at least to me – California. Generally, these are states with higher per capita income levels and generally have a better educated population.
These numbers comparing state tax payments to the federal government were compiled by various news organizations from information garnered from the U.S. Census.
But here is the point: Generally speaking, the states that are participating in the Medicaid expansion are those states that contribute more to the federal government than they receive or at least do not receive as much as some other states like Mississippi and Louisiana.
With the expansion of Medicaid, a large, new stream of federal funds will be pouring into those states. And taxpayers in states like Mississippi and Louisiana will be helping to pay for that expansion without getting anything in return – other than the satisfaction of knowing the working poor in California, New York, New Jersey, Illinois and the like will have access to Medicaid.
The political leadership in those states should at least send a thank you card to the Mississippi taxpayers. Maybe, a free vacation at the Jersey shore would be nice.
BOBBY HARRISON is the Daily Journal’s Capitol Bureau Chief. Contact him at or call (601) 353-3119.

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