BOBBY HARRISON: Looming Medicaid issue contains complexities

By Bobby Harrison/NEMS Daily Journal

JACKSON – This November’s presidential election could have more impact on the actions of the following session of the Mississippi Legislature than any federal election since the 1960s when the state was battling integration.
In 1964, Republican nominee Barry Goldwater opposed the Civil Rights Act and at times questioned the wisdom of the Supreme Court ruling banning separate but equal segregated schools.
If Goldwater had won that election in 1964, it is questionable whether the Voting Rights Act would have been passed during the following year. That law, of course, has resulted in a record number of African-American elected officials and the registration of literally millions of black voters.
It is not clear whether Goldwater would have tried to repeal the Civil Rights Act, but it is clear that he opposed it and voted against it as a member of the U.S. Senate. It would be naive to think that opposition did not result in Mississippi and other deep South states voting Republican in 1964 for the first time since Reconstruction.
This time the issue is health care. I do not intend to equate health care and civil rights, though many might. I am only stating that just as the 1964 election was one of the keys in ushering in many changes in Southern states, the 2012 election could lead to significant change to the health care arena in Mississippi.
At times during the current campaign, Republican presidential nominee Mitt Romney has said he would repeal the Patient Protection and Affordable Care Act if he is elected, though this weekend he appeared to hedge on that promise before he appeared to reconfirm it later.
But at any rate, many Republican elected officials in Mississippi hope Romney wins and hope he is true to his word – given earlier in the campaign – and that he repeals the act.
If the act is not repealed, the Republican-led Mississippi Legislature will have some tough decisions to make regarding Medicaid during the 2013 session – hence the earlier statement that the November election will have significant impact on the upcoming legislative session.
If Romney does not win, and it is not a guarantee he could repeal it if he does win, Mississippi and other states must decide whether they want to participate in an expansion of Medicaid.
Under the Affordable Care Act, some people would get tax credits to help them purchase health insurance. But those earning less than 133 percent of the federal poverty level or less than $14,000 annually can be placed on the Medicaid rolls in states that participate, starting in 2014.
Mississippi Republican officials have said the state cannot afford to participate in the Medicaid expansion even though the federal government will pay the bulk of the cost.
But it gets complicated. As part of the Affordable Care Act, a federal program that provides subsidies to hospitals for the treatment of those who do not have insurance will go away under the assumption people will have insurance through the Affordable Care Act.
This will cost the hospitals $210 million annually. If they are treating people with health care coverage, that will not be such a big deal. But if Mississippi does not participate in the Medicaid expansion, it has been estimated that up to 400,000 people will not have health care coverage. And when these people get sick and go to the hospital, they will not have the ability to pay for the care they receive.
The scuttlebutt is that in the coming weeks a study by respected analysts will be released on the economic impact of an expanded Medicaid program on Mississippi. This study presumably will consider factors such as the loss of the payments for uncompensated care to the hospitals.
True, it is apples and oranges. But for years, Mississippi’s reputation has been tarnished – sometimes fairly, sometimes unfairly – because of issues related to civil rights.
Before summarily rejecting a Medicaid expansion many health care advocates have argued it would make sense for state leaders to at least look at all the studies and consider all the ramifications.
At any rate, their decision could have a long-term lasting impact. Of course, the November election, perhaps, could take them off the hook.
That is what they were hoping for in 1964.

Bobby Harrison is the Daily Journal’s Capitol Bureau Chief. Contact him at bobby.harrison@journalinc.com or call (601) 353-3119.