BOBBY HARRISON: Medicaid provides ‘how’ in medical coverage

By Bobby Harrison/NEMS Daily Journal

JACKSON – When the U.S. Congress passed the Medicaid program in 1965, Mississippi was the poorest state in the nation with a lot of people without health insurance.
Because of that, Mississippi got the best matching rate for the federal-state program that provides health care to certain groups of poor people. At the time, the federal government would provide 80 cents of every dollar spent on the new program. All these years later, Mississippi still gets the best rate. The federal government now pays about 74 cents of each dollar spent on Medicaid.
Despite that favorable matching rate, Mississippi was one of the last states to opt into the program. The state joined the federal Medicaid program in 1970 along with Alabama, Arkansas, Florida, Indiana, New Jersey and North Carolina.
Alaska became the second to last to join the program in 1972. Arizona came on board in the early 1980s.
Today, Mississippi still has a lot of people without health insurance – or more importantly, without the means to pay for health care.
Mississippi, with 21 percent of its population uninsured, trails only Texas, New Mexico and Nevada in terms of states with highest percentage of its population without health insurance, according to a 2011 CNN study based on U.S. Census Bureau statistics.
Massachusetts has the smallest percentage of uninsured residents at 5.5 percent, according to the state study.
Roughly one-fifth of Mississippians are covered by Medicaid. They are primarily the disabled, poor pregnant women, poor children, and a certain segment of the elderly population. It is important to note that Medicaid is paying for a vast majority of Mississippians living in nursing homes.
It is a testament to the state Medicaid program that Mississippi with the highest percentage of its residents living below the poverty level at more than 22 percent is not last in terms of percentage of its population without health insurance.
It also is a testament to the effectiveness of the Children’s Health Insurance Program, another federal-state program to provide health care to the children of the working poor. The program was enacted in the 1990s. In the early 2000s, then-Gov. Ronnie Musgrove was criticized for an aggressive campaign to sign up children of the working poor for the program.
Perhaps Musgrove was thinking like former Gov. John Bell Williams was in the 1960s when he led Mississippi’s efforts to join the Medicaid program.
Williams, a staunch conservative, had voted against creating the program in 1965 when he was a member of the U.S. Congress. But as governor, he called a special session that lasted nearly three months in 1969 where the Mississippi Medicaid program was created.
In a speech to a joint session of the Legislature to kick off the special session, Williams reasoned “someone pays for health services, and we must decide who will do it and how.”
Williams understood that if an uninsured person got sick enough he or she would go to the emergency room. Someone pays for that visit. In many instances, the cost of the treatment of the uninsured is paid by increasing the rates on everyone else.
That is part of the reason an aspirin costs $25 in the hospital.
In the 1960s, Mississippi was reluctant to join the Medicaid program. In this decade, based on the comments of Gov. Phil Bryant, the state will be reluctant to participate in an expansion of the Medicaid program to cover people earning up to 133 percent of the federal poverty rate or $14,400 annually.
The federal government will pay all the costs of that program for three years and by 2020 will still be paying 90 percent.
Bryant, who ran for office on improving the state’s economy by enhancing the health care sector, and by moving Mississippi off the very bottom in terms of least healthy states, says the state cannot afford the added costs of the expanded program.
Perhaps that is so. But the truth is that the state already is paying those costs for being the nation’s least healthy. John Bell Williams knew that in the 1960s.
Medicaid may not be the answer. But the fact that so many Mississippians do not have health care insurance costs us every day.
Bobby Harrison is the Daily Journal’s Capitol bureau chief. Contact him at bobby.harrison@journalinc.comor (601) 353-3119.

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