By NEMS Daily Journal
The Supreme Court’s 5-4 order released Thursday upholding the key individual health insurance mandate provision in the Affordable Care Act – the centerpiece of President Barack Obama’s first-term legislative record and the focus of Republican opposition – also contained a decision about Medicaid expansion which Mississippi’s elected leaders should prepare to discuss and debate.
The court held that the law’s requirement, as passed, denying states all continuing Medicaid support from the federal government if they choose not to expand Medicaid programs, is unconstitutional.
Most Republican elected officials in Mississippi announced within hours of the Supreme Court decision that Mississippi cannot afford to expand Medicaid as the Affordable Care Act proposes, and that may be correct, but a full public discussion of the possibilities for greater impact in providing health insurance coverage for uninsured Mississippians is appropriate.
About 700,000 Mississippians are enrolled in Medicaid whose coverage is available for eligible children, pregnant women, the aged and disabled, and some other smaller constituencies.
Generally, Medicaid is a partnership between states and the federal government, with the federal government paying most of the cost, with those funds paired with a state’s share.
One projection prepared for state budget officials in 2010 projected Mississippi’s Medicaid enrollment could climb to 1.14 million under the law, which does not fully kick in until 2014.
The Medicaid expansion, if adopted, would be fully paid by the federal government for the first three years, and then drop in increments to a lower level.
Medicaid is almost always discussed in terms of cost to state government, and it is a major commitment, about $800 million this year.
The match is about 3:1, which means the impact is in the billions of dollars, including on hospitals. The Kaiser State Health Facts Website reports that in budget year 2010, Medicaid spent $4.145 billion in Mississippi.
The other side of discussion is a major element in Mississippi’s statewide economy because the money pays for services, which includes salaries of health care professionals and for institutional care like nursing homes and hospitals, and for medications. Nearly all the money is spent in the private sector.
A coalition of major medical advocacy organizations reported in 2011 that about 350,000 Mississippians with diabetes, chronic lung disease, diabetes and heart disease depend on Medicaid in Mississippi alone, and those figures includes thousands of children.
Moving forward, the human factor should be calculated first in terms of medical need before anyone declares more Medicaid unaffordable.