By Charlie Mitchell
OXFORD – In the jargon of sales, it’s a no-no – a big no-no – to “leave money on the table.”
The adage has nothing to do with leaving a tip. In sales, it means if a buyer is willing to pay $1 per unit and is charged only 99 cents, money has been left on the table – needlessly. The boss will not be happy.
But here’s the deal with state finances: If Obamacare survives the presidential election, Mississippi Gov. Phil Bryant says Mississippi not only should, but must leave money on the table.
One component of the federal health takeover is to enlarge Medicaid eligibility. About a fourth of Mississippians now have their medical expenses paid through the program for low-income and disabled people. It is funded by a combination of federal and state money. The expansion could increase participation to a third of the state population.
Bryant and several of his fellow Republicans are taking a stand against the expansion on principle, saying they will, as the Supreme Court says they can, reject the loosened requirements.
“How much better off are we really if 1 in 3 can charge health care expenses to Medicaid but we cannot afford to fund our schools or make the infrastructure improvements that attract businesses and jobs?” Bryant wrote for The Washington Times.
Although the governor concedes that federal dollars will pay for all but $81 million of the expanded program during its first three years, his position is that the entitlement – for which costs have been soaring each year – will quickly eat into state funds for education and everything else. (A crucial distinction is that while the federal checkbook is bottomless, Mississippi can only spend what it receives.)
The conundrum is that Bryant’s stand, if he’s backed by the Legislature, will cost the state money and jobs.
Lots of money.
Lots of jobs.
And the billions being left on the table and the jobs that will go unfilled would benefit the corporate health care industry – a sector known to support Republicans and the party’s tradition of being business-friendly.
The health care lobby might like Bryant’s principles in the abstract, but are they willing to forego billions in new revenue?
Of course, Mississippi is not alone in facing this choice. Most states say they will leap on the new federal largess. Only about a dozen are iffy or, like Mississippi’s governor, adamant that all the strings attached make this component of Obamacare a bad deal for the state and its people.
What’s different for us is the impact. Mississippi, in proportion, is already the biggest beneficiary of federal Medicaid dollars.
Kaiser Foundation figures for 2010 show the nationwide cost-sharing ratio in the $400 billion – $400 billion! – Medicaid program to be 68 percent federal, 32 percent state. In Mississippi, the ratio was 85 percent federal dollars to 15 percent state dollars.
But even coming up with that 15 percent was a stretch – a big stretch – for this state where the budget pie has been about the same size for several years and larger and larger slices have been claimed for entitlements.
Bryant put in it context: “In fiscal 2012, Mississippi spent more than seven times as much money on the existing Medicaid program as we did on economic development and most of our state public safety efforts combined.” (In dollars and cents, the federal payments totaled $3.62 billion and Mississippi’s share was $763 million.)
If Republican nominee Mitt Romney wins the presidency and succeeds in canceling Obamacare, there will be no showdown on leaving the new Medicaid dollars on the table.
It must be remembered, however, that Romney will fully expect states to do as Massachusetts did when he was governor – find some way for everyone to share in the cost of health care for everybody else.
The challenge of finding and funding a plan for Mississippi will not be as immediate, but it’s not going to go away, either.
America has decided correctly and collectively that access to health care is a basic human right. Although it’s a big one, the only remaining challenge is to figure out how to pay for it. There are many models, each with strengths and weaknesses.
To date, Mississippi’s leadership has been reacting instead of acting, waiting and wondering instead of trying to devise solutions.
There’s no cheap “out” for the state despite a heck of a lot of wishful thinking in Jackson.
Charlie Mitchell is a Mississippi journalist. Write to him at Box 1, University, MS 38677, or email firstname.lastname@example.org.