SID SALTER: Medicaid expansion battle sees both sides ramping up

By Sid Salter

As I noted in a recent column, the majority ruling in the Supreme Court’s decision upholding the Affordable Care Act presents a ready battle for state policymakers who must now determine whether the proposed expansion of the Medicaid program dictated by the Obama health care reforms will impact Mississippi.
On Medicaid, the court said that the federal government can’t threaten or withhold funding for the state’s existing Medicaid program simply because the state fails to expand Medicaid. Almost immediately, the sides began forming for what will likely be a bitter battle over the issue.
On one side are Republican leaders in both the executive and legislative branches of state government who are already on record opposing the Medicaid expansion for budgetary reasons. Gov. Phil Bryant said funding a Medicaid expansion would require substantial budget cuts in education and transportation.
Republican Lt. Gov. Tate Reeves said adding 400,000 people to Medicaid would cost about $1.7 billion over a decade. GOP House Speaker Philip Gunn called the expansion a “budget-buster” for the state.
But Democrats say the poorest state in the Union can’t afford to turn down additional federal dollars available for public health care. Advocacy groups are also beating the drums in favor of the state moving forward with a Medicaid expansion.
Under the ACA, federal taxpayers will pay the full cost of covering the new Medicaid enrollees for three years, from 2014 to 2016, and the federal share would then gradually decline to 90 percent in 2020. In poor states with large Medicaid populations like Mississippi, state officials worry that future costs will be shifted to the states to pay for the increased enrollments.
Groups like the Mississippi Center for Health Policy cite different numbers in analyzing the impact of Medicaid expansion: “Over the period from 2014 to 2019 state expenditures for the newly eligible Medicaid recipients will be about $11.4 billion with the federal government paying 97 percent of those costs.”
Ed Sivak, the dogged director of the nonprofit Mississippi Economic Policy Center, said after the high court ruling: “I’ve been asking, for a few years, about the health insurance status of people that I come across in daily life. The people who will likely be left out if Mississippi doesn’t expand Medicaid are very familiar such as the people who … take care of our kids or grandkids when we go to work.”
Joining the Medicaid expansion fight will be a familiar political adversary for conservative legislators – the state’s hospitals. Former Gov. Haley Barbour’s policy battles with the Mississippi Hospital Association were the stuff of legend.
But on the issue of Medicaid expansion, many hospitals will cite Mississippi’s soaring price tag for uncompensated care (the cost of treating uninsured patients that is not reimbursable by any federal program) as justification for the expansion. That cost last year was estimated at $315 million.
Proponents of Medicaid expansion argue that’s the best reason to expand the program. But Republican leaders remain wary of seeing state taxpayers left holding the bag for an expanded program by future congressional or White House policies if the economy continues to struggle.
Sid Salter is a syndicated columnist. Contact him at 601-507-8004 or

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