Medicaid is a state-federal program providing health insurance coverage for a broad range of poor and disabled people. Mississippi’s Division of Medicaid has about 600,000 clients. As many as 300,000 working poor Mississippians without health insurance could be added if the program were expanded under still-unfolding provisions of the Patient Protection and Affordable Care Act, better known as Obamacare.
Wednesday’s vote reauthorizing Medicaid was not a vote on the merits of expansion but to continue Medicaid as a Mississippi program. The federal government matches each state dollar with about $3 from the federal budget, the highest match among all the states and territories.
Wednesday’s vote allows expansion supporters and opponents to gather more information. Gov. Phil Bryant, Lt. Gov. Tate Reeves and House Speaker Philip Gunn all oppose expansion as unaffordable in the long term. Supporters, which include some health care providers and some prominent Democratic legislators, argue expansion would provide at least some reimbursement for care provided the uninsured working poor, whose care otherwise would be uncompensated except by charity, including write-offs by hospitals.
Under federal law, Medicaid can be expanded to cover people earning up to 138 percent of the federal poverty level, or about $15,000 per year. Republican governors in Ohio and Indiana have opted for the expansion route.
Under the federal law the state will have to pay 10 percent of the costs after the first two years when the federal government pays all the costs of the expansion, and then starts stepping down to 90 percent by 2020.
Many Democrats say the state cannot afford to reject the infusion of federal funds to provide coverage to a group of people who currently do not have insurance – primarily the working poor.
Keeping the option to expand Medicaid open at least for broader public discussion is reasonable. More evidence, clearly analyzed, could determine whether that option in the long run is in Mississippi’s best interest.