JACKSON – A host of freshmen legislators will be taking their seats in the ornate House and Senate chambers early next month fresh off their campaign pledge not to raise anybody’s taxes.

Those freshmen – 45 of them – are giving Republicans a majority in the House and Senate for the first time since the 1800s. They will take office with tremendous anticipation about what they can do to help Mississippi progress.

But they also will face many tough obstacles and decisions.

One of the toughest, no doubt, will be what to do with a hospital tax that will expire next year. The hospital tax, which generates roughly between $70 million and $90 million per year, was passed in 2009 at the behest of Republican Gov. Haley Barbour to help fund Medicaid.

The hospital tax revenue is used to draw down federal matching funds for Medicaid. The state normally gets about $3 in federal funds for each $1 it spends on the Medicaid program.

In 2009, the Mississippi Hospital Association opposed the tax, but only hours before the new fiscal year began the group conceded when Barbour made it clear he would not accept a budget for Medicaid that did not include the levy. Rather than risk the Medicaid program shutting down, the Hospital Association asked their allies – primarily Democratic legislators who were blocking the tax – to cease their opposition.

But, of course, Barbour will leave office in January. And the special hospital tax will expire on July 1. So it will be up to the 2012 Legislature to decide whether to extend the tax.

Several Republican freshmen who will be taking office criticized their Democratic opponent for voting for the hospital tax in 2009 – even though the chief proponent of it was Gov. Barbour.

Now, it will be up to the same freshmen to determine whether to extend the hospital tax or not.

If they renew it, some will at the very least be practicing a bit of hypocrisy since they hammered their opponents in campaigns earlier this year for voting to raise taxes on the hospitals. Plus, if they let the tax lapse, they can claim a true fiscal conservative mantra.

But, if they let the tax lapse, they also must find an additional $70 million to $90 million to help fund Medicaid. Sure, they could make cuts. Remember, though, that cutting Medicaid $80 million in state funds is in reality a reduction of $320 million because of the lost federal matching funds.

Medicaid, of course, is a federal-state program that provides health care for the elderly, disabled and poor pregnant women and children. About 90 percent of the residents of state nursing homes are Medicaid recipients.

While everyone wants to reduce the size of government, making large changes to the Medicaid program has proven difficult through the years. Early in his first term, Barbour tried to remove from the Medicaid rolls about 60,000 primarily elderly people who had worked most of their lives, but normally in jobs that did not provide Medicare coverage.

Barbour suffered a major public relations backlash from that effort, which was eventually blocked by the federal courts. After that, he was much more cautious in any effort to remove people from Medicaid coverage.

Legislative freshmen, like Barbour did, will learn that dealing with Medicaid – as with most areas of state government – can prove difficult.

Deciding what to do with the soon-to-lapse hospital tax will be an early example of how difficult it can be.

Bobby Harrison is the Daily Journal’s Capitol Bureau Chief. Contact him at bobby.harrison@journalinc.com or call (601) 353-3119.