When the U.S. Supreme Court upheld constitutionality of the Affordable Care Act, otherwise labeled Obamacare, it held that participation in an expanded Medicaid program, a vital part of bringing health care coverage to some 40 million Americans beginning in 2014, would be left up to individual states. That put tremendous power – actually life or death power – into the hands of elected state officials to decide if a large segment of their citizens will share in the benefits of health care reform.
Mississippi’s three top officials – the governor, lieutenant governor and House Speaker say they oppose participation, branding the federal funds offered the state with the canard as tainted money which could “bankrupt” the state. Actually, the state wouldn’t have to come up with matching money until 2017 and then only a pittance.
Mississippi’s compliance with the Medicaid expansion program will become a top priority in the 2013 session of the Legislature. Unlike most highly contentious legislative issues that break along Republican-Democratic lines, the far-reaching aspects of Medicaid expansion and its huge benefit of redeeming costs hospitals now must bear from uncompensated care could well transcend party affiliation. Cynics may argue (with respected studies for support) that failure of this state, with the nation's poorest people, to accept expanded Medicaid federal funds would be a prescription for more funerals.
Since the 2010 enactment of the health care reform law gave the state unusual lead time to analyze its fiscal and economic impact, several detailed studies have been made – none more respected than the latest one led by Dr. Bob Neal, senior economist at the University Research Center.
Apart from Neal’s other major findings, one sticks out: the state doesn’t have nearly enough health care professionals to meet the demand for medical care when as many as 300,000 non-elderly adults are added to Medicaid rolls. More than onehalf the counties, the study showed, had a shortage of healthcare providers – doctors, dentists, nurses – and 1.6 million Mississippians in 46 counties designated Healthcare Professional Shortage Areas by the U.S. Department of Health and Human Services. Largely these are counties with the highest rate of poverty and chronic illnesses. Over half the physicians in the state are located in only four urban areas.
Retired Dr. Alton Cobb, who became Mississippi’s first Medicaid director in the 1960s, produced his own study (using the URC's figures) of Mississippi's cost-benefit ratio from Medicaid expansion through 2025. He found the state would actually “make money rather than cost taxpayers' money” during the 12-year period it had to provide matching funds. And that's apart from Economist Neal's conclusion that increased access to health care "in the long term would result in a healthier and more productive workforce.”