Lawmakers: Medicaid expansion unlikely

By BRYN STOLE Staff Writer

Expanding Medicaid in Mississippi should again be a hot topic of debate when the Legislature begins its session Tuesday.

Vocal proponents of the expansion, primarily Democrats, have vowed to bring the issue back up again this year, but local lawmakers said they see little chance the state will expand the health care program this year.

The possible expansion of Medicaid in the state has been a controversial topic in the state ever since the U.S. Supreme Court ruled in 2012 that states could opt out of the federally funded expansion, a key part of the 2010 Affordable Care Act.

Past efforts to expand the program to cover an estimated 300,000 additional Mississippi residents have stalled due to opposition from Gov. Phil Bryant and the Republican legislative majority.

Under the expansion, people earning up to 138 percent of the federal poverty level, or about $15,000 a year for one person, would become eligible for the government health care program. The federal government would pick up the entire cost of the additional Medicaid recipients until 2017 and at least 90 percent of the cost thereafter.

In Mississippi now, the income cutoff is about $5,500 for one person, and many able-bodied adults are not eligible for Medicaid coverage regardless of how little they earn.

Although several other Republican-controlled states have recently considered expanding the health care program — including Tennessee and Wyoming — Bryant said in a recent interview with the Associated Press that there was no chance he’d change his mind.

Rep. Willie Perkins Sr., D-Greenwood, said he is prepared to enter a bill proposing an expansion of the program in the House of Representatives as soon as the 2015 legislative session kicks off Tuesday.

With the majority in the Legislature likely still firmly opposed to expanding the program, Perkins said it’d now be up to the voters to make their voices heard on the topic in next fall’s statewide elections.

“Just using plain common sense, we should’ve expanded Medicaid from day one,” Perkins said.

Rep. Bobby Howell, R-Kilmichael, chair of the House Medicaid Committee, said he didn’t see the expansion coming up this year in the Legislature because much of the Republican leadership — including Bryant, Lt. Gov. Tate Reeves and House Speaker Philip Gunn, R-Clinton — has voiced opposition to it.

Howell said the Medicaid rolls in Mississippi have swollen in the last year — he estimated by as many at 80,000 — even without expanding eligibility to those above the poverty line. He said he thought the state wouldn’t be able to handle 300,000 additional recipients administratively.

“My feeling is that if we increased or added those others, it’d just be overwhelming,” Howell said.

Both state Rep. Linda Whittington, D-Schlater, and Sen. David Jordan, D-Greenwood, expressed concern about the viability of the state’s rural hospitals without Medicaid expansion in Mississippi.

“As the Affordable Care Act is written, the uncompensated care that our hospitals in the Delta pay for is meant to be picked up by the expansion of Medicaid,” Whittington said. “The money that our rural hospitals have been receiving has not been there. You’re beginning to see stress on our rural hospitals.”

Greenwood Leflore Hospital CEO Jim Jackson has previously said that cuts to other payments to hospitals — including tacking on fees and penalties for readmission of treated patients and cutting down on some Medicaid repayments — have hit the bottom line of many hospitals in the state.

The planned expansion of Medicaid to cover additional uninsured residents was designed to help compensate hospitals for the cuts to other forms of revenue.

“The expansion of Medicaid was supposed to provide insurance to those who were previously uninsured,” Jackson said at a December Leflore County Board of Supervisors meeting. “That will continue to be a strain on this state as it continues to not consider expansion.”

Howell, who opposes expanding Medicaid, said rural hospitals have been hit by a number of changes in health care in the last several years.

“We’re in the middle of a lot of changes,” Howell said.“It certainly hasn’t been good for them right now.”

He said the Legislature might consider a number of ways to assist hospitals during the upcoming session.

“We’re not just turning our back on it,”he said. “It’s a combination of things that are hurting our rural hospitals that I don’t think Medicaid (expansion) can solve.”

Jordan said that passing over Medicaid expansion hasn’t just hurt hospitals.It’s also left many Delta residents struggling to find health care and hurt the state’s economy, he said.

Expanding Medicaid in Mississippi would’ve brought in about $10 billion in federal funds. Jordan said he hated to see money earmarked for the state go elsewhere, especially considering Mississippi’s struggling economy and bottom position on most health care rankings.

“We lost money we could’ve had by expanding Medicaid. That’s one big setback that I wish we could’ve avoided,”Jordan said. “If other states have decided they want to try it, I think this state, being 50th, needs to try something to move us from that slot.”

The debate aside, Whittington said she wasn’t optimistic that bills to expand Medicaid would have much success during this year’s session.

“I don’t look for that to be a priority of Gov. Bryant’s,”Whittington said. “It may be of other groups within the Legislature, but I don’t know.”