The Mississippi Senate has finally released its version of Medicaid expansion, and it’s an inferior alternative to what the House has proposed and passed.
The Senate plan, as authored by its Medicaid Committee chairman, would cover fewer people and cost the state more per person. And, if Joe Biden wins reelection, it’s unlikely to ever take effect because of a hard-and-fast work requirement.
The Senate plan has been aptly dubbed “expansion light” by Mississippi Today. That’s because, rather than covering individuals up to 138% of the federal poverty level as the federal government wants, Mississippi would only cover those who earn up to 99% of the poverty level.
That lower threshold, which is also advocated by Insurance Commissioner Mike Chaney, is theoretically designed to keep lower-income workers from leaving their federally subsidized private insurance in favor of Medicaid. How big a threat that is depends on who is doing the guessing. Opponents of Medical expansion estimate the number is around 140,000. Proponents say that’s an exaggeration.
What is certain, though, is that Mississippi, under the Senate plan, would have to pick up a larger share of the cost of those who newly qualify for Medicaid. Instead of the 90% that the federal government would pay under full-blown Medicaid expansion, this trimmed-down version would receive a federal cost-share of about 77%.
In addition, Mississippi would lose out on the huge carrot that the federal government has dangled as an incentive to the 10 recalcitrant states that have refused to expand Medicaid. In Mississippi’s case, that amounts to almost $700 million, more than enough to cover its share of the program for at least the first few years.
As far as the work requirement, the Senate may have good intentions in targeting the help to those who are trying to help themselves, but it’s politically unrealistic: The Biden administration has rejected tying Medicaid coverage to work. No one expects that to change as long as the Democrat is in office.
The Senate leadership apparently believes that it has to water down Medicaid expansion if it’s going to get the legislation past Gov. Tate Reeves, who has repeatedly said he is against expansion and threatened to veto any attempt to implement it. Unlike the House, the Senate apparently doesn’t have the votes to override the governor.
When Reeves won reelection in November, defeating a Democratic challenger whose campaign was based heavily on Medicaid expansion, the initial assumption was that expansion wouldn’t happen at least until after Reeves left office. When lawmakers, especially new House Speaker Jason White, suggested otherwise, it seemed too good to be true. Had the Republican-dominated Legislature, after a decade of indifference or opposition to the idea, suddenly realized that the state could use the extra billion dollars a year from Washington to help the uninsured and the state’s struggling hospitals while also giving the economy a nice boost?
As is the case with most major legislation, though, it’s never easy to get past the finish line. One chamber might be more enthusiastic about the idea than the other, and there are always interest groups lobbying hard for or against the proposal. Usually there has to be compromise to get something enacted.
Assuming the Senate follows its leadership’s lead, it may come down to what concessions the House is willing to accept, whether even a compromise can get past Reeves and whether the final product has a chance of getting Washington’s OK.
A lot is hinging on how this plays out, and not only for those who would most benefit from finally having health coverage that could improve their lives.
