MS Legislature: Medicaid expansion can save lives, money. Lawmakers likely won't pass it

Most Republicans and Democrats who ran for governor and lieutenant governor this year agreed on one issue: Mississippi should expand Medicaid coverage to working poor people.

They argued it would pump $1 billion in federal money into Mississippi's economy each year and create new jobs. They said it could help up to 300,000 low-income residents obtain good medical coverage, and inject new revenue into 31 struggling rural hospitals, some facing bankruptcy.

But Republican Gov.-elect Tate Reeves strongly opposed what he termed "Obamacare expansion" — and he won. Now, despite the recent bipartisan momentum, it appears unlikely the Mississippi Legislature will pass expansion in the new session that starts Jan. 7. Even if legislators did approve a bill, Reeves could veto it.

"The people voted no," said Sen. Hob Bryan, D-Amory, vice chairman of the Senate Medicaid committee and an expansion supporter. He said Reeves was "clear about his platform" opposing Medicaid, and beat Democrat Jim Hood by about six points.

There's still a chance expansion gains traction considering Lt. Gov.-elect Delbert Hosemann campaigned for it. As leader of the Senate, Hosemann will take over for Reeves in a role that wields significant power shaping state policy.

And several other prominent Mississippi Republicans now support it. Even outgoing Republican Gov. Phil Bryant — long opposed to the idea — in 2018 quietly asked the Mississippi Hospital Association to develop a customized Medicaid expansion proposal, according to the association's CEO.

Reeves: Election 'gave us a mandate' on Medicaid

Hosemann spoke with reporters in mid-December about the upcoming session. He sounded cautious about Medicaid expansion, but said he's been in contact with leaders in states that have successfully expanded Medicaid — including Arkansas, Indiana and Louisiana.

"It’s a billion dollar issue. A mistake would be catastrophic to Mississippi," Hosemann said. "We don’t have a chance for a mistake. When we do this, we have to learn from anybody else’s other issues and mistakes."

Hosemann discussed the possibility of a customized expansion plan that might include work requirements and fees — mandating that Medicaid recipients "have some skin in the game." He said several expansion ideas "are on the table and they are being actively explored daily.”

Speaker Philip Gunn declined an interview with the Clarion Ledger, but a spokeswoman said he would speak with reporters shortly before the session begins. Reeves also declined an interview about the session, including Medicaid expansion. A spokeswoman said he was too busy until after the Jan. 14 inauguration.

But in a recent SuperTalk interview, Reeves said the election "gave us a mandate" that Mississippians "do not want more government insurance."

In a WJTV-TV interview, he said there were other "innovative solutions" to help struggling rural hospitals and improve health care access and affordability. Reeves did not answer directly when asked if he'd veto a Medicaid expansion bill — but suggested Republican leaders now understand that voters don't want it.

During the campaign, Reeves released a plan to fund more rural physician residency programs in Mississippi and fund more scholarships for doctors in underserved areas. He did not offer a direct alternative to Medicaid expansion that could address the large uninsured population or struggling hospitals, however.

The Republican chairmen of both the House and Senate Medicaid committees, Rep. Chris Brown of Nettleton and Sen. Brice Wiggins of Pascagoula, have also said that they are opposed to expansion, though their leadership roles could change as a new legislative term begins.

"I'm not really sure why it's such a hot topic, to be quite honest," Wiggins said of Medicaid expansion. "It makes for good copy."

He said legislators made strides in recent years to bolster Mississippi's existing Medicaid program and improve services for patients — including covering more doctor visits and prescriptions — yet they got little credit.

Related: Mississippi forfeits $1M daily in Medicaid funds. How does it affect the mentally ill?

Instead, Wiggins said, the public and media focus has remained solely on traditional Medicaid expansion, which would only continue the "status quo" for health care delivery in Mississippi. Expansion and the resulting influx of federal money would only serve to prop up struggling hospitals and hamper innovation such as telemedicine, he said.

"They easy answer is, 'Hey, Medicaid expansion,'" Wiggins said. "That's the low-hanging fruit."

Hospitals push expansion plan that's 'not Obamacare'

Medicaid was traditionally meant for pregnant women, low-income seniors, people with disabilities and poor children.

But the 2010 Affordable Care Act ordered states to expand access to Medicaid to low-income adults who make less than 138% of the federal poverty line — about $17,000 for one person. The U.S. Supreme Court later ruled this mandate was unconstitutional, and expansion decisions should be up to states.

Mississippi is one of 14 Republican-controlled states that continue to refuse expansion. The Magnolia State has turned down about $6 billion in federal funding since the law took effect.

The policy has gradually become more bipartisan here and around the country. Nationwide, 77% of voters support expansion as do and 60% in Mississippi. Voters in the deep red states of Utah, Idaho and Nebraska recently passed expansion and are working on implementation.

Even Republican gubernatorial candidates Bill Waller Jr. and Robert Foster supported versions of Medicaid expansion.

"There's really just not any other option for us," Foster said earlier this year. "We cannot continue to operate as we're operating, or we're going to have hospital, after hospital, after hospital close."

Foster, Waller and other candidates often referenced an expansion proposal called Mississippi Cares, released in May by the Mississippi Hospital Association. Designed to appeal to Republicans — who often raise concerns over whether Mississippi could afford to cover its $100 million share of expansion costs — the plan would require participants to contribute monthly fees for their coverage. Hospitals would cover the remainder, so the state budget would not be impacted.

Hospital Association CEO Tim Moore has said Bryant asked him to draft the proposal in late 2018. Though Bryant never publicly supported the plan, Moore argued Republicans should back it. He underscored that it was modeled after a plan Vice President Mike Pence enacted when he was governor of Indiana.

Related: Mississippi hospitals have a Medicaid expansion plan they believe Republicans can get behind

"Mississippi Cares is not Obamacare. It’s PenceCare," Moore wrote in August. "Our proposal stays true to conservative principles by offering a helping hand to low-income adults who are already helping themselves."

Despite support from several prominent Republicans, Reeves said he opposed the customized Medicaid plan from the Hospital Association. He said he was "philosophically opposed" to expanding coverage, and often noted the proposal was still tied to former President Barack Obama's signature health care law.

Bryan said Republican opposition to expansion is largely "just to prove we don't like Barack Obama."

"I think this is the most bewildering public policy decision I’ve ever been involved in," said Bryan, a legislator since 1984, noting Mississippi forfeits more than $1 million each day by rejecting expansion. "Every day we're having people go without health care, who could have health care if we'd just let them."

How have other states fared under expansion?

A growing body of research shows positive results for states that expanded Medicaid.

Saved lives — The U.S. could have avoided 15,600 deaths if every state had chosen to expand — and Mississippi could have avoided 540 deaths from 2014 to 2017 if it had chosen to expand coverage, a team of researchers recently found. Among 55- to 64-year-olds, Medicaid reduced the probability of mortality by 70%, the study said.

— The U.S. could have avoided 15,600 deaths if every state had chosen to expand — and Mississippi could have avoided 540 deaths from 2014 to 2017 if it had chosen to expand coverage, a team of researchers recently found. Among 55- to 64-year-olds, Medicaid reduced the probability of mortality by 70%, the study said. Lowered uninsured rate — Numerous analyses show states that expanded saw sharp drops in their uninsured rates, thanks to large numbers of uninsured people gaining coverage via Medicaid.

— Numerous analyses show states that expanded saw sharp drops in their uninsured rates, thanks to large numbers of uninsured people gaining coverage via Medicaid. Resulted in state budget savings — Several studies show expansion created state budget savings, and did not result in significant cuts in state spending on transportation, education and other state programs. A Louisiana report found that state's budget savings tallied $199 million in 2017 thanks to expansion.

— Several studies show expansion created state budget savings, and did not result in significant cuts in state spending on transportation, education and other state programs. A Louisiana report found that state's budget savings tallied $199 million in 2017 thanks to expansion. Helped hospitals financially — Research shows expansion results in less uncompensated care costs due to people receiving emergency treatment without insurance. One 2018 study found the chances a hospital closed due to financial stress was reduced by 81% in states that expanded Medicaid.

During the campaign, Reeves said he worried Medicaid expansion would result in thousands of people moving from private insurance to government benefits.

He often referenced research by a conservative New Orleans think tank that said after Louisiana expanded Medicaid, 3,000 to 5,000 people each month shifted from private insurance to Medicaid.

But the secretary of Louisiana's health department, Rebekah Gee, refuted the think tank's claim. Writing in the Wall Street Journal, she said the group presented "incomplete data in a misleading way." She cited Louisiana State University research that found "relatively few" people had dropped their private coverage for Medicaid.

Related: Tate Reeves on health care, Medicaid in Mississippi

Medicaid expansion, Gee added, had slashed her state's uninsured rate in half. Mississippi's uninsured rate now stands at 18%, compared to the national average of 12%, according to a recent analysis by the Center for Mississippi Health Policy.

“In their steadfast refusal to expand Medicaid, our current governor and incoming governor have not only deprived working Mississippians who would otherwise be enrolled in Medicaid, but deprived Mississippi residents of greater financial security and longer lives," said Roy Mitchell, executive director of the Mississippi Health Advocacy Program.

Mitchell told the Clarion Ledger he recently met with a group of health leaders from around the state who want to build a stronger case to the public for Medicaid expansion. A ballot initiative also is being considered, he said.

Opposing Medicaid expansion, Mitchell said, "is like standing in front of a billion-dollar train" — the approximate amount the feds would pay Mississippi annually if it accepted the program.

“Will Tate Reeves be able to stand in front of a billion-dollar train, or will he get run over by a billion-dollar train?”

Contact Luke Ramseth at 601-961-7050 or lramseth@gannett.com. Follow @lramseth on Twitter. Please support our work at the Clarion Ledger by subscribing.