Medicaid expansion will be big issue in fall elections


With state Elections coming up, one of the hottest issues is expansion of Medicaid.

When Congress passed the Affordable Care Act nine years ago, it included the expansion of Medicaid to cover families and individuals making 138 percent of the poverty level.

Congress agreed to pay states for 100 percent of the expansion. Two-thirds of the states quickly jumped on the opportunity.

Seventeen states, all conservative, most in the south, declined the expansion after the U.S. Supreme Court ruled that the feds couldn’t force states to expand the program.

Mississippi did not expand. Our conservative leadership cited two main reasons: First, it was part of Obamacare. Second, they believed the feds would end up forcing the states to foot more of the bill, which would bust the state budget.

Both of these arguments were somewhat questionable. First, although the expansion of Medicaid was passed at the same time as Obamacare, it is a separate program, one which has a 55-year history. Second, after nine years, the feds are still paying almost all the cost of the expansion.

As a result, Mississippi has passed up about 10 billion dollars in federal money over the past decade.

This federal money would have given up to 300,000 working, low income Mississippi families health care coverage.

Of the current major candidates for governor and lieutenant governor, only Tate Reeves is dead set against expansion. And boy is he dead set.

When asked his reasons for not expanding Medicaid, Reeves simply repeated this line three times in a row: “I am opposed to Obamacare expansion in Mississippi.”

I believe turning down this money is hurting our state. I’m conservative, but if the feds want to pour money into our state, so be it.

Mississippi is a poor state for two main reasons: We lack a major urban area and we are still suffering from the vestiges of slavery, including the devastation of the Civil War.

As a result, our state has traditionally been a big beneficiary of federal dollars, getting two and three dollars back from every dollar we pay in federal taxes. It’s a good deal.

When the Democrats were in power, we took every advantage of federal largesse. But since the Republicans took over, we turn up our noses at this money, because Republicans don’t like welfare, even when it is beneficial to our state.

This could be one reason our state quit growing for the first time in 50 years. States that haven’t expanded Medicaid have much lower levels of job growth.

In rural areas, hospitals that were once the biggest employers in their communities are now going bankrupt and closing. Experts have identified the cause: Failure to expand Medicaid.

The Brookings Institute, one of the largest and oldest think tanks in the country, recently did a report titled “Do States Regret Expanding Medicaid?” Their conclusion: No.

The study found that states did not encounter increased costs.  Instead, Medicaid expansion caused the feds to pay for many services formerly paid for by the states. The study concludes: “The strong balance of objective evidence indicates that actual costs to states so far from expanding Medicaid are negligible or minor, and that states across the political spectrum do not regret their decisions to expand Medicaid.”

Meanwhile in Mississippi, the portion of Medicaid that Mississippi has to pay has skyrocketed from $258 million in 2010 (when Medicaid was expanded) to $840 million in the 2019 budget.

So by refusing to expand Medicaid not only has Mississippi turned down a billion dollars a year in federal manna, but our in-state cost has increased by $582 million a year.

We don’t have to look far for comparisons. Neighboring states Arkansas and Louisiana have expanded.

Arkansas Republican Governor Asa Hutchinson put it this way: “We should not punish Arkansans by denying health coverage simply because we are frustrated with Washington. I hope that Washington replaces Obamacare, but, until then, we would only be punishing Arkansans by turning down federal money.”

Hutchinson and the Arkansas legislature pioneered a private option in which the state received a federal waiver allowing a Medicaid work requirement. (The work requirement is nonsensical for the expansion since nobody without a job is going to make 138 percent of the poverty level.)


So how is Arkansas doing with Medicaid expansion? For one thing, Arkansas population is up 97,797, according to the U.S. Census Bureau. That’s five times the rate of Mississippi’s growth of 18,412. Arkansas tax collections are up $200 million this year and the state is doing well enough to give raises to state workers.

Louisiana expanded Medicaid three years ago. More than 470,000 people signed up, lowering the percentage of uninsured to below eight percent – an all-time record for the state.

Has the expansion busted the Louisiana state budget? Not apparently. Associated Press reports, “After years of fights over budget cuts and taxes, Louisiana's lawmakers have an unfamiliar problem this year, deciding where to spend millions of dollars in new and increased cash expected to arrive in the state treasury.”

By the way, Louisiana population is up by 126,493 people, seven times Mississippi’s growth rate.

Meanwhile, back in Mississippi, I recently heard the state director of Medicaid, Drew Snyder, speak at the Stennis Press Forum.

Snyder is super smart. He was Gov. Phil Bryant’s policy advisor. But when asked if he had studied the financial results of other states after expanding Medicaid, he drew a blank.

That’s also my problem with Tate Reeves on this issue. He won’t even study the issue. He won’t even give us a reason. He just says, to paraphrase, “Ain’t doing it.”

Likewise, House Speaker Philip Gunn has little interest in the issue. Last week at the Stennis Press Forum he said, “I am not in favor of it . . .  I don’t find any appetite within the state for it. I don’t know if I have received one phone call from any constituent of mine asking me to expand Medicaid and I have not heard from any of my colleagues saying they have received similar phone calls. Until the taxpayers rise up and say, ‘We want this,’ I don’t think there’s going to be an appetite for it.”

To me, this statement is mind boggling. A billion dollars in annual federal funding on the line. Three hundred thousand working poor who could finally receive federally subsidized medical coverage for their families, and Gunn has not received a single phone call or comment on the matter? How can that be?

According to the latest Millsaps state poll, “making healthcare more accessible and affordable” is the third most important issue to Mississippi voters, after fixing the roads and teacher pay raises.

As for the lieutenant governor, I get that Reeves doesn’t think Medicaid expansion is good politics. The first rule of politics is to get elected by the people.

But turning down a billion dollars a year and denying insurance to 300,000 working Mississippians seems a high price to pay for the furtherance of an individual’s political career.

Meanwhile, the current Republican leadership falls all over themselves to hand out billions in tax breaks to huge corporations with billions in net income, not to mention the hundreds of millions that went down the drain subsidizing cockamamie start-up companies now bankrupt.

So billions in public welfare for rich corporations is just fine but federally-subsidized health care for the working poor is socialism?

Should be an interesting political year.



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