Medicaid expansion supporters see little momentum

Aug. 23--JACKSON -- Supporters of expanding Medicaid under the Affordable Care Act, better known as Obamacare, hope that recent actions by the powerful Mississippi State Medical Association bolsters their cause.

The reason for optimism is the short, concise, Resolution 12 adopted earlier this month by the association, which comprises many of the state's physicians, stating that the group supports "the expansion of medical coverage as allowable under the Affordable Care Act to cover uninsured Mississippians under the age of 65."

The phrase Medicaid expansion is not in Resolution 12, passed earlier this month by the Medical Association's House of Delegates, but many believe that the inference is clear.

House Democratic Leader David Baria of Bay St. Louis tweeted out "we are happy to have help of the State Medical Association to enact common sense healthcare legislation."

Baria and most of the state Democrats, who represent a minority in the Legislature, have been working for years to try to enact Medicaid expansion in Mississippi. The controversial Patient Protection and Affordable Care Act expanded Medicaid to provide health care coverage to the working poor, who earn up to 138 percent of the federal poverty level or about $15,400 annually for an individual or about $33,000 for a family of four. The U.S. Supreme Court ruled, though, that states do not have to participate in the Medicaid expansion.

Based on that ruling, Mississippi has been one of 19 states not to expand Medicaid. Most of the non-expanding states are Republican-dominated primarily in the South, though Arkansas opted into the expansion early on and Louisiana did earlier this year.

An analysis published in the Journal of American Medical Association earlier this month found stastically significant gains in Kentucky and Arkansas, which both expanded coverage, as opposed to Texas, which did not expand.

"Healthcare coverage is the common denominator among those states that have experienced improvements in healthcare access, health status and outcomes," said Shane Spees, president and chief executive for Tupelo-based North Mississippi Health Services.

The Republican leaders in Mississippi, being led by Gov. Phil Bryant, Lt. Gov. Tate Reeves and Speaker Philip Gunn, have been adamant in their opposition.

Association silent

During most of the debate, the State Medical Association has been silent on the issue, though, there have been individual doctors expressing support for Medicaid expansion to improve health care access and provide them a mechanism of receiving some compensation for providing treatment to people with no health care insurance.

Early on, the Mississippi Hospital Association was a vocal supporter, saying local hospitals needed Medicaid expansion to cut down on the losses they were incurring by providing uncompensated care. The Hospital Association, like most professional groups normally more aligned with the state's Republican leadership, even helped finance Democratic efforts to win legislative seats in the 2011 elections. After Republicans garnered majorities in both chambers, though, the Hospital Association became noticeably quiet on the issue.

But when asked recently about expansion, Hospital Association Chief Executive Officer Timothy Moore said in a statement, "Mississippi has one of the highest rates of uninsured individuals in the country. MHA has maintained support for increasing insurance coverage for Mississippians, while recognizing there are legitimate concerns about funding Medicaid expansion.

"MHA will be glad to work with state leaders and other stakeholders to craft solutions to help the patients we serve access the health care they need."

Publicly the position of the Republican leadership on the issue of Medicaid expansion has not changed.

"I have not changed my position," Bryant said. "We simply cannot afford to expand a program under a law that I hope will be repealed and replaced with the election of a Republican president."

Reeves echoed Bryant's comments.

"Obamacare has proven to be a budget buster for state governments and a job killer for small businesses on Main Street," Reeves said. "Any expansion of this flawed big government program would be a bad choice for Mississippi."

During the first two years of Medicaid expansion, the federal government paid all of the costs for providing health care to those covered by the expansion. After the first two years, the percentage paid by the federal government stair-stepped down to 90 percent by 2020.

Federal commitment

Some opponents have questioned whether the federal government would continue to meet that 90 percent commitment after 2020. Supporters have said that is the intent and that the federal government always has met its commitment to the original Medicaid program that started in the 1960s.

Currently, in Mississippi the federal government pays about 74 percent of the costs of the original Medicaid program that provides health care coverage to poor pregnant women, poor infants, the disabled and certain segments of the elderly population.

Lawmakers react

Rep. Steve Holland, D-Plantersville, a long-time advocate of Medicaid expansion, said he hopes the position of the Medical Association at least leads to more debate on the issue.

"It is wonderful the association of medical providers has finally come to the realization they should support a health care expansion program that they should have been supporting five or six years ago," Holland said.

While the Medical Association does not mention Medicaid expansion in its resolution, it supports expanding coverage under the Affordable Care Act. The one aspect of the ACA that could expand coverage that Mississippi is not participating is Medicaid expansion.

Holland said expanding Medicaid "would revolutionize" not only health care in the state, but also the economy. A study has concluded that expanding Medicaid to about 300,000 primarily working poor Mississippians would create an additional 20,000 jobs in the state.

While not endorsing Medicaid expansion, Sen. Chad McMahan, R-Guntown, said North Mississippi Medical Center, the nation's largest rural hospital, is located in his district, and he would be willing to study anything that is believed to be beneficial to the Tupelo-based hospital and the community.

"I have not seen all the details," McMahan said. "...I support access to high quality health care just like North Mississippi Medical Center provides to hard-working North Mississippians."

Rep. Shane Aguirre, R-Tupelo, a freshman, said he would like to see more information about the issue. He said it was not discussed during his first year in the Legislature.

Rep. Jerry Turner, R-Baldwyn, said he remains opposed to expansion and wants to see in-depth study of the current program to ensure the money is being spent on providing health care for the recipients.

[email protected]

Twitter: @BobbyHarrison9

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Michaela Gibson Morriscontributed to this report.

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