Mississippi Medicaid expansion bill moves forward in GOP-led House over governor's opposition

The state's Republican-led House is expected to vote on Mississippi Medicaid expansion as soon as Wednesday after a committee unanimously approved it Tuesday.

House Bill 1725, authored by Republican House Speaker Jason White and Medicaid Chairwoman Missy McGee, R-Hattiesburg, has bipartisan support in the House, even as the state's Republican governor continues to oppose the policy.

The morning after Gov. Tate Reeves didn't mention health care or Medicaid expansion once during his State of the State address, he posted on Twitter "Count me amongst those 'extreme MAGA Republicans' who think Government should not run health care."

During Tuesday's meeting, McGee explained to committee members that Mississippi during the first two years of expansion would receive an extra $600 million in federal money for Medicaid. She said that amount would cover the state's share of expansion for four years. After that, under the House plan, hospitals and managed care organizations would pay more taxes to cover the state's 10% match, with federal funds covering 90% of expansion costs.

"You could almost look at it like the federal government is giving us a free pilot program, to run for four years," McGee said during the committee meeting. McGee said hospitals and MCOs would start paying the increased tax in the first year and the state could bank that money, perhaps in a health fund.

The bill, which expands Medicaid eligibility to adults without dependents between the ages of 19 and 65, has a built-in repealer, meaning it would automatically end after four years if lawmakers chose not to renew it.

Currently, low-income, adult Mississippians fall into the "coverage gap," which experts believe is a leading cause of Mississippi's poor public health metrics – such as leading the nation in preventable deaths, infant and maternal mortality, and lowest life expectancy. Mississippi remains one of only 10 states not to expand Medicaid. Expansion would provide health care to about 200,000 to 250,000 Mississippians, experts said.

The bill would expand Medicaid income eligibility to 138% of the federal poverty level. For a family of four, that would be an annual household income up to about $43,000.

The House bill has some strict limitations. It would not cover those who are offered health insurance from their employer — even if they couldn't afford the sometimes very expensive deductibles — and would make those who drop coverage even from the Affordable Care Act exchange wait 12 months before being eligible.

"If it doesn't work out, if we decide that our health outcomes have not improved, if it costs too much for the state, if for any reason we do not believe that it is doing the things that we want it to do, the program will simply repeal in 2029," McGee said.

The bill passed committee the day after it was assigned. But that's after 10 years of debate and GOP leaders in the poorest, unhealthiest of states eschewing "Obamacare" Medicaid expansion. Reeves and his Republican predecessor, Phil Bryant, likened the state-federal health coverage to welfare and voiced opposition to taking more federal tax dollars from it, even as Mississippi remains one of the most federal funding reliant states in the nation.

Meanwhile, lawmakers in the Republican-led Senate are moving at their own pace.

McGee and Blackwell say the House and Senate will be working together, but they haven't met yet. Their expansion bills are quite different – and coming to an agreement would involve heavy concessions from one or both sides.

"They can rush it all they want on their side," Medicaid Chairman Kevin Blackwell, R-Southaven, said Tuesday. "We've got our own pace. So they can pass it today and send it over tomorrow. It's going to sit in my committee until we get ours in."

While both bills are expected to have a work requirement, the House bill's work requirement is only a "best-case scenario." The bill has a "Section 2" provision that states that if the waiver necessary for federal Medicaid authorities to allow a Mississippi work requirement is not granted by Sept. 30, 2024, Medicaid would still be fully expanded to people up to 138% of the federal poverty level.

But the Senate bill, which as of right now is only a skeletal bill bringing forth Medicaid code sections to start, would according to Blackwell be entirely contingent on the federal government approving a waiver for a work requirement.

During the Biden administration, Centers for Medicaid Services has rescinded work requirement waivers previously granted under the Trump administration, and has not approved new ones. It is unlikely the administration would grant Mississippi's 1115 waiver – which Blackwell says is a must for him.

"If no work requirements, no expansion," Blackwell said about the bill he calls "expansion light."

McGee said she hopes the House doesn't back down on its provision to expand Medicaid even if the Biden administration doesn't grant the waiver.

"I think that Section 2 provides an opportunity for us to still get this across the finish line if for some reason CMS does not approve the work requirement," McGee said. "I think that we still want to help working Mississippians find a way to have health insurance. I would really hope we would leave Section 2 in the bill as a backstop in case we cannot get the waiver done, we still have an opportunity to provide the program and not delay another year in making this happen."

The Senate Medicaid Committee is still working on language and Blackwell said it "will have something next week," after which he said Senate leaders will sit down with the House and "see where the differences lie."

Blackwell, who said he didn't necessarily expect to author an expansion bill this session, is still adamantly opposed to full Medicaid expansion — which he calls "socialized medicine" and "welfare" — without work requirements and a private insurance option.

Republican Lt. Gov. Delbert Hosemann, who oversees the Senate, said he would also like to see a work requirement in any expansion bill, as well as a premiums payment plan.

"When I get a plan that covers working people," Hosemann said, "I would like for them to make some contribution to their health care," he said. "I think that's important, I think that's self dignity, you become part of the system when you're paying some part of it."

Blackwell has said he would not author a bill that allowed expansion without a work requirement and a premiums plan. At that point, he says, expansion becomes "palatable" — especially when thinking about the labor force participation rate.

"It's becoming a bigger need when you take a look at the hospital situation which was really highlighted during COVID," Blackwell said. "With what we're doing from an economic development standpoint, bringing in these large development projects, we need to have a healthy workforce. So from that standpoint, I can tolerate it."

Blackwell said he believes that with a work requirement, expansion would have the support it needs in the Senate to be veto-proof. That is, the Senate could muster a two-thirds vote to override a Reeves veto.

House Democratic Leader Robert Johnson III, said Tuesday morning at a press conference that Democrats are not in favor of a work requirement, as it would delay things and likely not be approved by federal authorities. But Johnson said House Democrats would accept a work requirement in a bill if it was the only way Medicaid expansion could pass. That was evident Tuesday as no Democrats offered amendments in committee and all voted to move the bill forward.

"The vast majority of people are already working or are not able to do so," Johnson said. "Far fewer people just choose not to work than our Republican colleagues would have you believe."

Johnson has also authored House Bill 38, which would create a commission to run Medicaid and take it out from under the governor. He said he knows it's not likely to pass.

"People's health care should not be politicized," Johnson said. "If we had a commission running it 10 years ago, we would already have expansion … I hope it at least starts a conversation about taking the politics out of health care."

-- Article credit to Sophia Paffenroth of Mississippi Today