Medicaid at Stake in Mississippi

The fight over Obamacare’s Medicaid expansion threatens to sink the entire program.

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Gov. Phil Bryant, R-Miss.

You might have heard about the Medicaid battles that have unfolded around the country in recent months as Republican governors and/or legislatures have fought the program's expansion under Obamacare because, well, Obamacare. But give the state of Mississippi credit for raising the stakes in its iteration of the battle: Their pols are mere days from letting the Medicaid program itself lapse, forget about the expansion.

Here's the story so far: The Supreme Court's decision last year that the Affordable Care Act – or Obamacare to its friends and enemies alike – was constitutional also undercut the government's ability to pressure states into accepting the program's Medicaid expansion by saying the feds can't revoke Medicaid funding for states that pass on the expansion. The expansion would be fully funded by the federal government for the firs three years and then Uncle Sam's share would go down to 90 percent of the new costs after that. It's a pretty sweet deal, especially if, like Mississippi, we're talking about one of the unhealthiest states in the nation (more on that in a moment).

[See a collection of political cartoons on health care.]

Mississippi Gov. Phil Bryant and his colleagues in the GOP-controlled state legislature, however, wanted no part of either the expansion or even a discussion of it. As the Jackson Free Press reported earlier this month, Republicans "have rebuffed efforts to expand or debate Medicaid expansion, citing costs and ideological differences with President Barack Obama." State Democrats have pushed this hard: When Republicans wouldn't even allow debate or an up-or-down vote on the expansion, Democrats blocked the reauthorization of Medicaid during the legislative session which ended in April.

More recently Democrats proposed a compromise – based on a plan enacted in neighboring Arkansas by a GOP legislature and Democratic governor – whereby Medicaid wouldn't be expanded, but the federal money would go directly to poor Mississippians to buy health care in state-run exchanges. Bryant, the Free Press reported, "rejected the offer without reviewing its details."

This is madness. A study by the nonpartisan United Health Foundation ranked Mississippi 49th in the country in terms of overall health. The state ranked dead last for sedentary lifestyle, diabetes and obesity (the obesity rate has been on an almost unbroken climb since 1990). Nearly one in five Mississippi residents lacked health insurance and the Medicaid expansion would add 300,000 to the rolls. The same group this year ranked Mississippi as the worst state in the country for senior citizen health.

[See a collection of political cartoons on the Republican Party.]

So now Mississippi's Medicaid program is set to expire when the current fiscal year closes at the end of this month. Bryant has called the legislature into a special session today, and while both sides say they want to renew Medicaid, just enough uncertainty exists for the Mississippi politicking to bear watching. Bryant left the Medicaid expansion off the agenda for the special session, theoretically meaning that it can't be considered, but state House leader Bobby Moak hinted to the Clarion Ledger that his side might have some ideas to work around that stricture. Meanwhile Bryant has suggested that he could run the program via executive order but the state's attorney general has indicated otherwise.

Hanging in the balance is health coverage for 640,000 already on Medicaid (not to mention the 300,000 who would qualify were it expanded). Stay tuned.

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