Why? The benefits of expanding Medicaid coverage in states like Mississippi with such a large amount of taxpayer-subsidized uncompensated care will ultimately be too large to ignore.
If that’s true, then why did Mississippi and eight other Southern states led by Republican governors like Phil Bryant see their state governments refuse to expand Medicaid under the current dictates of the Affordable Care Act?
The tenor of the political debate over Medicaid expansion has been that it’s a choice between compassion for the poor who are uninsured and indifference to their plight. But far from Mississippi, there have been voices who define the debate in more honest terms.
“From a social or humanitarian perspective, you could argue Medicaid expansion is a winner. But from a purely financial perspective, it’s clearly a loser,” Charles Blahous, a senior research fellow at the Mercatus Center, a market-oriented research center at George Mason University in Virginia, told a South Carolina newspaper in April.
The fact is that in the nation’s poorest states, Medicaid is the second largest expenditure by the states after they pay for their educational systems. For Bryant and other governors and the legislatures they work with, the fear is that an expanded Medicaid program would reduce resources for every other function of state government.
Proponents of expansion point to the fact that the federal government has pledged to pay all medical costs for the newly eligible Medicaid enrollees in 2014, 2015 and 2016 and no less than 90 percent of their costs thereafter as evidence that Mississippi can’t afford not to expand Medicaid.
But many Mississippi lawmakers understand all too well the history of Medicaid finance in this state. The state has traditionally authorized a more expansive Medicaid program than the state actually funded — and then in the latter stages of each legislative session scrambled to actually fund Medicaid with one-time money plans held together with political bubble gum and bailing wire.
That’s been difficult with the existing Medicaid program. Lawmakers who consider that same process expanded to having one- in-three Mississippians covered by Medicaid are extremely slow to embrace expansion because of the state’s still fragile economy.
A Mississippi Institutions of Higher Learning economic brief by state economist Bob Neal last year made the nuts-and-bolts of the Medicaid expansion question clear: “The results in each scenario indicate that Medicaid expansion will generate additional state Medicaid costs in years 2017-2025. From 2014-2020, cumulative state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $109 million to $98 million. From 2014-2025, total state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $556 million to $497 million.
The Kaiser Commission on Medicaid and the Uninsured was more succinct: “While some states will see net savings, others will need to weigh the trade-offs between small increases in state spending in return for large gains in coverage supported by mostly federal dollars.”
The Mississippi Legislature faced a choice between raising public health care costs for Mississippi taxpayers and expanding health care coverage to the state’s poor and working poor. The wild card remains the cost of uncompensated care which is also subsidized by taxpayers and health insurance ratepayers.
The ultimate political fear for many in state government has been the expansion of Medicaid in a fiscally unstable manner that cannot be sustained. Legislators don’t want to create additional dependence on Medicaid and then be forced by fiscal constraints to have to take it away.
But at some point in the future, it’s clear that Mississippi will again confront Medicaid expansion and the likelihood is that it will be adopted.
(Daily Corinthian and syndicated columnist Sid Salter can be contacted at 601-507-8004 or firstname.lastname@example.org.)