Mississippi
Mississippi Medicaid Expansion: Don’t Lose a Friend Over This
- Pepper Crutcher discusses the complexities of Medicaid expansion.
“From thirty feet away she looked like a lot of class. From ten feet away she looked like something made up to be seen from thirty feet away.” – Raymond Chandler, The High Window
That’s typically true of legislation that seeks to solve complex problems. How you see the House-passed Medicaid Expansion bill probably depends on your pre-existing point of view. The Mississippi House passed HB 1725 with a vote of 98-20 on February 28, advancing it to the Mississippi Senate.
Everyone would like to see reliable, relevant data about a truly comparable, prior State expansion, but no such data is available. Since we have little more than confirmation bias to inform us, none should question the character or motives of those who see this differently. Here’s a short, over-simplified explanation of why this topic confounds so many who sincerely want to get it right.
Who would be eligible for expanded Mississippi Medicaid coverage?
There are 15 coverage categories; low Modified Adjusted Gross Income (MAGI) alone won’t suffice. To qualify under the most restrictive category, non-disabled adults with dependents, your MAGI must be very low indeed. Typically, these are households with reported income from part-time or sporadic employment at or just above the minimum wage. Mississippi has the option to raise this limit to 138% of the Federal Poverty Limit (FPL), thereby drawing a more generous federal Medicaid match – currently up to 95% of qualifying expenditures.
HB 1725 goes all-in. Even if CMS (the federal Centers for Medicare and Medicaid Services) disapproves the bill’s work requirement, full expansion will happen; so says section 1(f) of HB 1725. Mississippi Medicaid would no longer cover only the abjectly impoverished; it would cover many people with full-time jobs that pay more than the minimum wage.
When would Mississippi Medicaid expansion become effective?
Even if CMS denies Mississippi’s work requirement request, the enrolled expansion population would be covered beginning January 1, 2025, based on HB 1725 as passed by the House.
What is the difference between Medicaid and “Obamacare”?
Medicaid is a federal/state health insurance program administered mostly by states but funded, in the poorest states, almost entirely with federal dollars. Payments to providers are, in most situations, lower than private insurance or Medicare payments.
Currently, there is a gap between the upper MAGI limit for adult Mississippi Medicaid and the lower limit of “Obamacare” subsidy eligibility. Mississippi households with income 100% to 400% of the Federal Poverty Level are eligible to buy federally subsidized, privately issued health insurance plans through Healthcare.gov – the “Obamacare” web site. See for yourself. Go there, enter single member household, minimum wage, full-time job numbers (amounting to $14,720 annually) and the site’s calculator will tell you that your income is too high for Mississippi Medicaid but that you are eligible for Obamacare subsidies.
Through “Advance Premium Tax Credits,” the Feds pay all Obamacare premiums for households with incomes between 100% and 150% of the FPL. There also are “Cost Sharing Reduction” subsidies, but, even with them, beneficiaries may have to bear several thousand dollars annually of “out-of-pocket” (OOP) costs that they would not bear if Medicaid had covered the same medical expenses.
What’s the problem?
Lest this article become a book, let’s just scratch the surface. Should HB 1725 become law as passed by the House, the upper Medicaid adult MAGI limit will substantially overlap the lower limit of Obamacare subsidies. Healthcare.gov will redirect Mississippi applicants to Medicaid if they enter Medicaid-qualifying MAGI numbers, reducing federal expense for that household’s coverage (100% of premiums plus cost sharing reduction subsidies), while increasing State expense (5% of covered costs of care for the expansion population). The added Mississippi Medicaid burden of the newly enrolled would be known in percentage terms but unknown in absolute dollar – i.e., budgetary – terms. The State’s cost could be raised further by small employer decisions to drop their plans. Some people now working full time for their employer-sponsored insurance might quit or go part time, and Mississippi already has the nation’s lowest workforce participation rate. HB 1725 anticipates this and directs the Division of Medicaid to make coverage hoppers wait a year to enroll in Medicaid. Just like the work requirement, this would require CMS approval.
Plus, enforcement mechanisms and capacities are unclear. If the people dropping from employer insurance plans tend to be younger and healthier than average, those plan terms and premiums may get worse as claim experience trends badly. Some small employers might become uninsurable, effectively. In the worst-case scenario, expansion might solve much of the Obamacare OOP problem for current uninsureds while creating a new group of uninsureds who would be less likely to qualify for full Obamacare subsidies. A similar expansion consequence could wreck Mississippi Obamacare. About 286,000 Mississippians are enrolled in a 2024 Healthcare.gov plan.
If insurers expect most of them to shift to 2025 Medicaid, will those insurers compete for the shrunken 2025 Healthcare.gov business? How much would the remaining insurer(s) raise premiums in response to what they may see as increased risk? If rates spike or if insurers bail out, many new uninsureds could fall in a new gap between expanded Medicaid and employer-provided coverage.
What could go right?
“Only two people know the future: God and a fool,” says the Lebanese proverb. Medicaid expansion worries may turn out to have been excessive. Expansion might cost the State little, solve the Obamacare OOP problem, throw a lifeline to struggling providers, increase workforce participation, and not wreck the Obamacare exchange program. An old joke, told by Milton Berle, is an apt one: “Two Irishmen are leaving a bar …. What? It could happen!” This, too, could happen. In hindsight, expansion proponents might seem to have been prescient.
But everyone is guessing. If your friend’s guess doesn’t match yours, he or she should remain your friend. Let it be so, please.
JACKSON, Miss. (WLBT) – The spotlight was on the Magnolia state top up-and-coming innovators at the Innovate MS Accelerate Conference.
Eight finalists were selected to pitch their company’s idea in hopes of landing a deal from investors.
Innovate Mississippi’s CEO said, “This pitch day is really the culmination of something that started with eight regional partners. We had 240 applications that then turned into about 120 pitches. Those pitch competitions awarded up more than $100,000 of prizes at the pitch. But now of that Group, eight of them have been selected. They’ve been working their butts off for the last 12 weeks.”
One of the presenters started his company just this past summer. He is blending medical care with artificial intelligence.
Brandon Newton, founder and CEO of Gen Med Labs, said, “My background is mostly like chemistry and medicine, and I’ve recently started studying computer engineering. I have passion for both medicine and technology, so I wanted to create a company that leverages both of those skill sets in order to basically aid the medical industry as a whole.”
Gen Med Labs is working on a pair of ordinary glasses that function as a portable computer.
So, when the user puts them on, it’s a type of virtual reality. The other presenting all had something different to bring to the table.
“Well, that’s kind of the front of this is we don’t focus in any one industry. So we have, you know, a company that can allow you to do food delivery where you sort by price or time. We have a company that does videos. For homes, we have companies that help with, you know, getting away from that annoying clipboard when you go to the doctor’s office. They’re companies doing all sorts of different things,” Jeff said.
The conference will continue on Wednesday, where interested investors can meet with innovators to discuss how involved they want to be in advancing their companies.
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President-elect Donald Trump’s announcement to nominate former U.S. Rep. Matt Gaetz as attorney general has, again, thrust Mississippi Congressman Michael Guest, chairman of the House Ethics Committee, into the national spotlight.
Guest’s committee will potentially vote at its Wednesday meeting whether to release an ethics report on Gaetz. The committee, which was investigating Florida’s Gaetz over allegations of sexual misconduct and illicit drug use, was set to release the report before Gaetz abruptly resigned from Congress.
Guest is a Republican who represents Mississippi’s 3rd Congressional District and has chaired the bipartisan House committee that investigates whether House members have committed ethics violations since January 2023.
Gaetz resigned last week shortly after Trump announced he planned to nominate him to lead the Department of Justice, despite having been previously investigated by the department for alleged sex trafficking crimes. The department declined to pursue criminal charges against Gaetz.
After the resignation, House Speaker Mike Johnson announced that he does not want the House to make the committee’s report public because Gaetz is no longer in office.
Guest declined to comment to Mississippi Today about recent developments with the committee’s investigation into Gaetz. But the Mississippi Republican told Politico that the panel will make its own decision about releasing the report, regardless of Johnson’s opinion that it should be kept under wraps. Lawmakers on both sides of the aisle have called for the report to be provided to senators before a confirmation vote on Gaetz and-or to the public.
Guest is the former district attorney of Rankin and Madison counties. He also gained national attention when he introduced a resolution last year to expel New York Congressman George Santos from the House.
Some U.S. senators such as Republican John Cornyn of Texas have publicly called for the Ethics Committee to hand over its report of the Gaetz investigation. Neither of Mississippi’s two U.S. senators, Roger Wicker and Cindy Hyde-Smith, sit on the Senate Judiciary Committee, but they will get to vote on the nomination if it reaches the full Senate.
Wicker, a Republican from Tupelo, told Mississippi Today that the Senate has the constitutional obligation to “provide the president with advice and consent on executive and judicial branch nominations” and he takes that responsibility seriously. He did not comment on Gaetz.
“I think that we are in a position to give President-elect Trump good advice on what is likely to work,” Wicker said. We are going to fulfill our constitutional role, and we are going to do so as friends of the president-elect and as members of a team who want him to be as successful as possible.”
Hyde-Smith, a Republican from Brookhaven, did not respond to a request for comment.
State decline in election figures mirrors preliminary national voter turnout
Voter turnout in this year’s election came out higher than early vote counters predicted, but still far lower than in some of the previous presidential elections over the last 20 years.
The trend also seems to follow a national decline in voter turnout, though, national numbers are still being tallied up and finalized as of Monday.
According to finalized reporting by the Mississippi Secretary of State’s Office, 1,225,176 people voted by or on Nov. 5 in the presidential, congressional, state and special elections. That figure represented about 62% of the state’s electorate, or the total number of eligible voters.
Compared to previous years, it’s a bit of a drop.
“While we were hopeful to see our voters rise to the occasion, it has become apparent we continue to face voter apathy and fatigue,” Secretary of State Michael Watson said in a press release issued last week before the count was finalized. “I encourage each of you to continue to encourage your family, friends, and neighbors to engage in the elections process and fulfill civic duty and responsibility. Mississippi needs an engaged electorate now more than ever.”
In 2020, 66% of the state’s electorate cast a ballot in the election. In 2016, 2012 and 2008, it was 64%, 67% and 68%, respectively, according to the Mississippi Secretary of State’s Office.
In respect to the nation, as of Friday afternoon about 149 million ballots were cast across all 50 states, which is still about 7 million than what was seen in the 2020 election.
Mississippi Secretary of State’s Office Communications Director Elizabeth Jonson said that voter turnouts were actually pretty high during the early hours of Election Day, but overall, they just didn’t exceed previous years’ numbers.
As for Mississippi, there are still two elections left undecided: The Mississippi Supreme Court Central District race and the Mississippi Court of Appeals race. Candidates in those races are heading to a runoff on Nov. 26, just two days before Thanksgiving.
Grant McLaughlin covers the Legislature state government for the Clarion Ledger. He can be reached at gmclaughlin@gannett.com or 972-571-2335.
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