Be aware: This text is a part of Mississippi As we speak’s ongoing Mississippi Well being Care Disaster mission. Learn extra concerning the mission by clicking right here.

Whereas operating for governor in 2019, then-Lt. Gov. Tate Reeves was quizzed at a Capitol Press Corps luncheon whether or not his opposition to increasing Medicaid protection to working-poor Mississippians was softening.

“I’m against Obamacare enlargement in Mississippi. I’m against Obamacare enlargement in Mississippi. I’m against Obamacare enlargement in Mississippi. I don’t know what number of methods I can clarify this to y’all,” Reeves mentioned.

Reeves’ fellow Republican Home Speaker Philip Gunn has steadily given equally deep and erudite explanations of his steadfast opposition to accepting $1 billion a 12 months in federal cash to assist the working poor and Mississippi’s distressed hospitals.

“From what I learn about it, we can not afford it,” Gunn mentioned tersely to questions because the 2021 legislative session ended, clearly not wanting to debate the difficulty additional.

For greater than a decade, regardless of most different states increasing Medicaid and regardless of hospitals, docs, economists and consultants saying it could be a web profit to the poorest, sickest, most uninsured and most federally dependent state within the nation, most of Mississippi’s prime elected leaders have refused the provide.

As some hospitals throughout the state shut their doorways and others battle on the point of collapse — even because the state price range sees document positive factors from different federal spending — Mississippi leaders’ recalcitrance growingly seems extra political than pragmatic.

Reeves and Gunn, who can block enlargement from their posts, stay steadfast of their opposition. Republican Lt. Gov. Delbert Hosemann has mentioned he’s open to the thought, as are a small however rising variety of legislative Republicans. However Hosemann avoids even saying the phrases “Medicaid enlargement” and hasn’t pressed his colleagues on full enlargement. He has, unsuccessfully, pushed for increasing postpartum Medicaid protection for moms.

Q&A: What’s Medicaid enlargement, actually?

Notably, all three prime leaders declined interviews or feedback for this story. Medicaid enlargement hasn’t gotten an actual listening to with the Legislature in years, even because the federal authorities has tried to sweeten the deal and counter arguments towards enlargement.

At instances, together with lately, some state leaders have mentioned they might as an alternative want individuals to have good jobs that present non-public insurance coverage. However this has proved elusive, with Mississippi seeing sluggish job development, the bottom median earnings within the nation and among the many highest charges of uninsured individuals.

Mississippi As we speak compiled a listing of the primary arguments towards Medicaid enlargement that opponents have given over the past decade, with counterpoints from proponents:

We will’t afford it/it’ll tank the state price range

“I don’t see Medicaid enlargement as one thing that’s useful to the state of Mississippi,” Gunn mentioned in 2021. “I simply don’t suppose the taxpayers can afford it. That’s what it boils right down to is the taxpayers. It’s their cash. I simply don’t have the taxpayers calling saying we wish you to boost taxes so we are able to broaden Medicaid.”

Up to now, Medicaid enlargement hasn’t tanked any states’ budgets, nor have any been pressured to boost taxes to cowl ACA Medicaid enlargement.

Quite a few research, together with these by Mississippi’s state economists, say the state — together with authorities coffers — would see a web financial profit, together with development in GDP and inhabitants and the creation of hundreds of jobs.

Research in Arkansas, Kentucky, Louisiana, Michigan, Montana and Virginia confirmed the states noticed a web discount of greater than 4% in spending on their conventional Medicaid packages after enlargement. Louisiana’s Medicaid enlargement in 2016 introduced a 33% discount in uncompensated care prices for hospitals, together with a 55% discount for rural hospitals.

READ MORE: Right here’s what consultants say about increasing Medicaid in Mississippi

The federal authorities will stop paying its share

“For us to enter into an enlargement program can be a fools errand,” then-Gov. Phil Bryant mentioned in 2014. “I imply, right here we might be saying to 300,000 Mississippians, ‘We’re going to offer Medicaid protection to you,’ after which the federal authorities via Congress or via the Senate, would dispose of or alter the Reasonably priced Care Act, after which we’ve got no option to pay that.”

However the Reasonably priced Care Act, together with Medicaid enlargement, has survived via three presidents, together with Republican Donald Trump who wished to dispose of it, and thru a number of congresses, together with two below Republican management of each chambers. It has survived quite a few court docket challenges (Mississippi has joined in not less than a few these).

Mississippi leaders made the identical argument to postpone adopting the Medicaid program when it was created within the Nineteen Sixties. It was one of many final states to take action, in 1969. Arguments that the feds would cease funding it and go away Mississippi within the lurch have proved inaccurate, and the Magnolia State has loved the best charge of federal reimbursement for its current Medicaid program for a few years.

It’s subsidizing individuals who received’t work/it’s extra welfare

“We consider all able-bodied people should get off the sofa and go to work,” state Agriculture Commissioner Andy Gipson, a longtime former lawmaker, mentioned on the Neshoba County Truthful in July, mirroring feedback many different leaders have revamped years. “This is the reason we oppose Medicaid enlargement.”

By its definition, protecting individuals who make as much as 138% of poverty stage earnings, Medicaid enlargement is aimed toward serving to the working poor.

“These are individuals which are working,” mentioned Tim Moore, president of the Mississippi Hospital Affiliation. “By definition, to be at 138% above poverty, you need to have earnings from someplace. In reality these are individuals which are typically working a number of jobs, however nonetheless don’t have the discretionary earnings to afford the excessive price of premiums.”

“Medicaid enlargement is just not about placing individuals on the welfare rolls,” state Insurance coverage Commissioner Mike Chaney mentioned final 12 months. “That is about increasing well being care availability to the poor, the disabled, the parents that fall via the cracks, that aren’t in a position to get on the Reasonably priced Care Act.”

READ MORE: How Medicaid enlargement may have saved Tim’s leg and altered his life

It might drive up non-public insurance coverage prices, particularly if hospitals assist pay for enlargement

“If hospitals are going to pay for it, that signifies that your price whenever you go to the hospital goes to go up,” Reeves mentioned throughout a 2019 gubernatorial election debate, referring to Mississippi hospitals providing to pay the state’s share of enlargement. “If in case you have non-public insurance coverage, that signifies that your insurance coverage charges are going to go up.”

Others through the years have warned that enlargement normally would drive up non-public insurance coverage premiums.

However driving down uncompensated care prices for Mississippi hospitals, which has hovered round $600 million a 12 months (lowered quickly a bit lately due to federal COVID-19 aid cash) would enable hospitals to decrease costs, Moore mentioned. One latest research mentioned enlargement would reduce Mississippi hospitals’ uncompensated care by a median of $251.6 million a 12 months from 2020-2030. The identical research initiatives non-public premiums paid every year would additionally fall by $52.6 million over the identical interval.

“Treating individuals with no protection forces the prices onto everybody else,” Moore mentioned. “Plus, if individuals have protection, they get care in a extra well timed, extra environment friendly method. You’ve much less persistent issues, much less higher-cost issues.”

As for hospitals paying the state’s share of enlargement, as MHA proposed with the MS Cares plan in 2019, Moore mentioned that’s a moot level now, as a result of Mississippi hospitals are struggling so dangerous financially now that they couldn’t afford to do it.

Medicaid is damaged, filled with fraud and gives poor well being outcomes

When Mississippi lawmakers in 2017 handed an act aimed toward stopping fraud in Medicaid and welfare, one concern cited throughout debate was that there have been lifeless individuals on Medicaid rolls.

“Are you speaking about lifeless individuals on the rolls of Medicaid?” one lawmaker requested then-Senate Medicaid Chairman Brice Wiggins, R-Pascagoula. He responded: “I’m speaking about everyone, sure. It doesn’t matter whether it is lifeless individuals. It doesn’t matter whether it is individuals double dipping. They have to be following the legislation.”

Medicaid doesn’t present cash to beneficiaries. It gives well being care, and cash goes to suppliers. As a number of lawmakers identified on the time, it could be exhausting for lifeless individuals to be receiving well being care.

Many, together with some state politicians, seem to conflate Medicaid with “welfare.” Medicaid is a state-federal medical health insurance program that, in Mississippi presently, is on the market solely to the disabled, aged poor individuals, poor pregnant ladies and poor youngsters. An able-bodied grownup can not merely be poor and qualify for Medicaid.

Mississippi has been plagued with fraud, corruption or misspending in Medicaid, welfare and different authorities packages. However this has been principally dedicated by politicians, bureaucrats, enterprise individuals, or massive companies. Beneficiary fraud in all these packages would look like a smaller downside.

It’s true that Mississippi Medicaid beneficiaries have very poor well being outcomes. However on condition that a big portion of qualifying beneficiaries are very sickly and poor to start with, this would seem self-fulfilling prophecy. The purpose of enlargement is to cowl the more healthy, working poor and supply extra preventive care.

“If you happen to begin early and supply well being care, the result is best,” Moore mentioned. “If you happen to delay treating a situation, it will get worse. Diabetes is an instance. You’ve a person that doesn’t have well being care protection they usually have neuropathy however delay therapy. They get a gap within the foot that will get contaminated. Then they lose a leg. Or they lose eyesight or have renal failure. Then rapidly they’ve a incapacity and may’t work, they usually must be taken care of. However we may have prevented it, and we may have managed the fee a lot better.”