June 28, 2013 10:32:31 AM
JACKSON -- Mississippi lawmakers appear to be on track to renew and fund Medicaid beyond this coming weekend, when the program is set to expire.
In the opening day of a special session Thursday, the House voted overwhelmingly to reauthorize the existence of the program and to set its budget. Bills also must pass the Senate, which is expected to act on Friday.
Republicans hold the majority in both chambers, and in the House they blocked Democrats' efforts to expand the federal-state health insurance program to another 300,000 people.
"It is good business to want everybody to be well in this state," said Rep. Tommy Reynolds, D-Charleston.
Medicaid expansion is an option under the federal health law that President Barack Obama signed in 2010. There was little said against expansion during the House debate Thursday, but Republican leaders, including Gov. Phil Bryant, have said for months that Mississippi can't afford it, even with the federal government paying most of the tab.
Medicaid already covers about 644,000 of Mississippi's nearly 3 million residents. It's a big source of money for nursing homes, hospitals, pharmacists and other health care providers.
Lawmakers' work is far from finished in the special session that started just four days before the end of the fiscal year. The House has voted to end the session at midnight Friday, but senators must agree to that.
House Bill 1, which would keep Medicaid in business, passed the House 96-20. House Bill 2, the budget, passed 114-1, but only after a party-lines vote against an amendment that said no Medicaid money could be spent until lawmakers have a full debate about expansion: 51 members voted yes, and 65 voted no.
Both bills were held for more consideration in the House, and that is expected to happen Friday. After that, the bills would go to the Senate.
Legislators on Thursday did not immediately consider a way to renew a hospital bed tax that helps pay for the Medicaid program. The governor controls the agenda of the special session, and he'd have to give lawmakers the go-ahead to consider the tax.
Legislators ended their three-month regular session in early April without reauthorizing or funding Medicaid because of a partisan dispute over expansion. The federal law says that starting next January, states can extend coverage to people making up to 138 percent of the federal poverty level, or about $15,000 for one person. In Mississippi now, the income cutoff is about $5,500, but many able-bodied adults below that income threshold still don't qualify.
The federal government would pay 100 percent of medical expenses for the newly qualified Medicaid enrollees from 2014 to 2017. The federal share would be reduced to 90 percent by 2020, with each state paying the balance. Bryant has said he doesn't trust Congress to fulfill its funding promises and he doesn't want state government to be left with large obligations it can't afford.
The bill that the House passed to keep Medicaid alive would remove a repealer provision that requires lawmakers to periodically review and reauthorize the agency. One reason lawmakers find themselves in a bind now is because Medicaid is set to expire this weekend under a repealer.
During Thursday's House debate, Democrats broadened the discussion to try to make health care more accessible to hundreds of thousands of uninsured residents by mandating that the state operate a health exchange, an online marketplace where people can buy insurance.
All states are required to have some sort of exchange available by Oct. 1, with coverage to start Jan. 1. If a state doesn't run its own, the federal government will run one.
Federal officials earlier this year rejected Mississippi's exchange proposal, citing Bryant's opposition. Insurance Commissioner Mike Chaney, who's Republican, proposed a state-run exchange and still wants one. He said last week that so far, private insurers plan to cover exchange coverage in only 46 of Mississippi's 82 counties. Unless something changes, 36 counties will have no insurance available through an exchange.
Rep. Bo Eaton, D-Taylorsville, said an exchange would help the people who can't currently afford insurance but make too much money to be on Medicaid.
"You've got bricklayers, carpenters, all kinds of people who work hard every day," Eaton said.
On a party-lines vote, the House rejected Democrats' proposal to create a state-run exchange.
Rep. Robert Johnson, D-Natchez, proposed a separate plan to let low-income people use federal subsidies to buy private health insurance, which would be similar to a plan Arkansas wants to use. Johnson said it would be an alternative to expanding Medicaid, and the exchange would not be tied to Medicaid.
House Speaker Philip Gunn, R-Clinton, ruled the House could not debate Johnson's proposal, saying it was not germane to keeping Medicaid alive.