Expansion not in Medicaid bill, but not dead issue


Emily Wagster Pettus/The Associated Press



JACKSON -- Mississippi lawmakers are holding onto a chance to debate Medicaid expansion in the next few weeks, even though Gov. Phil Bryant and other Republican leaders oppose growth in the program.


With no debate Wednesday, the Republican-controlled Senate passed a bill to keep Medicaid in business after the budget year ends June 30. Some Democrats had said they wanted a detailed discussion about making more people eligible for the program, which is an option under the federal health overhaul that President Barack Obama signed in 2010.


The debate did not happen, however.



On a day when senators were considering dozens of other bills, Sen. Hob Bryan, D-Amory, gave a calm and brief explanation of the Medicaid bill and said it could be changed later to expand the program. Some lawmakers want more information about whether hospitals will take a financial hit if the expansion doesn't happen.


Several hospital administrators have said that because of the complicated restructuring of health coverage under the federal law, they're worried about losing money the facilities now receive for treating uninsured patients. The U.S. Department of Health and Human Services hasn't given a clear answer about whether reimbursement for uncompensated care will remain the same, be reduced or disappear altogether.


"Clearly, we're getting more and more information about our options every day," Bryan told the Senate.


Republican Lt. Gov. Tate Reeves issued a statement later saying he's proud of the Senate for passing the bill without expansion in it.


"The rules and regulations from Washington are not complete, and Mississippi taxpayers cannot afford Medicaid expansion under Obamacare," Reeves said.


Mississippi has about 3 million residents, and more than 640,000 are on Medicaid, the federal-state health insurance program for the needy.


The federal law gives states the option to expand Medicaid to people making up to 138 percent of the federal poverty level. The federal government would pay 100 percent of medical expenses for the newly qualified enrollees from 2014 to 2017, then the federal share would be reduced to 90 percent by 2020, with each state paying the balance.


The poverty level is about $11,000 for one person, so the expansion could cover a person making up to about $15,000. Each state sets its own upper income limit for Medicaid enrollment, and Mississippi has one of the lowest in the country, at about 50 percent of the poverty level.


A recent study conducted by the Urban Institute for the nonpartisan Kaiser Commission on Medicaid and the Uninsured estimates about 288,000 newly eligible people could be expected to enroll in Medicaid if Mississippi does an expansion. The study says another 57,000 who are eligible for Medicaid under current standards could be expected to sign up.


The study estimates that with expansion, Mississippi would pay about $1.2 billion more for Medicaid, stretched over 10 years, and would collect more than $15 billion in federal money.


Bryant relies on research from the Milliman firm, which shows larger potential enrollment and substantially larger state expenses. He says the state can't afford expansion.


Senate Bill 2207, which keeps Medicaid alive, moves to the Republican-controlled House, where Speaker Philip Gunn, R-Clinton, opposes expansion.





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