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The Mississippi Medicaid Debate
I guess we technically could expand, but should we?
By Alan Lange
While the debate over charter schools seems to be on the wane in the Capitol, another larger debate is emerging. This protagonists and antagonists in the debate are generally the same, but the stakes on Medicaid expansion are much higher.

No Republican in the state House or Senate wants to expand Medicaid. That’s a given. There are some technicalities in terms of the difference between House and Senate rules about why some votes have had to happen the way that they have. But the bottom line is that House Democrats have put a gun to the head of Medicaid recipients and have refused to approve an up or down vote on Medicaid reauthorization. Instead, they’re trying to leverage the current reauthorization to force an attempt at expansion jeopardizing 600,000 existing Medicaid recipients in the bargain.

If Republicans were in the minority, you can bet that Republicans blocking a Medicaid reauthorization would be pilloried on the front page of every newspaper and that every special interest group would be marching on the Capitol demanding “justice”. Remember the PLAD and face to face reauthorization issues in 2008/2009? It just shows how irrevocably in the tank the Capitol Press Corps are for House Democrats. To the point, Bobby Harrison’s article today expresses shock and dismay over House Rules committee voting down the Senate Medicaid bill on Friday. Meanwhile, two weeks ago, he portrayed Democrats’ voting down Medicaid reauthorization as a crafty “maneuver”.

Democrats want to take advantage of a temporary federal incentive, courtesy of Obamacare, to bloat the rolls of state Medicaid eligibility to conscript 300,000 new Medicaid enrollees in Mississippi. These new enrollees would join the already 640,000 Mississippians already on the program. Mind you, those potential new enrollees haven’t had their income or healthcare status change one iota. Obamacare is simply lowering the bar (temporarily) to cover them via Medicaid.

Republicans counter that as the incentive is only temporary, in a few years, Mississippians will collectively be “holding the bag” with a total Medicaid population of over 1,000,000 people and new costs to be borne by the state in excess of $1 billion.

Channeling their inner-carnival barkers, legislators like the ever-glib Rep. Steve Holland have spouted some doozies. He said, "Think about all of God's children, think about local hospitals and health care professionals, think about the maimed." The maimed? Really?

Not to be outdone, Rep. Bobby Moak said that bloating state Medicare rolls would be good for hospitals and hence economic development and implored, "It's too many Mississippi souls on the line." Rep. Moak, if eligibility in Medicaid is what leaves people’s “souls” in the balance, you may seriously want to reconsider who or what you say grace to every night.

While much of this debate has centered around technical arguments of DSH payments and Obamacare’s impact on existing Medicaid programming, I’ve yet to hear any conservatives in the state actually talk about whether bloating our Medicaid rolls by 50%, even temporarily, is a good public policy decision.

Let’s talk plainly. Medicaid is a program for the poor. To pose it in terms of “economic development” is bogus. For if it were “economic development”, then why not have every single Mississippian on Medicaid?

When those outside Mississippi look at the statistics like education, healthcare, food availability, there is not a whole lot of economic development cachet in saying that 1 in every 3 Mississippians would be on Medicaid. Medicaid is much like food stamps (or SNAP), which has ballooned over 35% under Obama and now includes about 600,000 Mississippians. Should we, as a state, agree to lower the bar even only temporarily to include nearly 10% of our population in a program for the poor? And while we are at it, it’s probably not a bad idea to ask, how are those programs working out? How well are they run? What sort of positive impacts do those programs have on people in the long run? How long do recipients stay on SNAP, Medicaid, HUD assistance, etc.?

While Democrats in the Mississippi legislature seem to have the forethought and self-discipline of a 6 year old presented with a bowl of candy one hour before dinner, someone has to be the grown up here. Leadership has to say that not only can we not afford it in the intermediate to long term, but that it’s also just a bad policy idea. While hospitals might get a temporary sugar rush of higher revenue, the hangover to our business community from bloating our rolls will have real economic policy effects in the not too distant future. Our over-commitment to Medicaid will have opportunity costs like not being able to fund education, infrastructure, public safety and all the rest.

Children react to immediate gratification, but grown ups have to see past the immediate make tough choices. What may feel good in the short term may do real damage in the long term. I go back to the days of Jack Kemp, who I admired greatly, who made the very public political argument that compassion should not be defined by how many we help. Rather, it should be determined by the policies we can create that create the environment for people not to need it.

Republicans ought to force the issue loudly and publicly on reauthorization. Reauthorize the program as it stands first and then debate potential changes later without jeopardizing continuity of services for 600,000 Mississippians. If that means a special session, then they should do that. Forcing Democrats to repeatedly vote against Medicaid reauthorization is a political killer among their base and making those votes will come back to haunt legislative Democrats that aspire to higher offices.

It’s time for Republicans in the Capitol dome and in the Governor’s mansion to speak really plainly about what’s at stake and play hardball to get the job done.


Posted February 18, 2013 - 2:53 pm


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