This past week, President Obama made Mississippi Republicans leaders look downright prescient by proposing that DSH payments for Medicaid should stay the same this upcoming budget cycle. House Democrats have been overly shrill about the need to expand Medicaid per the (rotten and/or magically vanishing) carrot provided by Obamacare.
Not to be outdone, Rep. Bobby Moak doubled down on stupid and said essentially that President Obama’s keeping DSH payments the same is now more reason than ever to inflate Medicaid to unprecedented heights.
There are two things going on here. There’s the politics and then there’s policy.
Politically, Republicans hold all the cards whether they actually believe that or not. They have a majority in both Houses. They control the Chair and the call. The Democrats I have talked to privately are not real happy about this turn of events and think that their goose is cooked and that their leadership really overplayed its hand. Fortunately, Republicans are right on the policy here as well. We will talk more about that in a minute.
A ton of money and time and effort went into building these majorities. Groups like BIPEC, MCPP and hundreds of donors and party activists have put years of planning and millions of dollars to work so that they would one day have the power to win the fight based on the values that they had endorsed in ballot boxes all over the state of Mississippi. Speaking plainly, it’s time to use them. There’s a political fight to be won and everyone from Governor Bryant on down needs to recognize that and go win it. There’s nothing to be ashamed of and there’s nothing to be hesitant about. Go win the vote. And that vote specifically is to reauthorize Medicaid without precondition and roll over anyone that gets in the way of that. Don’t get cute. Don’t do it 2 days before the deadline. Go win. Go win big. Go win early and make a political example of anyone, Democrat or Republican, who can’t fall in line. And, as I’ve said before, putting Democrats to a special session up or down vote against reauthorizing Medicaid is an impossible vote for them.
So how do Republicans do that?
1. Keep a narrow call and do NOT debate expansion. “Reauthorize Medicaid without precondition”.
2. Play political offense in Democratic and squishy Republican districts with robocalls and direct mail
3. Make it plain that this is a “with us or against us” vote
4. Dominate the media narrative
Now, the policy.
Republicans are on the right side of policy as their stance has generally been that there’s too much variance in what federal Medicaid reimbursement policy will actually be. Predicting what Obamacare and Medicaid policy is or will be is like nailing Jello to a wall. What we do know is that Obamacare and Medicaid is extremely complicated. Down the road, when the facts are known (in arrears), there may be some policy or eligibility adjustments that can or need to be made to serve the most people in the best way. I can pretty much guarantee you that it won’t to be let 10% of the entire population of the state of Mississippi on the Medicaid rolls, as Mississippi Democrats are now left pitifully begging for. However, it may just be some minor policy adjustments.
Republicans can make adjustments, if any are even necessary in the future, AFTER THEY’VE WON – clearly, decisively and from a position of strength.