I have been pressing on the Medicaid expansion issue because it’s a winner for Republicans and they just don’t seem to want to really go on offense and win. At least not yet.
As I’ve stated before, the Democrats have handed Phil Bryant a club in the form of a special session and are betting that he will not have the fortitude to beat them over the head with it. They’ve pretty much said so publicly as Democratic Legislative leaders are basically banking on the fact that Bryant will not call legislators back to Jackson until “a deal has been reached”.
Bryant is showing the beginnings of an offensive. He talked on the Paul Gallo show this morning. That’s fine, but it’s preaching to the choir. Bryant needs to start preaching to the masses. That means editorial boards that may not like him very much. That means TV interviews. That means having visuals like press conferences on the Capitol Steps with signs saying “Reauthorize Medicaid Now” and “Democrats, Stop Holding Medicaid Hostage”. That means taking the message to the streets and saying only but one thing . . . “We need to reauthorize Medicaid without precondition to help the 600,000 poor Mississippians keep those services and Democrats keep voting to end Medicaid as we know it.”
There’s some work to do inside the Dome as well. In order to put the screws to the Democrats, the House Republican Leadership absolutely has to square its caucus votes away. There have been four votes on Medicaid.
The first two votes were on House Bill 560 which was the House bill that was the up or down vote on extending Medicaid. It got defeated 62-52 (it needed 69 to pass) on January 31. Then two weeks later, it got defeated again 60-52 (it needed 68 to pass).
Then there was the actual appropriation for Medicaid in the form of House Bill 1653. It got defeated twice as well. On the conference report on March 31, it got defeated 58-49 (with 60 needed to pass). The next day, an almost identical result with a 57-49 vote (needing 60 to pass again).
In legislative leadership, you only have so many opportunities to say, “this is a vote that the party has to have and this vote is the price you pay for having an ‘R’ by your name”. This is one of those times. There are some pretty squishy Republican votes that should have gotten drug across the line that didn’t. Most of the sideline votes are Chairman or Vice Chairman. Some are claiming that they may have a conflict on the vote, but whether or not an Ethics Commission opinion has been requested is not known. Like the other representatives, they’ve got an election coming up in two years. Medicaid reauthorization is a key deal for the Governor, the Lt. Governor, the Speaker and the people of the state.
So the strategy, if I were drawing it up, is threefold.
1. Governor Bryant goes on the media offensive and dials up the heat. He’s really good on the stump, especially in campaign mode, and he needs to treat this like a campaign. He can use this as a way to help him in places (in the media and Democratic districts) where he may not often do as well. He can because he is right as rain on this issue and he should exploit the hell out of that.
2. House Leadership should put the heat on squishy Republican votes. Let them know that Chairmanships and Vice-Chairmanships can be reassigned after next election AND primary challenges can be arranged.
3. Call the House Democrats bluff. Don’t negotiate with them at all. Make them come back to Jackson and vote up or down on Medicaid as many times as it takes and break their backs politically. Eventually, if enough resolve is shown, the House Democrats and the Hospital Association will have to give in. Eventually, the smart ones will wise up and try and find a way out of this mess. Remember, a vote to expand Medicaid would take a 3/5ths vote (73 House Members), which they are never EVER going to get. So why hijack the ongoing medical needs of 600,000 poor, aged and disabled Mississippians for a political pipe dream?
If Medicaid needs to be changed after uncompensated care payments from the federal government become more of a known quantity, policy leaders can sit down with ALL the information and formulate a plan. But that should not be a precondition for an up or down vote on reauthorization. Democrats are trying to negotiate now because when the actual information comes out about the changes in Medicaid at the federal level, they’re privately spooked that the lower payments that the federal government is threatening may not be as bad as are represented now.
It’s a good thing when being right on policy and politics is the same issue. This is one of them.