JACKSON — Top Mississippi Republicans say their opposition to Medicaid expansion is getting a boost from an unlikely source — President Barack Obama.
The Democratic president released his proposed federal budget yesterday. It includes a one-year delay in reduction of “disproportionate share” Medicaid payments — money hospitals receive for treating large numbers of uninsured patients.
Mississippi has high numbers of uninsured residents. Hospital administrators have said reducing the payments would hurt their finances, and some have used that as an argument to support expansion of Medicaid, the federal-state health insurance program for the needy. Putting more people on Medicaid would mean fewer uninsured patients.
Under the federal health overhaul that Obama signed into law in 2010, states have the option of expanding Medicaid to people making 138 percent of the federal poverty level, or about $15,000 for one person. In Mississippi now, the income cutoff for Medicaid eligibility is about $5,500, and the program does not cover many able-bodied adults, regardless of their income.
During the three-month legislative session that ended last week, Democrats said they want to expand Medicaid to help the working poor. Republican Gov. Phil Bryant and leaders of the Republican-majority House and Senate said Mississippi can’t afford expansion, even with the federal government paying all of the tab initially and 90 percent after several years.
Because of bickering about expansion, Mississippi lawmakers ended the session without passing a Medicaid budget for the state fiscal year that begins July 1, or even authorizing the program to stay in existence beyond that date. Bryant will have to call lawmakers back for a Medicaid special session before the end of June.
Discussing details of the president’s budget yesterday in Washington, U.S. Health and Human Services Secretary Kathleen Sebelius said the proposal to delay the reduction in Medicaid disproportionate share payments was done to give states a chance to get through their budgeting processes this year. The reprieve does not affect cuts in disproportionate share payments for Medicare, the federal health insurance program for people 65 and older and for the disabled.
Bryant said in a news release yesterday that he’s pleased about Obama’s proposal to delay the reduction in some payments to hospitals.
“I have long advocated that cuts to this program should not be used to affect budgets in states that choose not to expand Medicaid,” Bryant said. “This move should give us additional time to make a reasonable decision about any changes to the Medicaid program.”
Mississippi’s population is about 3 million. More than 640,000 people are enrolled in Medicaid, and expansion could add an estimated 300,000.
The 2010 law says the federal government will 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.
State House Speaker Philip Gunn, R-Clinton, said Obama’s proposal affirms House members’ opposition to Medicaid expansion.
“As I’ve said before, there are too many unknown factors to make such a decision,” Gunn said in a news release. “We cannot afford the expansion. We do not have enough details, and we will continue to stand firm against it. Even the President recognizes that there is an issue with the way Medicaid is currently funded.”
House Democratic Leader Bobby Moak, of Bogue Chitto, said in a news release that lawmakers need a chance to vote on Medicaid expansion during the special session.
“The president’s proposal gives states like Mississippi the opportunity to get our house in order by expanding Medicaid now and preventing catastrophic cuts later,” Moak said. “It also serves as further proof that Medicaid DSH payments will be cut to historic lows in the very near future.”
Moak also said cuts to the Medicare payments will hurt hospitals and their vendors.
There’s no guarantee that the U.S. House and Senate will agree to adopt Obama’s budget.
Many Republicans, including U.S. Sens. Thad Cochran and Roger Wicker, of Mississippi, issued news releases saying the president’s overall spending plan would add to the debt while increasing taxes and spending.
“This is just the beginning of a process which I hope we can control more effectively with restraint and common sense than has been the case in the past,” Cochran said.
Wicker said: “This is not a serious plan for putting the country on a sustainable financial path or encouraging the job creation that we urgently need.”