The issue of Medicaid expansion, which seldom is debated in the Mississippi Legislature, was briefly the topic of conversation Tuesday in the state Senate.

Sen. Hob Bryan, D-Amory, bemoaned that working people, who cannot afford private insurance, were having to go without health care because the state would not expand Medicaid as allowed under the federal Patient Protection and Affordable Care Act.

“These are working people, people who work a lot harder than we do,” Bryan told his fellow senators. He added they were people working everyday even though they need to go to the doctor but do not because they can’t afford it.

Mississippi is one of 19 states choosing not to expand Medicaid as is allowed under the federal law to cover those making up to 138 percent of the federal poverty level – $33,948 annually for a family of four.

When the ACA, known as Obamacare, was passed in 2010, Mississippi’s Republican leadership said it would not expand Medicaid, a key part of the federal law. In the early days, Democrats made efforts in the legislative process to convince the leadership to accept the expansion.

But in recent years, the issue has seldom been debated by the Legislature. Bryan did not offer an amendment to expand Medicaid Tuesday, but simply stated that he believes creative ways could be found to pay for the state’s share of the expansion – 10 percent of the total costs. He said drawing down the 90 percent share paid by the federal government could actually be an economic boon to the state as multiple studies have found.

Plus, he said, “We could alleviate human suffering if that is of any consequence.”

Mississippi’s political leadership maintains that the state cannot afford the existing Medicaid program, which covers 700,000 Mississippians – primarily poor children, poor pregnant women, the disabled and poor elderly residents.

Bryan’s discussion about Medicaid expansion came up Tuesday as the Senate considered and passed what is known as the Medicaid technical amendments bill. The bill reauthorizes the program and is normally the vehicle where substantive changes are made in the federal-state health care program.

Legislative leaders are hoping to use the technical amendments bill this year to save money in the program that costs the state nearly $1 billion annually. While expensive to the state, Mississippi does get roughly $3 in federal funds for each $1 it spends on Medicaid.

Among the issues under consideration in this year’s technical amendments bill are proposals to expand the number of physician visits and drug precipitations Medicaid recipients can receive in a month.

The Senate proposal also enhances the governor’s ability to make cuts in the program and establishes a commission to look at such items as whether to expand the managed care program.

A large portion of the Medicaid population is in managed care programs where the companies receive a set amount of money to provide health care to the beneficiaries.

The technical amendments bill pending in the House would allow a coalition of the state’s hospitals to operate a managed care program for Medicaid.

The complex legislation will ultimately be hammered out by House and Senate leaders in March near the end of the session. What changes will be incorporated in the Medicaid program will be decided then, but it is almost a certainty that Medicaid expansion will not be one of those changes.