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Medicaid reform: Will GOP embrace expansion by another name?

Call it Medicaid reform, not Medicaid expansion.

That’s part of the Mississippi Hospital Association’s latest effort to get Republicans to accept federal money and provide health insurance to now-uninsured adults.

The association on Monday unveiled a plan it calls Mississippi Cares. By combining payments from people who get coverage and hospitals, the association says Mississippi can avoid spending any of its own tax dollars to match federal money. The association envisions beneficiaries paying up to $20 a month and proposes that beneficiaries without jobs would enroll in training or volunteer work to qualify for coverage.

“Our objective is to get as many people covered as we can legitimately get covered, and to make sure hospitals and doctors get reimbursed fairly,” said Tim Moore, the association’s president and CEO.

He said hospitals are struggling with patients who can’t pay bills. Mississippi has seen five hospitals close since 2013. Another four declared bankruptcy last year, although all remain open. Consulting firm Navigant earlier this year suggested 31 of Mississippi’s 64 rural hospitals were at risk of closing, based on poor financial data.

The authors of President Barack Obama’s 2010 health insurance overhaul expected that states would expand Medicaid to cover uninsured able-bodied adults up to 138% of the poverty line for incomes. However, Mississippi is one of 14 states that balked at expanding coverage.

The Kaiser Family Foundation estimates 163,000 Mississippians would be covered if Medicaid were expanded. The hospitals estimate 300,000 people would be covered under their proposal.

Republican leaders have said the state can’t afford such an expansion, and Gov. Phil Bryant’s administration has pushed able-bodied adults who benefit from other social programs to work or enroll in school.

The hospitals’ proposal is tailored to get around both those objections. Moore said the association estimates the total cost would be $1.5 billion, with more than $1.3 billion coming from the federal government and the remaining $150 million coming from policy payers and hospitals. Moore said if 300,000 people paid $20 a month, that would generate up to $72 million a year. However, he also said people in deep poverty would probably be required to pay less. Moore said hospitals would pay the other $78 million.

“How do you walk away from this if it doesn’t cost you anything?” Moore asked.

The hospitals want to use their jointly-owned insurer, Mississippi True, to provide coverage, and not the managed care companies that Medicaid now uses. Mississippi True tried unsuccessfully to win a managed care contract. Moore said hospitals believe managed care companies are getting too much money and not showing health benefits.

“We should be seeing an improvement in care and that’s not happening,” Moore said.

Moore said he proposed a similar plan to Bryant and Medicaid Director Drew Snyder last year. Moore said he made a second presentation but never heard back from Bryant’s office.

Moore said the association wants to spark conversation during the 2019 elections.

“This is too important to the state of Mississippi to poke out your eyes and say ‘No, no, no,'” Moore said.

Lt. Gov. Tate Reeves, who leads Republican candidates for governor in fundraising, rejects any expansion.

“Other states are already recognizing they need to raise taxes to pay for ill-advised Obamacare expansions they pursued,” Reeves campaign spokesman Parker Briden said. “There is no free gift from Washington.”

Former Supreme Court Justice Bill Waller, also seeking the Republican nomination, said he favors the plan. As Moore did, he likened it to one adopted in Indiana when now-Vice President Mike Pence was governor.

“I am in favor of using conservative principles to reform our health system,” Waller said in a statement. “The proposed Mississippi Cares plan will similarly address these issues by increasing access to care without putting taxpayers at risk.”

State Rep. Robert Foster said months ago that he favors a plan similar to the one Indiana adopted under Pence.

Michael Rejebian is campaign spokesman for Democratic Attorney General Jim Hood, who is running for governor. He said the Hood campaign has not studied the hospital association plan enough to comment.


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