JACKSON • After Mississippi's Republican-controlled Legislature again refused to seriously consider Medicaid expansion this year, a new nonprofit says it's time for voters to decide.
A group of state health leaders filed paperwork in February for a Medicaid expansion ballot initiative. If Initiative 76 is approved, it would tap into billions of dollars worth of federal health care insurance money over the next several years.
Those funds would be used to cover possibly hundreds of thousands of working, low-income Mississippians who cannot afford health care. Mississippi Today first reported Monday on the existence of the initiative effort.
Mississippi is one of 12 states that has refused to accept Medicaid expansion money dating back to 2014. Advocates estimate the state has missed out on roughly $1 billion per year since.
The nonprofit Healthcare for Mississippi that is organizing the ballot initiative was incorporated by Mississippi Hospital Association President Tim Moore, Hattiesburg pediatrician Dr. John Gaudet and health care executive and advocate Nakeitra Burse. Moore said the Hospital Association's board has not endorsed the initiative or agreed to help fund the endeavor, but it is expected to take a vote on the subject Friday. He declined to reveal which other groups and individuals are involved, noting a formal announcement has yet to be made.
In a recent filing with the state, Healthcare for Mississippi says its goal is to improve health care by expanding Medicaid eligibility to people making up to 138% of the federal poverty level — about $17,600 for a single person.
These Mississippians presently fall into a coverage gap — they make too much money to qualify for traditional Medicaid, yet not enough to qualify for a subsidized plan on the federal Affordable Care Act marketplace. Estimates suggest between 170,000 and 300,000 Mississippians would qualify for the expanded coverage.
“The time is right to advocate for Medicaid expansion in Mississippi for these hard-working adults, who otherwise don’t have access to coverage," Gaudet told the Daily Journal. "It will help their kids, too, who are my patients.”
Moore said that expanding government-backed health insurance would also provide a financial boost to Mississippi hospitals struggling to recover from the pandemic. Hospitals covered more than $600 million in uncompensated care in 2019 thanks to the state's high share of uninsured residents. A handful have either closed in recent years or have said they are near bankruptcy.
“There’s all kinds of reasons we should be jumping all over this," Moore said of expansion. "We’ve given the Legislature time, and time and time again ... It just has not come."
Healthcare for Mississippi is working to finalize the initiative's language with the state attorney general's office. Gaudet said there is a "wordsmithing" problem that needs to be fixed: the AG's proposed language makes it sound like the initiative proposal calls for Medicaid for all Mississippians, but in reality it would only cover people making up to 138% of the poverty line.
Once the wording is approved, the group will need to collect more than 106,000 certified signatures by September if it hopes to put the question before voters in the 2022 midterm election. The Legislature would also get to review the initiative and possibly offer an alternative question for the ballot, as lawmakers did with medical marijuana.
If Mississippi voters opt to expand Medicaid, the feds would cover 90% of the price tag. The state would cover the other 10%, which experts say would cost roughly $100 million annually.
The Hospital Association previously proposed an expansion plan, called Mississippi Cares, where hospitals themselves would pay for the state's portion. But Moore said the ballot initiative language does not include this provision, or any other specific mandates, beyond requiring the state to expand coverage to adults making up to 138% of the poverty line.
"We’re saying, 'Look, you’ve got to take care of this population,'" Moore said. "And if we have to put that in the constitution, then that’s what we’re going to do.”
Moore pointed out that President Joe Biden's $1.9 trillion American Rescue Plan offers additional incentives to encourage Mississippi and other holdout states to expand Medicaid coverage. Those incentives would increase the federal match rate for Mississippi's existing Medicaid programs, Moore said, resulting in the feds paying Mississippi about $300 million extra a year for two years.
Even with the additional federal incentives on the table, two of the state's three top Republican leaders — Gov. Tate Reeves and House Speaker Philip Gunn — recently said they remain opposed to expanding coverage.
“My position has not changed," Reeves said last month. "I am opposed to expanding Medicaid in Mississippi. I am opposed to Obamacare expansion.”
"I've been one who's been very outspoken against Medicaid expansion," the speaker said when asked whether he would consider it after the new federal incentives. "I don't see it as something we can afford, I don't see it as something that's beneficial. So personally I would not favor (expansion)."
Lt. Gov. Delbert Hosemann has been more open to the idea. He said last week state lawmakers would study health care issues including expansion this summer as they prepare for the 2022 session.
But the Republican-controlled Legislature does not appear interested in approving expansion on its own anytime soon. Votes in both the House and Senate this past session failed along party lines.
Some Republicans express general concern about rising Medicaid costs for the state and federal government, and whether covering additional expansion costs is sustainable long-term. GOP leaders around the country have also long opposed the policy due to partisan politics: Expansion was made possible as part of former President Barack Obama's signature law, the Affordable Care Act.
Yet many other red states have approved expansion, calculating it would both help low-income residents and grow their economies. A Hospital Association analysis from 2019 found expansion could generate thousands of jobs and add $200 million in additional revenues to state coffers.
Some Republican-led states such as Idaho, Nebraska, Utah, Missouri and Oklahoma have successfully passed Medicaid expansion by ballot initiative after state legislators declined to act.
"It just shows that (for voters), it’s not a partisan issue, it’s not a rural or urban issue," Gaudet said. "It’s something that’s bubbling up all over the country.”
Recent surveys from Millsaps College and Chism Strategies show about 60% support for expansion in Mississippi. Voters have also said in recent Millsaps polls that their top concern is rising health care costs.