Jonathan Bain

Jonathan Bain

ObamaCare’s Medicaid expansion: That’s been the $100 million question for states since 2014.

The question of whether or not Mississippi should further expand Medicaid to able-bodied populations has been looming for years. The Mississippi Institutions of Higher Learning (IHL) recently published a report that includes, at best, faulty and misguided information on the impacts of expansion, so the question has once again come to the forefront of political discussion in the Magnolia State.

The myths and falsehoods that permeate this report desperately need to be dispelled and put to rest because the consequences of expanding in Mississippi will change the direction of our state for generations.

Report grossly miscalculates enrollment estimates

The foundational issue with the report is that it operates on grossly underestimated enrollment figures. The report estimates that nearly 234,000 Mississippians would be eligible for expansion enrollment. They derived this estimate from Census Bureau data to determine the number of Mississippians who would become eligible and how many individuals are enrolled into traditional Medicaid right now.

The report claims that average total Medicaid enrollment in 2020 was just a tick above 642,000. But one need only to look to the Mississippi Division of Medicaid to confirm this is wildly inaccurate. According to the Division, actual monthly enrollment was nearly 749,000 — which is 16.5% higher than the MSHL report states.

Furthermore, the report states Medicaid enrollment in Mississippi was expected to drop in 2021. Instead, enrollment has increased every single month so far this year. And that’s not all — the U.S. Treasury and Office of Tax Analysis (OTA) claims expansion populations are as much as 72% higher than Census data would indicate.

Our neighbor, Louisiana, estimated that 392,000 people would enroll if the state expanded. But as of September 2021, 75% more people enrolled than originally estimated. And according to estimates from the Foundation for Government Accountability, expansion states nationwide are facing enrollment overruns of 145%, more than double original estimates.

Should the state choose expansion, Mississippi should expect nearly double the enrollments estimated by IHL.

Report misses mark on expansion costs

IHL's poor enrollment estimates necessarily lead to an underestimation of expansion costs in Mississippi.

In 2012 the Centers for Medicare and Medicaid Services (CMS) estimated that by 2018, monthly expansion costs for enrollees would be $3,961. But by 2018 expansion costs reached more than $6,000 per member per month. Overall, expansion states experienced cost overruns of 157% by 2018.

We can look again to our neighbors in Louisiana for foreshadowing of how this would play out in Mississippi. By 2018, Louisiana had spent more than 115 percent more on expansion than expected.

Mississippi should expect to spend more than $333 million annually with expansion—again, nearly double MHSL’s estimates.

Forcing people out of private coverage, onto welfare

Here’s a fact the IHL report neglected to mention: Nearly half of the would-be expansion population in Mississippi already has private health insurance.

A new federal provision offers free private insurance — at no cost to the individual or the state — to people earning between 100% and 150% of the FPL. But here’s the caveat: If someone is eligible for Medicaid, they’re excluded from taking advantage of this option.

If Mississippi expands, as many as 110,626 low-income Mississippians will be forced off of or disqualified from free private health insurance and onto Medicaid, an objectively inferior option in terms of quality of care. Unsurprisingly, the IHL report fails to mention any of this.

The answer to the question

How will Mississippi answer the million-dollar question of Medicaid expansion under ObamaCare? Will we enroll more people than ever imagined, and spend more than we can possibly afford? Will we force thousands off their private insurance and onto welfare, and deprive more than 100,000 Mississippians access to free private plans? Will we hurt our hospitals by having a much more sizable Medicaid population, forcing them to accept much lower reimbursement rates for their services?

Will we end up just like other states that have expanded Medicaid, or will Mississippi make the right decision, as we have for years? If Mississippi looks hard at the data, how expansion would impact more than 100,000 low-income Mississippians, and how other states have fared with expansion, the answer is clear: We cannot, and should not, expand Medicaid.

JONATHAN BAIN is a research fellow at the Foundation for Government Accountability. Contact him at

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