Medicaid expansion could become a reality within two years. Exactly what that expansion looks like — and how easily it will be to adjust the system in the future — largely depends on whether lawmakers finally do it themselves or leave it up to voters.
The Mississippi Hospital Association is backing a ballot initiative to expand Medicaid with a constitutional amendment. If an amendment makes it to the ballot, voters are almost certain to pass it.
There is one big caveat: the Mississippi Supreme Court is currently hearing a challenge to the ballot initiative process. If they throw out the process, then all talk of a ballot initiative is moot -- something many lawmakers would welcome.
But if the Supreme Court lets the ballot initiative process stand, then lawmakers have a big decision to make. They can pass Medicaid expansion through the normal legislative process, crafting a program on which the majority of them can agree and one they can update easily, or they can allow the people to pass a constitutional amendment that can only be changed by future votes of the people.
Lt. Gov. Delbert Hosemann said he would hope lawmakers have learned a lesson from Initiative 65, which created a statewide medical marijuana program after voters passed it with 74% approval. Even some supporters of medical marijuana have taken issue with portions of how the program is set up under Initiative 65, including the lack of tax revenue for the state and what they see as insufficient control over where dispensaries can locate.
While not specifically naming Medicaid expansion, Hosemann's comments are clear. Lawmakers for years ignored the overwhelming majority of the state calling for a medical marijuana program, so voters did it themselves. The result was an imperfect system the Legislature is mostly powerless to control.
All things considered, it seems a better option for lawmakers to expand Medicaid than for it to be done via the ballot. Medicaid is an expensive, complex program. It requires well-considered solutions and the ability to adjust those solutions over time. And having that much state funding tied to a constitutional requirement is a scary prospect when lean years could cause unimaginable havoc on other state agencies.
Lawmakers need to expand Medicaid. It is the clear will of the people. As we have argued before, it also makes clear financial sense. Regardless of what the Mississippi Supreme Court does with the ballot initiative process, it is time for lawmakers to listen to the people and act accordingly.