Less than 36 hours after Donald Trump won the presidential election, Mississippi legislators on both sides of the aisle were wondering what kind of impact a repeal of the Affordable Care Act might have on state agency budgets.
On the campaign trail, the president-elect said many times that his first priority in office would be to replace Obamacare with “something terrific,” likely a privatized plan.
Although Thursday’s legislative budget working group hearings focused on commodities, anxiety and excitement about healthcare reform permeated the session. Ten minutes into the session with the Department of Health, Sen. Sollie Norwood, D-Jackson, veered from vehicle usage and procurement cards to ask how a potential repeal of the Affordable Care Act would affect the agency’s costs.
“We have been hearing a lot of chatter about the Affordable Care Act … looking at the services that are provided, the impact that it’d have on your department. Do you have any notion or expectation of how you expect it to impact healthcare in the United States?” Norwood asked.
Mary Currier, the state health officer, said that without subsidies from the federal government, more people would be uninsured — and rely on the state to fill in services.
“One of the things that would occur is that a lot of those patients who’ve gone to private providers will come back to the state, and we have to be prepared to stand up and work that out … and provide that care,” Currier said.
Speaker of the House Philip Gunn, R-Clinton, then asked whether providing this extra care would have much financial impact on the Department of Health.
“Well, so it would be very difficult, because we’d have to hire more folks in our clinics, more nurses, nurse practitioners and aids and clerks and to do that takes money, even if we get reimbursed (federally) at the lower rate … that’s down the road, so it would be difficult, ” Currier said.
Mitchell Adcock, chief administrative officer for the Department of Health, said their clinics have had a significant drop in patients since the national health law was implemented in 2013. But if numbers increase with a repeal, he said, the department would ask the Legislature for additional funding.
Some legislators, however, expressed optimism that departments could save money if they lost certain requirements from the Affordable Care Act. During the hearing on Medicaid, Sen. Brice Wiggins, R-Pascagoula, asked if the department would be able to avoid buying some expensive equipment if the health law is repealed.
“In light of the recent presidential election my guess is Obamacare is going to be looked at pretty quickly and likely to be different from what it is now, will that affect … the purchasing of equipment? My guess is because of Obamacare, the states were required to do different things to meet the mandates,” Wiggins said.
Dr. David Dzielak, executive director of the Division of Medicaid, said that the cost of commodities was likely to remain the same because Affordable Care Act regulations center on expanding eligibility guidelines.
Despite the increase in beneficiaries, the Division of Medicaid never hired more staff when the expansion was implemented in 2013. As a result, he told the legislators, he probably wouldn’t be able to make cuts in payroll, either, if the law is repealed.
Rep. Sam Mims, R-McComb, asked Dzielak about the likelihood of block grant funding. Both Trump and U.S. House Speaker Paul Ryan have endorsed a plan to transform Medicaid from an entitlement program into a block grant program.
The difference is that in an entitlement program, coverage is guaranteed for everyone who is eligible and the federal government covers 60 percent of the costs without caps. A block grant would curb this open-ended approach and provide states with annual lump sums. In return, states would have more autonomy over their Medicaid programs, allowing them to cut benefits and eligibility as they see fit. But they would also be responsible for covering costs beyond their federal allotment.
The block grant program has a history of support in Mississippi. In 2011, then-Gov. Haley Barbour advocated it, telling a Congressional committee, ““Y’all would save a lot of money if you let us run the program.”
But two days after Tuesday’s election, Dzielak admitted he had few answers about the future of funding in his division.
“I wish I had a crystal ball. That’s something we’ll have to study very carefully and see how it affects our agency and business,” Dzielak said.
Most of the budget group hearings focused on commodities, specifically state-owned vehicles. The numbers of vehicles vary widely by department, with fleets as large as 707 in the Department of Mental Health and as small as 15 in the Division of Medicaid.
Dzielak said that Medicaid replaces vehicles after they reach 120,000 miles. But other departments until they literally fall apart. The Department of Health has nine emergency trucks, one for each of the nine public health districts. The trucks were donated to the state during cleanup for Hurricane Katrina in 2005, and all are still in use — or were until last week, when one blew up in Meridian.
Currier said that the department’s strategy has been to replace the vehicles only “as they fall apart.” Lt. Gov. Tate Reeves asked if the department is concerned that waiting for an emergency vehicle to stop running before replacing could be a danger to public health.
“It does (concern us) because of the situation after this week,” Adcock said. “We do do maintenance on them to keep them safe, but … I’ll tell you this. We will probably have to address that this year.”