Emotions came to a head on the House floor Monday as Democrats fought for more spending for four health agencies.
Democrats failed, largely along party lines, in efforts to recommit appropriations bills for the departments of Health, Mental Health, Rehab Services and Human Services and the Division of Medicaid.
The Senate also easily passed their budgets for Medicaid and the Department of Health.
For Democrats, the crux of the issue centered on a newly discovered gap in revenue projections for the next fiscal year. On Friday, state economists downgraded next year’s revenue growth projections from 1.8 percent to zero, giving legislators $175 million less to spend as they iron out final budgets for the next year.
Given the size and timing of the cuts, many Democrats argued that Republican leadership was slashing agencies before anyone understood what the impact might be.
During debate on the bill for the Department of Mental Health, Rep. Tom Miles, D-Forest, honed in on this point while questioning Rep. Sam Mims, R-McComb, who presented the Health and Medicaid bills.
“When you cut this agency again like you did last year … you’d have to agree that the quality of care for our patients and our most vulnerable adults in our state is going to be affected by this?” Miles asked Mims.
“Well, as I said, I think the agency’s going to be affected,” Mims said. “I can’t tell you which part of the agency which group of people are going to be affected, but yes, this agency’s going to be affected by these cuts.”
“And you’re okay with that?” Miles continued.
“Well, I would say this budget is a piece of the pie, it’s part of the puzzle, and so I would think that each person who presents a budget to you today is not going to be thrilled with the budget they’re presenting,” Mims said. “So this budget has challenges like every budget that we’re going to present to you today.”
Republican leaders did not deny that the four rounds of cuts this fiscal year have made for a “challenging” budget. In fact, Mims used that word more than a dozen times Monday when presenting the Health and Medicaid bills.
During the discussion on the Department of Human Services, for which the House appropriated $51.5 million for Fiscal Year 2018, down $8.5 million from its original 2017 appropriation of $60 million, Miles asked Mims what he should tell constituents who are asking if programs like Meals on Wheels will continue under the new cuts.
Mims said he tells his constituents the same thing he tells his children: the state of Mississippi can’t spend money it doesn’t have.
“I guess I’d tell them what I tell those who call me,” Mims said. “We find ourselves in very challenging budget times, so we’re trying to be as responsible as we can be … We’re doing the best that we can.”
“What I always tell my children, gentlemen, is that we can’t print money,” Mims added. “Often I look outside in my backyard, and I say, ‘Do you see a money tree?’ And I don’t see a money tree. … So tell them we’re doing the best we can with the budget we have today.”
Some Democrats pushed back against that logic, arguing that the state would have plenty of money to spend on Health, Mental Health and Medicaid — if the state would opt into the Medicaid expansion.
“Well if we could make (uninsured Mental Health patients in our state) a payer through Medicaid expansion, wouldn’t that save us money? Because you’ve mentioned a lot about looking at all of the money that’s out there available,” said Rep. Jarvis Dortch, D-Raymond. “Or are you refusing to look at that money that’s out there available?”
“I don’t want to get into a debate on Medicaid expansion in the Mental Health budget, but I would just say that, no, I’m not in favor of Medicaid expansion so, no, I do not think it would help this Mental Health budget at this time,” Mims said.
The Medicaid expansion has been a controversial topic in Mississippi since the Affordable Care Act was enacted in 2014, pitting the governor and Republican lawmakers, who opposed it, against some of the biggest healthcare providers in the state.
Under the expansion, states that opt into the program receive billions of dollars in exchange for making Medicaid available to individuals who make up to 133% of the federal poverty level. Currently, single adults in Mississippi must make below $300 a month to qualify for Medicaid.
The question of the Medicaid expansion came up again in the House debate on Medicaid which, at a proposed 2018 appropriation of $918 million is nearly $90 million under 2017’s $1.1 billion dollar budget request.
In addition, four rounds of state budget cuts and a reduced appropriation left Medicaid with an $89 million deficit for 2017, some of which could carry over into the next fiscal year without a deficit appropriation from the Legislature.
Dortch pushed to recommit the legislation and open up a discussion on expanding Medicaid, arguing that it would increase Mississippi’s current federal match rate for Medicaid to 95 percent. Currently, Mississippi’s federal match rate is 75 percent, meaning the state receives three dollars from the federal government for every dollar it spends on Medicaid.
“Do you know that the match is 95 percent for adults (under Medicaid expansion),” Dortch said. “So instead of paying 25 cents we’d be paying a nickel.”
“There’s no sense in having a hypothetical debate about expanding Medicaid when it’s not in this legislation and it’s not happening,” Mims said.
Appropriations bills for the departments of Health, Mental Health, Rehabilitation Services, Human Services and the Division of Medicaid passed largely along party lines.