Nothing in the Senate’s Medicaid technical bill hints at Medicaid expansion, but that didn’t stop a string of Democrats from advocating for it during the floor debate Tuesday afternoon.

As the bill, which is intended to reauthorize the Medicaid program for another three years, headed to a vote, several Democrats took the podium, pushing well-trod arguments that expanding Medicaid would benefit both recipients and the state’s economy.

Mississippi currently has the highest Medicaid match rate in the country, receiving three federal dollars for every one dollar the state puts into the program. If the state had expanded Medicaid, which was a provision of the Affordable Care Act, that match rate would have temporarily jumped to nine federal dollars for every one state dollar spent, a point Sen. Barbara Blackmon, D-Canton referenced at the podium.

“As a result of us not taking advantage of the Affordable Care Act we lost about $9 billion that could have benefitted so many Mississippians. And when I say Mississippians, I’m not talking about just those people who are the recipients of Medicaid. I’m talking about those health care providers, those doctors, those nurses, those community hospitals that are closing,” Blackmon said.

“Maybe we want Mississippi to die on the vine? Because everything that we have been doing since I’ve been here the last three years is ensure the death of Mississippians.”

Although Blackmon and Sens. Hob Bryan, D-Amory, and David Jordan, D-Greenwood, spoke for nearly half an hour, their comments had little impact on the votes of their Republican colleagues who passed the bill, largely along party lines.

Only one provision within the Senate Medicaid technical bill sparked controversy during Tuesday’s debate. The language would allow the governor to “take all appropriate measures to reduce unnecessary costs” during a deficit. This includes dropping from Mississippi Medicaid any services not mandated by the federal government such as prescription drug coverage.

Sen. Brice Wiggins, R-Pascagoula, who sponsored the legislation, said the clause was triggered only if the agency had a deficit. But as Sen. Willie Simmons, D-Clarksdale, noted, the agency has run a deficit nearly every year for the last decade, sometimes to the tune of $90 million.

“We are giving the governor the authority to gut Medicaid,” Simmons said.

Wiggins has said that his Medicaid bill has two goals. One is to improve health care. The other is to control costs. The provisions that are geared towards the latter, such as raising the cap on the number of allowed prescriptions and on the number of doctor visits, met little push back from either Republicans and Democrats.

The same likely can’t be said for the cost containment measures in the House Medicaid technical bill, which is set to hit the floor of that chamber before Thursday.

That bill contains a provision carving out 10 percent of the managed care program,  currently occupied by three for-profit companies, to make room for a provider-sponsored plan. Currently the only provider-sponsored plan in the state is Mississippi True, a nonprofit that has garnered wide support among legislators.

But working Mississippi True into the managed care program is a tricky situation, even for the plan’s strongest supporters. Presenting the bill before the House Medicaid committee, Rep. Jason White, R-West, expressed concern that this carve out is an example of the House bending Medicaid’s rules to help out one particular company.

“You’re talking about a no-bid contract worth hundreds of millions of dollars,” White said.

Meanwhile, representatives of Mississippi True have said that 10 percent isn’t a large enough share of the market for the plan to work.

“It’s not actuarially sound unless it’s 20 percent (of the market),” said Chuck Reece, board chairman of Mississippi True.

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.