Is history repeating itself on Medicaid expansion in Mississippi?

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Under current state law, an adult does not qualify for Medicaid unless she is pregnant, disabled or caregivers in certain circumstances.

History just may be repeating itself right now in Mississippi.

In 1969 the state’s politicians, led by then-Gov. John Bell Williams, reversed course and opted to become part of the federal Medicaid program.

That reversal did not come easy. It necessitated a special session that incredibly ran from July 22, 1969, until Oct. 10, 1969, and the leadership of Williams, who had previously been a staunch and vocal opponent of the Medicaid program.

Kayleigh Skinner / Mississippi Today

Bobby Harrison

Could 1969 repeat itself? Now the state is bucking the national trend and rejecting efforts to opt into the Medicaid expansion program to provide health care to as many as 300,000 primarily working Mississippians.

It appears that the first signs of a softening of the position of many state politicians in the majority Republican Party may be occurring.

Conservative Republican gubernatorial candidate Robert Foster of DeSoto County, and popular Secretary of State Delbert Hosemann, who is running this year for lieutenant governor, have both indicated that they might consider some form of Medicaid expansion.

And excellent reporting by Larrison Campbell of Mississippi Today has revealed that Republican Gov. Phil Bryant, the most vocal opponent of Medicaid expansion, might be toying with the idea.

Medicaid expansion is part of the Patient Protection and Affordable Care Act, commonly called Obamacare and commonly disliked by Republican politicians, especially Mississippi Republican politicians.

Under Medicaid expansion, states, with the federal government paying the bulk of the cost, can provide health care coverage to those earning up to 138 percent of the federal poverty level or $16,753 for an individual. It is important to note here that under current state law an adult does not qualify for Medicaid unless she is pregnant, disabled or caregivers in certain, rare circumstances.

Dr. Alton Cobb, who served as the state’s health officer for almost 20 years starting in 1973 and previously served as executive director of the first Mississippi Medicaid Commission, saw up close Wiliams’ metamorphosis.

Cobb, who was working in the state Health Department, was recruited primarily by David Bowen, who later served in the U.S. House, to work in the Williams administration on the Public Health Advisory Board. Part of the Board’s mission was to look at federal funds available for health care.

“I didn’t vote for him,” Cobb recalled recently of when he was approached to work for Williams. “I think he probably knew that.”

But Cobb said he saw potential in what the advisory board and Medicaid could mean for health care in Mississippi.

“I wanted to be part of that,” he said.

The panel held hearings across the state, listening to health care providers and others.

“In Clarksdale, somebody asked when did Gov. Williams start hiring socialists, referring to David Bowen. They did not know who I was,” Cobb said.

Williams attended the meetings, though, he seldom spoke. He primarily listened.

At the end of the process, Cobb said he recalls Williams telling his staff he was calling a special session to take up the issue of opting into the Medicaid program.

As a U.S. House member prior to being elected governor, Williams had voted against the legislation to create the Medicaid program and had campaigned for governor railing against the excesses of the federal government.

But in a joint session of the Legislature on the first day of the special session, he told members, “In fairness, I must point out that my philosophical reasons for resisting the program as a member of the United States Congress is neither relevant nor applicable to the present issue before us. The program is a reality. It is available to our state and now devolves wholly into a question of whether you, in your wisdom, should determine our participation will be in the best interests of our state and people.”

He then went on to provide an argument for Medicaid much like is made today for Medicaid expansion. He said the program would provide health care for a segment of the population that needed it and would help the state’s health care providers and indeed the whole state by pumping more funds into the economy.

Cobb said he believes Williams was successful in pushing the controversial program through the Legislature because members saw him “as one of them.”

Cobb said he has doubts that Medicaid expansion will occur this year, but believes it is only a matter of time before it expands in Mississippi.

He does not believe the state political leaders can continue to ignore a program where the federal government picks up 90 percent of the costs for health care.

And if Cobb is right, Mississippi might act quicker than it did in 1969.

That year Mississippi was the next to last state to opt into Medicaid. Right now 14 states have yet to opt into Medicaid expansion.