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A nonprofit backed by the Mississippi Hospital Association plans next week to kick off its petition drive to put Medicaid expansion before voters on the 2022 midterm ballot, hoping to override a recalcitrant Legislature and put expansion in the state constitution.
Healthcare for Mississippi next week will hold two yet-to-be announced press conferences — one in central Mississippi and one in the north — announcing the drive and naming numerous other groups that are supporting the campaign.
Tim Moore, president of MHA and a founder of Healthcare for Mississippi, said the nonprofit has inked contracts with two Mississippi companies to gather petition signatures and is “getting print materials ready, lining up speakers for next week’s opening and there will be an educational campaign starting relatively quickly.”
“I’ve been amazed at the number of people who have called, and the other groups asking how to get involved and who to give money to,” Moore said. “We’re not going to name them until next week, but we have a wide assortment of groups that are involved in this. I think the numbers are growing even faster than we expected.”
Medicaid expansion through the federal Affordable Care Act has brought heated — and most often partisan — debate in Mississippi, the poorest state in the union. Mississippi, despite its dependence otherwise on federal money, is one of just 12 states that has refused to expand Medicaid, leaving hundreds of thousands of “working poor,” uninsured Mississippians without health coverage and rejecting at least $1 billion a year in federal funds to provide it.
Proponents estimate that expanding Medicaid would provide coverage for at least 200,000 working poor Mississippians, in addition to the roughly 750,000 poor pregnant women, children, elderly and disabled people already on Medicaid.
Most of the state’s Republican leadership, starting with former Gov. Phil Bryant, have opposed expansion, saying they don’t want to help expand “Obamacare” and don’t trust the federal government to continue footing most of the bill. Meanwhile, Mississippi’s hospitals — especially smaller rural ones — say they are awash in red ink from providing millions of dollars of care each year to uninsured and unhealthy people. Hospitals pitched a plan to lawmakers to cover the state’s share of expansion with taxes on hospitals and fees for new Medicaid enrollees, to no avail.
Now, Moore said, he believes voters should take matters in hand through the state’s ballot initiative process. He believes, in part based on polling, that the push will have bipartisan support among voters.
“What do you do after a decade of waiting for the Legislature and leadership to do something and it hasn’t happened?” Moore said. “Do you wait another decade? … This shouldn’t be political. We are talking about working Mississippians who can’t afford coverage, and that shouldn’t be political at all.
“Certainly, there will be significant support from the Democratic side, but I think there is more and more support on the Republican side as well. Too many Republicans have told me, off to the side, ‘It’s time. It’s time to do something.'”
Moore and others have said expanding Medicaid by constitutional amendment is not the preferred path, and he noted that lawmakers still could tackle the issue themselves in next year’s legislative session starting in January. But should the petition drive successfully net about 106,000 signatures by October, the issue would still be on the 2022 ballot.
“(Lawmakers) can take action, not take action, come up with an alternative and put it on the ballot as well,” Moore said. “I would be tickled to death if they moved forward in January of next year… but they would have to address it early.”
Lt. Gov. Delbert Hosemann has said he’s open to discussion on the issue, one of few state Republican politicians to say so.
But House Speaker Philip Gunn has remained steadfastly opposed.
Neither Gunn nor Hosemann immediately responded to requests for comment on the ballot initiative drive kickoff coming next week.
Gov. Tate Reeves has also reiterated his opposition to Medicaid expansion, and the ballot initiative campaign is likely to face opposition from other conservative corners.
Jameson Taylor, with the conservative Mississippi Center for Public Policy, recently wrote that “Medicaid expansion is bad for Mississippi.” He said that while Medicaid is an insurance program, “Medicaid is also a welfare program. This is the root of the problem for Medicaid.”
“… Unlike TANF (cash welfare) and other welfare programs, Medicaid is an open-ended entitlement,” Taylor wrote. “… In order for Medicaid to work better, two things have to happen. First, Medicaid needs to begin operating like other welfare programs. This means enrollment is going to have to be limited. (Which also means expanding Medicaid to able-bodied, working-age adults is a very bad idea if your goal is to provide healthcare to those who really need it.)”
But health care, racial justice and other advocates of expansion say it would help impoverished Mississippi tackle one of the global and persistent problems that keeps it on the bottom: the unhealthiness of its people. The ACA expansion would provide health coverage for people making up to 138% of the federal poverty level, or about $17,600 a year for an individual.
Proponents say the expansion would also have pragmatic financial benefits for the state economy and state government budget. Besides helping hospitals cover the $600 million a year and rising they have to eat in uncompensated care for uninsured people, expansion would create thousands of jobs and improve the state health care industry overall.
The proposed Initiative 76 addresses some of this in its language, noting that the state would draw down at least $907 million in new federal funding in fiscal 2023, with the state share being about $99 million.
“However, an estimated 82% of these costs — or $80 million — would be offset by reductions in other state health care spending as a direct result of Medicaid expansion and the remainder more than offset by new tax revenue generated by productivity gains,” the proposed measure reads. “For example, in SFY 2023 Mississippi would save an estimated $51 million on currently eligible Medicaid enrollees, such as low-income pregnant women, becoming eligible for enhanced federal funding. The state would also save an estimated $29 million by accessing federal funding for hospital care for incarcerated individuals and mental health and substance use disorder treatment that currently is funded entirely by the state.”
It also says that, “Further, the infusion of new federal funding into Mississippi’s economy is projected to generate over $95 million in new state and local tax revenues each year. This would more than offset the remaining state costs of expansion and result in a net benefit to the state budget of over $76 million.”
Besides the ACA covering 90% of the cost of expansion with federal dollars, the American Rescue Plan recently passed by Congress would further increase the federal share of the cost of traditional Medicaid for two years for any of the 12 holdout states that agree to expand the program.
The Medicaid expansion ballot initiative — and other pending ones including early voting and the state flag — face an uncertain future with a pending state Supreme Court decision. The high court has heard a constitutional challenge to the medical marijuana program voters approved in November through a ballot initiative.
The court is expected to rule soon whether the initiative was constitutionally flawed because the state’s initiative language says petition signatures must be equally gathered from the state’s five congressional districts. But Mississippi has had only four congressional districts since the 2000 census, and state lawmakers neglected to address the issue.
Moore said the Medicaid expansion initiative drive is trying to take that into account, and will try to collect enough signatures to be able to meet the thresholds for either four or five districts.
However, the Supreme Court’s ruling could also halt the state’s ballot initiative process, at least until lawmakers and voters rework state law and constitutional language.