Democrats in the U.S. Congress are considering a way to offer health care insurance for low income Mississippians who have been denied coverage because of the refusal of the state’s political leadership to expand Medicaid.
The proposal would provide health care coverage to people who are below the federal poverty level (an individual making $12,880 per year or less) in the 12 primarily Southern states — including Mississippi — that have not expanded Medicaid under the Affordable Care Act.
Two million Americans could access health care coverage through the plan, with the bulk of those being in Texas, Florida, Georgia and North Carolina, according to an analysis by Judith Solomon, a health policy analyst with the Washington-based Center for Budget and Policy Priorities.
In Mississippi, studies have estimated that between 200,000 and 300,000 primarily working Mississippians could qualify for coverage if the state would expand Medicaid.
“The problem is the 12 states that refuse to expand despite overwhelming evidence of the benefits of expansion of coverage to people, state budgets and health care providers,” Solomon said. “Given it’s been seven years since expansion took effect and huge financial incentives in the American Rescue Plan Act haven’t moved any states into the expansion column, this is the only way to get coverage to those who have been left out.”
The congressional proposal is being considered as part of the budget reconciliation bill that Congress is currently negotiating. The initial budget plan was $3.5 trillion, which was met with intense pushback by Republicans and moderate Democrats.
The proposal is tied up in political negotiations, and it’s possible it will not make the final bill. Southern Democrats, in particular, are lobbying their party’s leadership for the workaround to Medicaid expansion in the 12 non-expansion states. But some Democrats in states that have already expanded Medicaid are arguing that if concessions must be made in the final budget bill, they would prefer to focus on other aspects of the sweeping bill — namely providing free dental, vision and hearing coverage to seniors across income levels.
Health care is a chief policy platform of Democrats across the nation, and considering how best to move forward on providing coverage to more Americans is at the forefront of the debate. But because most of the 12 states are controlled by Republicans, and Democrats typically lose elections in those states, there is tension within the party ranks about whether the Medicaid expansion workaround is politically advantageous.
If Mississippi were to expand Medicaid under current law, the federal government would pay 90% of the health care costs with the state paying the remainder. Gov. Tate Reeves, House Speaker Philip Gunn and others have argued Mississippi cannot afford the costs of expanding Medicaid, though multiple studies — including one last week from the Mississippi state economist — have found that the expansion with the infusion of billions of dollars in federal funds would actually increase state revenue collections.
Under the proposal being considered by federal lawmakers, Mississippi would not be required to provide any matching funds.
“I imagine if there was any program like that, the governor and attorney general (Lynn Fitch) would sue to try to keep us from getting the money,” surmised Senate Public Health Committee Chair Hob Bryan, D-Amory, who has been a proponent of Medicaid expansion.
The federal American Rescue Plan, passed earlier this year as a response to the COVID-19 pandemic, provides additional incentive for Mississippi to expand Medicaid, offering more than $600 million over a two-year period. The other non-expansion states received similar incentives as part of the American Rescue Plan. Presumably, because the 12 states refused to take advantage of those incentives, congressional leadership is developing the workaround to provide coverages to the uninsured in those states.
As the proposal is currently written, people who earn under the federal poverty line could obtain insurance on the Healthcare Marketplace. People, based on their income level, receive federal subsides to help pay for their marketplace policies.
Under current law, people who earn below the federal poverty level do not qualify for marketplace policies.
Also under the proposal, those falling below the federal poverty level could obtain the insurance on the marketplace at no cost to them. And then in 2025, the people would transition to a Medicaid program run solely by the federal government.
If passed, states currently in the Medicaid expansion program could opt out of their current program and rely on the solely federal program, but they would have to provide a payment to the federal government.
“I hope the expansion states that have embraced expansion and seen its benefits will understand that this is critical to do,” Solomon said.