Senate Medicaid expansion plan shows generosity to the poor — but mostly in other states

About once a year, Mississippians are quick to share articles showing that our home state ranks No. 1 for the nation’s most charitable citizens.

Perhaps the leaders of the Mississippi Senate genuinely want to continue that tradition. But based on reporting about their soon-to-be-announced Medicaid expansion plan, maybe it’s fairer to say they’d rather bestow that generosity on citizens of other states. They would rather give federal taxpayer funds to help poor people in other states instead of allowing that money to be used to benefit their own Mississippi neighbors.

For more than a decade, the working poor in most other states are getting help through the Medicaid expansion program under the Affordable Care Act. But in Mississippi, because of state leaders’ long refusal to expand Medicaid, the working poor are not getting that same help.

Senate leaders, based on Mississippi Today’s reporting this week, plan to unveil a plan to expand Medicaid to cover those earning up to 99% of the federal poverty level — or individuals making about $15,000 a year. Also, as a condition, only those Mississippians earning less than $15,000 a year who are also working will be eligible for Medicaid under the Senate bill.

The Senate plan is puzzling for several reasons. One could view the Senate proposal as simply an early effort in a legislative process, where the hard work and negotiation remains to be done. This could just be simply a first draft to send to a conference committee, where House and Senate leaders — who obviously differ in their views about what an expansion program should look like — will hash out the final Medicaid plan.

By expanding Medicaid to 99% of the federal poverty level as Senate leaders reportedly will propose, the federal government would pay just 77% of the health care costs of those covered by the expansion. But if Medicaid were to be expanded to cover those earning up to 138% of the federal poverty level (about $20,000 annually) as 40 other states have done, the federal government would pay 90% of the cost.

When it comes to the expensive proposition of health care, that 13% difference in the matching rate literally means Mississippi is losing hundreds of millions of dollars each year. Instead, that money is going to the 40 other states that have expanded Medicaid to 138% of the federal poverty level.

Put more simply: If the Senate expansion plan is passed into law, Mississippi would be leaving hundreds of millions in federal funds on the table every year and covering fewer people.

No doubt, California, Massachusetts, New York and those 37 other states will appreciate the generosity of Mississippi if the Senate plan becomes law. It will continue a tradition of Mississippi taxpayers subsidizing their Medicaid expansion.

Oh, and another thing: In addition to losing the 90% matching rate under the Senate plan, the state would also forfeit another $700 million that the federal government was offering to Mississippi as an incentive to expand Medicaid to 138% of the federal poverty level. Again, the Senate leadership apparently is saying, “Thanks, but no thanks. Give that money to someone else.”

Even though we have the nation’s lowest life expectancy, we apparently don’t need that money for health care.

It should be pointed out that it does not appear the generosity of the Senate leadership reaches across the halls of the Capitol to the House leadership. The House overwhelmingly passed legislation to expand Medicaid to 138% of the federal poverty level and help the working poor in Mississippi instead of in California. Their plan would draw down the 90% match from the federal government, and it would capture the $700 million in incentives.

But under the Senate plan, Mississippi would actually have to pay money — an estimated $70 million to $100 million per year — to expand Medicaid to those earning less than 100% of the federal poverty level, according to numbers produced by Mississippi Insurance Commissioner Mike Chaney.

On the other hand, multiple studies — including one by the Mississippi University Research Center and state Economist Corey Miller — show that it would not cost the state any money to expand Medicaid to 138% of the federal poverty level for almost a decade. Miller’s study concluded there would be no costs to the state until 2032 for expanding Medicaid to 138% of the federal poverty level.

Miller’s study added, “This estimate does not reflect the economic impact of Medicaid expansion in Mississippi … which we expect will result in additional revenues to the state.” Various studies, including by the state’s University Research Center, have found that Medicaid expansion would be an economic boon to the state, generating as many as 11,000 new jobs, state revenue growth and even population growth.

But Senate leaders, being as generous as they apparently are, would rather allow those federal funds earmarked for primarily poor working Mississippians be given to those people in other states.

Bobby Harrison