Medicaid battle different now

Columns

March 13, 2013

Medicaid battle different now

Sid Salter, Syndicated columnist The Picayune Item Picayune Item Wed Mar 13, 2013, 11:30 AM CDT

PICAYUNE — In most years and certainly in recent years, Mississippi’s annual state legislative battle over Medicaid has been different than it is in 2013.

Medicaid is the federal-state public health care program for the aged, the blind, the disabled and members of low-income families with dependent children. Almost 40 percent of Mississippi’s Medicaid recipients are children, 25 percent are elderly and about 22 percent are disabled.

Prior to 2013, Medicaid funding battles were fought on the more familiar political turf of the state’s peculiar history of actually authorizing a more expansive Medicaid program than it funded — a program that would extend benefits far in excess of state funding provided to pay for it.

The legislative battles were two-fold — first over the scope of Medicaid services to be provided, then how much money to provide to pay for the program authorized. That process generally produced Medicaid deficits and likewise produced fights over deficit appropriations or administrative rabbits pulled from hats in the Division of Medicaid to pay for the program and prop it up until the next term.

Over the last decade, there were various strategies to fund Medicaid. In 2005, lawmakers began meeting the state’s growing Medicaid deficits with one-time money. They used money from the supposedly “inviolate” Health Care Trust Fund — the monies supposedly won by the state in the state’s tobacco litigation to provide a long-term supplement for public health care costs.

Then, against the backdrop of a running battle between former Gov. Haley Barbour and the state’s hospitals over funding Medicaid with increased “provider fees” or the so-called hospital tax, lawmakers use substantial portions of the federal funds provided for relief from Hurricane Katrina to meet Medicaid expenses. Then those funds were exhausted.

Next came the legislative strategy of funding Medicaid from federal stimulus funds trumpeted by President Barack Obama and approved by Congress. Those dollars are now exhausted, too.

That’s a brief history of Medicaid funding in Mississippi — which has been a reliable farce in terms of seeing the executive and legislative leadership careen from one pile of one-time money to the next to fund the state’s outsized Medicaid program. The state’s Medicaid program was made large not by political irresponsibility but by the sheer size and scope of poverty in Mississippi — one exacerbated in recent years by recession and joblessness.

But the 2013 battle is different in that lawmakers and the executive branch leadership are pausing over the decision of whether to fund Medicaid with the ultimate pile of one-time money — the Affordable Care Act or “Obamacare” — in a fashion the state’s Republican leadership believes could leave future legislatures holding the fiscal bag.

The Republican leadership — Gov. Phil Bryant, Lt. Gov. Tate Reeves and House Speaker Philip Gunn — all say they oppose a Medicaid expansion in Mississippi funded by the Affordable Care Act because of state budgetary concerns.

But Democrats and public health care advocacy groups say Mississippi can't afford to turn down additional federal dollars available for public health care in a state with such a high percentage of uninsured citizens.

Republicans have a 65-55 majority in the House, which is enough to block Medicaid expansion but not enough to force Medicaid’s reauthorization. Without reauthorization, the program technically shuts down on July 1.

The remaining days of the 2013 legislative session could see new coalitions forming, could see a special session on the subject called by Bryant, or could see Bryant forced to try to operate the program by executive order— which will bring almost certain lawsuits from those seeking to expand Medicaid under the ACA.

Regardless, Medicaid will dominate the legislative proceedings for the rest of the session. (Sid Salter is a syndicated columnist. Contact him at 601-507-8004 or sidsalter@sidsalter.com)

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