Proposed Medicaid reform plan stirs debate

Medicaid expansion has been proposed in Mississippi. After the recent announcement of a proposal, Mississippi Cares, from the Mississippi Hospital Association to bring about Medicaid reform for roughly 300,00 Mississippians.

Mississippi Cares would cover non-disabled adults age 19-64 earning up to 138% of the federal poverty level (currently approximately $17,000 for an individual or $35,000 for a family of four). Plan participants would contribute $20/month in premium payments, with a $100 co-pay for non-emergency use of a hospital emergency department.

“The interesting part I think of this proposal is the fact that it doesn’t cost taxpayers a dime,” said Timothy Moore, President of the Mississippi Hospital Association. “There will be no state dollars in this. The hospitals have stepped up and said that if the participants will participate and they pay minimal monthly premiums, then we will cover the rest of it. If you stop and think of it, this is truly a healthcare policy that is paid for, [majorly] by hospitals for patients that they are already taking care of.”

Instead of state funds needed to make the program work, Moore says roughly $1 billion in federal dollars would be coming in if the 300,000 is correct. Participants would pay a $20 a month premium and hospitals would make up the difference in the 10% state share which would then be used to draw down the 90% state share.”

However, Insurance Commissioner Mike Chaney says there are some issues with the idea. While he said he applauds them for bringing forth an idea, he says Medicaid expansion isn’t the way to go.

“The legislature will have to address the issue because it is Medicaid expansion,” said Chaney. “Although they don’t call it that, it is Medicaid expansion. If you’re charging the consumer $20 a month, and you’ve got to make up the other $400 a month somewhere it’s got to come from the federal government. Some will come from the hospital association, but if they’re making that much money they need to lower their rates.”

Chaney said if it is a pure insurance product then he will regulate it, but if it is a Medicaid product then the Governor and the legislature will be in charge of it.

“The legislature will have to give them a sole source contract and I don’t see that happening on a $1.5 billion project,” said Chaney. “That’s a lot of money. That’s 20% of the state budget and when you have that much money coming out of the state coffers, it affects education funding, it affects highway funding, it affects all the core elements of government that you have to look at.”

There would also need to be a waiver from the federal government which Chaney says is not likely to happen in a reasonable time frame. Through the process of creating the proposal, Moore said they looked at a number of states including Indiana, Louisiana, Arkansas, and Utah which recently put in place a new waiver program.

“We looked at a number of states, Indiana being one of them,” said Moore. “We were very excited about some of the things that Vice President Pence did there as Governor. They made sense both from providing and addressing healthcare needs there and they also represent some very conservative principles that we feel like are important in the state of Mississippi, but we are still getting coverage to those individuals that need it. It’s a challenging situation, but when you take the economic effects out of it, you take the costs out of it for the state I can’t imagine anybody being against it.”

Governor Phil Bryant who has repeatedly said he is decidedly against an expansion of Medicaid in the state says this isn’t a realistic proposal as he believes a Supreme Court decision will soon overturn the lawfulness of the Affordable Care Act, otherwise known as Obamacare.

“The expansion of Medicaid right now is a fool’s errand because another federal judge in Texas has ruled that Obamacare is unconstitutional,” said Bryant. “It is making its way to the Supreme Court which I believe will also say it’s unconstitutional when that happens, the federal government will not have the authority to pay their portion of Medicaid, so the states will have to pick up every bit of it. The expanded states are going to have to pick up that expansion population. Mississippi does not need to do that, we need to wait and make sure that the federal courts do not overturn Obamacare. If that happens, it is going to have to go back to Congress and we all know it will take years if it ever [happens] to rewrite a law that will be constitutional.”

Bryant says he believes the real causes are due to the reductions of Medicare.

“The Obamacare bill unnecessarily took funding away from Medicare, so when a Medicare patient goes to a hospital, those numbers are affecting the cost of that patient care dramatically because they are being absorbed by rural hospitals. It is Obamacare that cut Medicare that is the real problem, not an expansion of population.”

However, others say something has to be done. Former Supreme Court Justice and Republican gubernatorial candidate Bill Waller Jr. expressed his approval for the Mississippi Cares plan which he says would not put taxpayers at risk.

“I have pushed for access to quality health care since the beginning of my campaign. We have 31 hospitals in Mississippi in danger of closing. I am in favor of using conservative principles to reform our health system just like Vice President Mike Pence did as Governor of Indiana, and that has been adopted in Arkansas and other states. The proposed Mississippi Cares plan will similarly address these issues by increasing access to care without putting taxpayers at risk.”

Louisiana which is two years into their new program has decreased uncompensated care by 50%. Moore said uncompensated care was $623 million in Mississippi last year alone.

“When it exceeds $600 million we’ve got issues that are creating catastrophic problems for rural hospitals as well as urban hospitals,” said Moore. “This is not Medicaid expansion. If we were going to do Medicaid expansion, we would just take this group of people and put them in the existing Medicaid program. That is not what we are doing. This is a completely different model. This is truly a health insurance policy that is paid for by those participants and hospitals and the federal government to provide services and create a more healthy lifestyle.”

Chaney added that Mississippi currently has the lowest insurance rates in the United States, and yet there is high-quality healthcare being given.

“We don’t want to dumb that down,” said Chaney. “What we want to do is to continue having high-quality healthcare at reasonable prices and I am not sure this plan will do that.”

READ MORE: Mississippi hospitals propose Medicaid reform alternative