Lawmakers in the Senate came out with a dimmed version of Medicaid expansion earlier this week, and some House leaders weren’t too thrilled to hear about it.
House Minority Leader Robert Johnson took exception with his cross-chamber counterparts completely gutting an approved House bill that would have expanded Medicaid with a tentative work requirement up to 138 percent of the federal poverty level (FPL) and instead replacing it with one that only goes up to 99 percent with a strict work requirement. On Thursday, the Democrat from Natchez said the Senate plan not only would not help enough people but it would be bound for a courtroom as it somewhat mirrors a Georgia plan that has been subject to two years’ worth of litigation.
“The Senate plan looks a lot like the Georgia plan that is in litigation right now. The Georgia plan that serves 3,500 people in a state as large as Georgia, so it just doesn’t make much sense to me,” Johnson said during an appearance on MidDays with Gerard Gibert. “If all we’re going to get is the Senate plan, then we might as well not expand Medicaid.”
There are a few points of contention between the House and Senate plans to expand Medicaid, one of which is the contingency of a work requirement. The way the House bill was written before being scrapped by the Senate, the Centers for Medicare and Medicaid Services (CMS) would have had until Sept. 30, 2024, to approve Mississippi’s bid to require people to work 20 hours a week for an employer who does not offer insurance if they want to receive government-provided coverage. If CMS denied the application, full-force Medicaid expansion would then go into effect.
In the Senate’s plan, CMS would have to approve a 40-hour-a-week work requirement, or the plan would be null and void.
Secondly, the House and Senate differ on how many people to extend coverage to. While the Senate plan would have the capability to cover up to 74,000 people, Johnson fears that it could end up like Georgia’s where strict stipulations and courtroom activity have discouraged people from opting in. The House plan, on the other hand, would have covered an estimated 263,000.
The Senate’s main concern with the number of people covered under the House plan is that the federal government would transfer those presently enrolled in the Affordable Care Act (ACA) exchanges to Medicaid under full expansion. This could boost enrollment higher than estimates while also increasing the state’s projected cost of expansion. Under the Senate’s plan, those eligible for subsidized coverage in the ACA exchanges would not be eligible for Medicaid since the ACA only covers those whose income is 100 percent of the FPL or greater.
“I understand that concern, but the no-cost premium coverage is still covered by the same federal money that we’re going to be expanding Medicaid with. I mean, it’s the same money,” Johnson said when asked about worries over ACA exchange numbers. The House also attempted to address this issue in its original bill by requiring anyone with private coverage to disenroll from those plans for at least 12 months before becoming eligible for Medicaid.
Speaking of money, cost is another big factor. With how the House plan was set up, 90 percent would be covered by the federal government as it is in the 40 other states and Washington, D.C., that have all opted into Medicaid expansion since it became available in 2014. Mississippi’s 10 percent share would be covered through a tax on managed care organizations such as health insurers, according to Republican Speaker Jason White.
“Under our plan, it wouldn’t cost the state a dime,” White said prior to the House vote in February. “We would cover our 10 percent share that the state has to pay through a tax on managed care organizations that will manage this population.”
The House plan was also strategically set up with a four-year repealer that would allow the state to opt out if lawmakers don’t like the statistics or the federal government unexpectedly decides to drop below the 90 percent mark. Dr. John Mitchell, who serves as president of the Mississippi State Medical Association Board of Trustees, said Medicaid expansion will ultimately make Mississippi money.
“Everybody wants to dwell on cost. Everything in business costs (money), but you make revenue off that cost. So, let’s look at the Medicaid expansion side of revenue generation for the state of Mississippi as well as what it’s going to cost us,” Mitchell said. “Right now, we’re in a great position…because probably for six years at a minimum, it won’t cost Mississippi a dime.”
The Senate’s plan, which would decline the federal match rate as fears of full expansion being more expensive than expected and not actually free under the House plan, would cost around $26 million annually to implement, according to Johnson.
“It would cost us about $26 million a year under the Senate plan. We would forgo the opportunity to collect that $600 million that they would give us to implement a plan,” Johnson said, assuring that the money will be there to ensure Medicaid expansion is free for at least the first four years.
While Senate leaders argue that their plan is the more conservative approach to bridging the healthcare access gap without disrupting the labor force participation rate, Johnson is hopeful that they can all get together before sine die and meet somewhere in the middle to expand coverage to working Mississippians without insurance.
“I think the Senate’s approach is, ‘We’re going to be as draconian as we can about where we start, and so when we go into that room to talk to the House, where we’re going to be is somehow, we are negotiating from one end and they’re negotiating from the other end,’” Johnson concluded. “That’s the way the legislature works.”
