JACKSON — Advocates who want to extend Medicaid to hundreds of thousands more Mississippi residents know they face long odds at the state Capitol, where opponents of expansion are in control. Still, they say they’ll make noise about the issue during the election-year legislative session that begins in January.
“We’re going to keep that issue alive because we think it’s the right thing to do,” House Democratic Leader Bobby Moak told The Associated Press last week.
Gov. Phil Bryant and other Republican leaders have said for years that they’re flatly against putting more people on Medicaid because they’re skeptical about federal promises for future funding in a program that has already grown dramatically in recent years.
Under the federal health overhaul that President Barack Obama signed into law in 2010, states have the option to expand Medicaid to people earning up to 138 percent of the federal poverty level, or about $15,000 a year for one person. In Mississippi now, the income cutoff is about $5,500 for one person, and many able-bodied adults are not eligible for Medicaid coverage regardless of how little they earn.
The law says the federal government would pay 100 percent of medical expenses for newly qualified Medicaid enrollees from 2014 to 2017. The federal share would be reduced to 90 percent by 2020, with each state paying the balance.
Roy Mitchell, director of the Mississippi Health Advocacy Program, says about 130,000 Mississippi residents fall in an “insurance gap” because they earn too much to be on Medicaid but too little to qualify for federal tax breaks that would make private insurance more affordable. One of them is 44-year-old LaShombee Hoard of Clinton, a contract worker at a call center. She has a full-time job that does not provide insurance. Her salary, while modest, is too high for her to qualify for Medicaid unless the program is expanded.
Hoard was diagnosed in 2010 with diabetes. After housing, food and other household expenses, Hoard said she can’t afford the $400 or more a month it would cost to buy private health insurance, so she often stretches her diabetes supplies by reusing syringes to give herself insulin shots. She estimates she spends about $300 a month on insulin and supplies such as syringes for shots and lancets to prick her finger to draw blood for testing.
Paying for health care is not a luxury, she said: “It’s a life and death situation for me.”
Republicans hold a majority in the Mississippi House and Senate. For Medicaid expansion to pass, Democrats in both chambers would have to persuade a significant number of Republicans to defy the leadership. Even a simple majority of the 122-member House and 52-member Senate would not suffice. It takes a two-thirds majority in both chambers to override a governor’s veto. If all members were present, that’s at least 81 votes in the House and 35 in the Senate.
For the state budget year that begins July 1, Medicaid officials are requesting more than $1 billion of state money for the first time in the program’s history; more than three times that amount would come from the federal government. Legislators rarely grant agencies’ full requests for money, but even something just short of $1 billion would be a significant portion of a state budget that’s expected to be just over $6 billion.
During the current budget year, legislators set aside $885 million for Medicaid, and the program’s director, David Dzielak, said it needs another $99.5 million before June 30. He said the biggest reason for rising expenses is not increasing enrollment: “It’s due to the ever-escalating medical services cost.”
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