JACKSON — Top Republicans in Mississippi say the state can’t afford to expand its Medicaid program to cover more people under the federal health care overhaul. Some Democrats, however, say the state should jump at the chance to provide coverage for its more than half million uninsured residents.
The U.S. Supreme Court upheld most of the federal Affordable Care Act on Thursday. But justices said the federal government can’t withhold Medicaid money from states that choose not to expand Medicaid coverage to more low-income adults.
Medicaid is a health insurance program for the needy, paid by federal and state governments. Because Mississippi is one of the poorest states in the nation, it has a high percentage of its residents already on Medicaid and receives one of the most generous federal contribution rates.
The federal health care law says that starting in 2014, states should expand Medicaid coverage to people whose income whose income is up to 133 percent of the federal poverty level, now about $30,650 for a family of four. The federal government will pay most of the tab in the early years of the expansion. Mississippi currently allows Medicaid enrollment for people whose income is up to 100 percent of the federal poverty level, about $23,050 for a family of four.
Republican Gov. Phil Bryant said Thursday that Mississippi would have to make deep cuts to education and transportation to cover expenses for an estimated 400,000 new people on Medicaid, the federal-state health insurance program for the needy.
“I understand there is some leeway in the decision to not penalize states for not complying with Medicaid requirements, and we’re going to look at that,” Bryant said in a brief interview.
The Kaiser Family Foundation gives a lower estimate of how many people could enroll in Medicaid in Mississippi if the state expands coverage under the federal health law — about 330,000.
Mississippi had 641,454 people enrolled in Medicaid in May, the most recent figure available. That’s about 22 percent of its 3 million residents.
The U.S. Census Bureau said Mississippi had about 618,000 uninsured residents in 2010, or 21 percent of the population.
House Speaker Philip Gunn, R-Clinton, said in a statement that the federal health care law could be “a budget-buster for our state.” Republican Lt. Gov. Tate Reeves said adding 400,000 people to Medicaid would cost about $1.7 billion over 10 years.
“Mississippi taxpayers simply cannot afford that cost, so our state is not inclined to drastically expand Medicaid,” Reeves said in a statement. “True health care reform should look at reducing costs for services, not increasing the burden on taxpayers.”
State Rep. Steve Holland, D-Plantersville, said Mississippi should take advantage of federal money that would come with a Medicaid expansion to provide coverage for thousands who lack it now.
“We, among all states, have a higher percentage of uninsured,” said Holland, who chaired House Public Health Committee until Democrats lost the state House majority in the 2011 election.
“The only thing that scares me with them in charge and there is no penalty for not expanding Medicaid is they’ll say, ‘We can’t afford it,”‘ Holland said of Republicans. “I tell you what, I welcome that war….. I want that debate taken straight to the people.”
Rep. Bobby Moak, D-Bogue Chitto, the House Democratic leader, said the public is already paying to provide health services for the uninsured, whether through hospital taxes or through programs to reimburse health providers for uncompensated care.
“Let’s face it … the same people that we’re not expanding Medicaid to — aren’t they using our health care services right now, anyway?” Moak said.
The current House Public Health chairman, Sam Mims, R-McComb, spent part of Thursday at the Capitol meeting with attorneys and governor’s staff members to evaluate how the Supreme Court ruling will affect Mississippi.
“We cannot afford to expand Medicaid, and we are going to do everything we can for that not to happen,” Mims said.
Senate Public Health Chairman Dean Kirby, R-Pearl, said of a Medicaid expansion: “There’s no way the state can afford it now.”