Medicaid expansion may be the topic at hand, but for Mississippi legislators, Medical Marijuana may be on their minds after Hattiesburg pediatrician John Gaudet filed a proposal for a ballot initiative that would allow voters to decide whether to expand Medicaid, something the state Legislature has steadfastly declined to do for more than a decade.
Gaudet filed the motion with the Secretary of State’s office on Feb. 17. A petition signed by 106,000 registered voters is required before the measure — called Initiative 76 — is put on the ballot, most likely as part of the 2022 midterm elections.
As part of the filing process, Gaudet, who filed on behalf of the national advocacy group The Fairness Project, was required to include a section on how the expansion would be funded.
That section does not require Medicaid enrollees to pay a portion of the health care cost, something Medicaid expansion in other states — most notably Indiana — requires.
Under Initiative 76, residents between ages 18 and 65 whose income does not exceed 133 percent of the federal poverty rate would be eligible for Medicaid health benefits. Various estimates indicate the expansion would extend coverage to anywhere from 200,000 to 300,000 Mississippians who do not currently have health care.
The Biden Administration has offered Mississippi, along with the other 11 states that have not expanded Medicaid under the 2010 The Affordable Care Act, additional federal funding that would offset 95 percent of the costs. Wyoming became the 39th state to pass Medicaid expansion last week.
Gov. Tate Reeves and Speaker of House Philip Gunn remain opposed to expansion while Lt. Gov. Delbert Hosemann has expressed support for a modified form of Medicaid expansion, frequently referring to the Indiana model.
Like medical marijuana prior to 2019, Medicaid expansion efforts have gained no traction in either chamber, however.
The Initiative 76 filing may stir the Legislature to take up Medicaid expansion during the 2022 session when there is still time for the Legislature to craft its own expansion rather than leave it up to the voters.
“I do think we’ll take that up in the next session,” said Rep. Dana McLean (R-Columbus). “Like medical marijuana, this is something the Legislature should decide.”
This year, the Legislature passed its own Medical Marijuana law, but only after Initiative 65 had qualified for the ballot. In November, voters passed the initiative by an almost 3-to-1 margin.
McLean doesn’t want to see a similar outcome with Medicaid expansion.
“It’s a very complicated issue, one that we should rely on our experts to explain so we can put together legislation that doesn’t create problems down the road,” she said. “That’s the problem with referendums. Voters don’t always understand the complexities, and in the end you get something that can create more problems. That’s why I think Medicaid expansion is something that should be addressed in the Legislature.”
According to polling, 53 percent of Mississippians favor Medicaid expansion. Expansion also has a network of organizations supporting it, including the Mississippi Hospital Association, whose board will vote today on supporting Initiative 76.
Gaudet said Medicaid expansion should not be a matter of political ideology.
“This issue is not something that needs to be political or create division,” he said. ”I think Mississippians have a heart for each other. I’ve seen the issue go from being a divisive one to something a broad swath of people can get behind.”
The main resistance comes from conservative Republicans, including Reeves and Gunn, but Rep. Rob Roberson (R-Starkville) believes there is some support for Medicaid expansion among rank-and-file Republicans.
“I think it’s about 50/50 for some kind of expansion,” Roberson said. “I think a plan that would require some kind of payment by those who are getting the coverage would be something a lot of Republicans could support.”
When the Legislature meets in January, the issue may be a choice between fashioning a modified form of Medicaid expansion conservative legislators can live with or leaving it up to the voters on Initiative 76, which does not provide the limitations they prefer.
“It seems like (the Legislature) always wants to come back after the fact and throw something together,” said Rep. Kabir Karriem (D-Columbus). “I would love to see the Legislature pursue this, but if history is any indicator … well, I’m not sure that will happen. The silver lining is that at least it will be open for discussion now.”