Hospitals retool Medicaid expansion, hope public outcry presses governor to actBy LARRISON CAMPBELL/MISSISSIPPI TODAY,
With Gov. Phil Bryant and hospitals locked in an impasse over Medicaid expansion, a group of Mississippi hospitals is hoping the public will rally behind a new plan to expand Medicaid access in Mississippi.
Tim Moore, the chief executive officer of the Mississippi Hospital Association, announced the plan, called Mississippi Cares, before a crowd of hospital administrators on Monday. Moore said state leaders are out of touch with Mississippians, a majority of whom support Medicaid expansion, he added.
“If you look across the state of Mississippi, and you look at the support that’s in this room, that it’s time to move forward with (expansion),” Moore said. “I think our administration, our leadership, needs to understand there’s a lot of support in Mississippi to move forward with a plan like this.”
Since the launch of the Affordable Care Act in late 2013, 37 states have opted to expand Medicaid access to adults who earn less than 138 percent of the federal poverty level. Many fall into what’s called “the coverage gap,” meaning they earn too much to qualify for federal Medicaid and too little to qualify for a subsidy under the health care law. Despite qualifying for a 90 percent federal match rate, the highest in the country, Mississippi has not yet expanded Medicaid.
More than 350,000 Mississippians currently don’t have health insurance, according to the Kaiser Family Foundation. This leaves Mississippi hospitals, which are federally required to treat anyone who comes to the emergency department, regardless of an ability to pay, on the hook for $600 million in uncompensated care each year.
Late last year, Moore said that the hospital association met with Bryant and Division of Medicaid officials to discuss potentially expanding Medicaid within Mississippi. Moore said the governor asked for a proposal but never responded after it was delivered.
“I’ve not heard back from the governor since November on that. At the time he was interested in learning more about it, actually asked for a proposal. That proposal was presented. I can’t tell you what his thoughts were on it after that. I can’t probably say more than that. I was asked not to talk about it after that meeting,” Moore said.
The governor’s office did not immediately respond to a request for comment for this story.
In December, Mississippi Today reported that Bryant had quietly been in talks about a form of Medicaid expansion, similar to the one Vice President Mike Pence had rolled out when governor of Indiana. Bryant, officials in his administration and his supporters dismissed the report as unfounded, later saying that Medicaid expansion would not be a part of the governor’s 2019 legislative agenda.
Speaking Monday, Moore compared Mississippi Cares, which is based on the proposal the association submitted to Bryant in November, to Pence’s Indiana plan, stressing, as Indiana officials had, that “this is not Medicaid expansion.”
“We’re using ‘Medicaid reform,'” Moore said.
Regardless of what Moore calls it, Mississippi Cares, like Healthy Indiana, is technically Medicaid expansion, made possible by the federal Medicaid reforms passed under the Affordable Care Act. And like Healthy Indiana, Mississippi Cares would subsidize part of the state’s 10 percent share of costs — projected to be around $117 million a year — by charging participants limited fees, in this case a $20 monthly premium and $100 for every non-emergency visit to the emergency room. Hospitals in the plan would pay the rest of the state share.
Another similarity the plan shares with Indiana is how it would be implemented. Although most states that expanded Medicaid did so through legislative action, a handful, including Indiana, applied through a federal waiver program. Mississippi Cares would also depend on that waiver, which only the Division of Medicaid has the authority to seek.
Since Bryant controls the Division of Medicaid, he would need to approve the application, hence the Hospital Association’s hope that the public will persuade Bryant to support the plan.
“We need public support for this,” Moore said.
Mississippi Cares also revives Mississippi True, which would act as the insurer for all enrollees, by Moore’s estimates could be as many as 300,000 people. Mississippi True, a provider-run insurance company formed by many of the Hospital Association member hospitals, failed to get a contract to insure current Medicaid recipients back in 2017.
The hospital association lobbied lawmakers hard after this, but a clause that would have required the Division of Medicaid use Mississippi True to insure some of its beneficiaries dropped out of the Medicaid tech bill in the eleventh hour of the 2018 legislative session.
But Moore said Mississippi Cares is not just an attempt to save Mississippi True, which member hospitals had invested tens of millions of dollars creating.
“This is an insurance policy that is funded by hospitals for this population, a population that can’t afford insurance, (so) it is different,” Moore said.
Regardless of what the current administration does, Medicaid expansion has become a big campaign topic among those vying for Bryant’s job in 2019. This includes not just Democratic front-runner and Attorney General Jim Hood but also two Republicans pursuing the gubernatorial nomination.
Shortly after Moore announced the Mississippi Cares, one of those two Republicans, retired Chief Justice of the Supreme Court Bill Waller Jr., voiced support for the plan. Current Republican front-runner Lt. Gov. Tate Reeves did not respond to a request for comment, but he has steadfastly opposed all forms of Medicaid expansion.
“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,” Waller said in an emailed statement. “The proposed Mississippi Cares plan will similarly address these issues by increasing access to care without putting taxpayers at risk.”