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Biggest election impact will be on health care

November 11, 2012

Sid Salter

As it turns out, Mississippi Insurance Commissioner Mike Chaney was wise to keep quietly plugging on a health care exchange plan despite drawing criticism from some in his own Republican Party.

With President Barack Obama winning a second term and Democrats keeping control of the U.S. Senate, the Affordable Care Act or “Obamacare” public health care reforms are here to stay. Obama’s win send many state scrambling for direction on how to move forward, but in Mississippi the groundwork had already been quietly, systematically laid for being able to meet a Nov. 16 deadline for states to tell the federal government whether they will create a health insurance exchange.

The same Supreme Court ruling that initially gave Republican leaders some wiggle room on Medicaid expansion leaves far less such on the health exchange. Under the ruling, states are left with three choices: First, the states can operate their own insurance marketplace using federal funds to acquire and implement the technology to allow insurance customers to compare and buy their own insurance.

Second, the states can leave that responsibility and the control of the process to the federal government. Third, states can create a federal-state “partnership” to set up a health exchange.

Despite prior criticism from some in his own party, Chaney chose to lay the groundwork for Mississippi to operate its own health insurance exchange under state control. While many states are now scrambling after President Obama’s re-election, Chaney quietly prepared to operate a state-run exchange and is now considered somewhat of a national expert on how states can go about setting up the exchanges from within the guidelines of the three possible approaches.

That’s the post-election good news in Mississippi regarding the Obama health care reforms.

But the bad news is that a monumental battle now looms over Medicaid expansion.

When the Supreme Court ruled that the federal government can’t threaten or withhold funding for the state’s existing Medicaid program simply because the state fails to expand Medicaid as dictated by the Obama health care reform act, conservatives in the Mississippi Legislature and Gov. Phil Bryant found their opportunity to resist a major component of the legislation.

Republican leaders in both the executive and legislative branches of state government are on record opposing the Medicaid expansion for budgetary reasons. Bryant said funding a Medicaid expansion would require substantial budget cuts in education, transportation, corrections and other essential functions of state government.

Republican Lt. Gov. Tate Reeves said adding 400,000 people to Medicaid would cost about $1.7 billion over a decade. GOP House Speaker Philip Gunn called the expansion a “budget-buster” for the state.

But health care advocates, the Mississippi Hospital Association and many others disagree to the point of calling a failure to expand Medicaid the equivalent of missing an economic development opportunity. The debate of what constitutes “the right thing” is one that will generate more heat than light, but the debate will continue over how the state can afford an expansion of Medicaid in the future.

Proponents of expansion cite the belief that as the poorest state in the union Mississippi can ill afford to turn down that infusion of public health care dollars both from the standpoint of public health and that of the state’s stagnant economy. Opponents say with the federal government drowning in debts and deficits from entitlement programs that are already in dire fiscal danger, betting the future on yet another expanded entitlement is not only a danger to the federal government’s stability but to the state’s fiscal well-being as well.

Get used to hearing those arguments, for they will dominate the 2013 legislative session. Bottom line, state officials worry that future Medicaid costs will be shifted to the states to pay for the increased Medicaid enrollments.

Sid Salter is a syndicated columnist. Contact him at 601-507-8004 or

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