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Medicaid expansion still an unclear path

February 17, 2013

Sid Salter

Proponents of putting another 288,000 on Medicaid in Mississippi contend that Medicaid expansion would serve as long overdue relief to the state’s large number of uninsured and provide a boost to the state’s economy.

Republican leaders in both the executive and legislative branches of Mississippi’s government are already on record opposing the Medicaid expansion for budgetary reasons. Gov. Phil Bryant said funding a Medicaid expansion would require substantial budget cuts in education and transportation.

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.

Democrats say the poorest state in the Union can’t afford to turn down additional federal dollars available for public health care. Advocacy groups are also beating the drums in favor of the state moving forward with a Medicaid expansion and many of the state’s hospitals support the expansion as well.

Are the choices on Medicaid expansion really that clear? Do lawmakers face two distinct choices? Unfortunately, the answer is “no.”

Consider the report released recently by the Kaiser Commission on Medicaid and the Uninsured that documented that regardless of the decision of Mississippi’s government on whether to expand Medicaid as part of the Affordable Care Act (ACA), state Medicaid costs will increase because of those made newly eligible for Medicaid – expanded or not.

“State Medicaid costs will jump $76 billion, or nearly 3 percent, during the next decade if all 50 states decide to expand Medicaid eligibility in 2014 under the federal health law. But state spending on the program would still increase to the tune of $68 billion even if not a single one opts for the expansion,” according to the Kaiser study.

So the inherent increased Medicaid costs regardless their actions are an uncertainty for lawmakers. In addition, there’s another piece of information that clouds the debate and it’s particularly relevant in a state with a high degree of poverty, uninsured citizens, and a growing illegal immigrant population.

There are other budget considerations about expansion and “hidden” growth in Medicaid costs.

While federal law generally bars illegal immigrants from Medicaid coverage, there is a provision for Medicaid coverage for emergency treatment. Congress approved the coverage after mandating that hospitals “screen and stabilize” all emergency patients regardless of their citizenship or insurance status.

Last year, the national Medicaid program spent $2 billion on emergency treatment for Medicaid patients. Kaiser Health News reports that the group benefitting from those expenditures was “mostly” illegal immigrants. The Kaiser report identified “the lion’s share” of the $2 billion as being spent on delivering babies for women who show up at hospital emergency rooms.

Gov. Phil Bryant was pilloried by MSNBC’s Rachel Maddow and others in the national media when he recently said regarding the Affordable Care Act: “There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room. There are better ways to deal with people that need health care than this massive new program.”

But the fact is that Bryant’s perception of how public health care is delivered at street level is accurate. The poor, the uninsured and illegal immigrants are in fact flooding hospital emergency rooms to get health care. The problem is that doling out public health care through emergency rooms is the most expensive means of doing so.

Lawmakers will be whipsawed between justifiable concerns of the unknown long-term costs of Medicaid expansion and the state’s hospitals and advocacy groups supporting expansion to offset the costs of delivering public health care through the state’s emergency rooms.

Anyone who tells you this isn’t a complex decision with far-reaching ramifications for the state’s budget isn’t paying attention.

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

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