When it comes to the provision of public health care in Mississippi, the partisan political considerations have changed little since Democratic former President Barack Obama signed his Affordable Care Act into law.
Democrats favor it. Republicans oppose it.
Republicans have generally opposed Medicaid expansion in Mississippi, citing budget considerations and fears over future changes in Medicaid coverage and reimbursement rates. Mississippi Democrats have generally supported the health care policy initiatives of their party under the ACA. Still, both parties have worried about how such possible fiscal impacts would influence an old legislative truism. Once state government agrees to provide a service and constituents come to depend upon it, it’s politically difficult to take that service away.
Historically, Mississippi lawmakers have been fine with the federal government paying the lion’s share of health care provision for the poor, the aged, the blind, and children, but they are wary of being left holding the fiscal bag should Congress or a future White House administration change the Medicaid rules.
Mississippi Gov. Tate Reeves and Republican Mississippi House Speaker Philip Gunn have repeated their opposition to Medicaid expansion in recent days. Gunn was characteristically direct in his comments on the topic to Mississippi Today: “I don’t see Medicaid expansion as something that is beneficial to the state of Mississippi. I just don’t think the taxpayers can afford it. That is what it boils down to is the taxpayers. It is their money. I just don’t have taxpayers calling saying we want you to raise taxes so we can expand Medicaid.”
Twelve states have yet to adopt Medicaid expansion: Mississippi, Wyoming, Texas, South Dakota, Wisconsin, Tennessee, Alabama, Georgia, North Carolina, South Carolina, Kansas and Florida.
As noted often before when discussing Mississippi’s public health care, taxpayers will continue to pick up most of the tab. The only real mystery is whether federal, state or local taxpayers bear the lion’s share of those costs or – and this is the more likely outcome – a combination of all three with varying percentages of responsibility.
Currently, Mississippi “pays” for that health care through Medicaid dollars and the delivery of uncompensated care. Nationally, uncompensated care in the U.S. is estimated to comprise 55 percent of all emergency care delivered. In Mississippi’s state-owned rural hospitals, that percentage is believed to be significantly higher.
The
Mississippi Supreme Court is considering a legal challenge questioning
the legality of Secretary of State Michael Watson’s certification of the
state’s successful medical
marijuana initiative placed on the 2020 ballot based on the contention
that it was done in violation of Section 273 of Article 15 of the
Mississippi Constitution. The outcome of that case looms large over the
future of a new initiative effort to sidestep the
Legislature and put Medicaid expansion to a statewide vote. (KF: The column was submitted before Friday's decision.)
Spurring the Medicaid expansion initiative efforts are congressional efforts to offer non=expansion states like Mississippi substantial additional fiscal incentives to expand the program.
Many dominoes must fall to get to that possible initiative, but if it eventually transpires, what about legislative concerns over the fiscal ramifications of Medicaid expansion in Mississippi?
A 2020 National Bureau of Economic Research working paper by Massachusetts Institute of Technology economist Jonathan Gruber and Harvard economist Benjamin Sommers offered the following assessment from the non-partisan, non-profit think tank:
“We find that Medicaid expansion increased total spending in expansion states by 6% to 9%, compared to non-expansion states. By source of funds, federal spending in the states increased by 10% in the first year of Medicaid expansion, rising to 18% in 2018. Changes in spending from state funding were modest and non-significant, with less than 1% change from baseline annually in the most recent years, 2017 and 2018.
“Meanwhile, we find no evidence that increased Medicaid spending from expansion produced any reductions in (state) spending on education, corrections, transportation, or public assistance.”
Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.
13 comments:
a non-partisan think tank with a Harvard professor--seems unlikely. The think tank is partially funded by the social security administration. Bill Gates helps too.
He could have started and finished this column in three paragraphs.
And this statement of Sid's is a total 'so what?'
"Twelve states have yet to adopt Medicaid expansion: Mississippi, Wyoming, Texas, South Dakota, Wisconsin, Tennessee, Alabama, Georgia, North Carolina, South Carolina, Kansas and Florida."
Let's go ahead and spend our brains out. We need to get the inevitable national insolvency out of the way. Sooner the better.
Soon as they fix this referendum mess Medicare expansion is going to be on the ballot and it is going to have as much or greater support than MM. Good luck with circumventing the will of the people on that one.
Mississippi tax payers cannot afford Medicaid expansion but somehow we can afford to continue and try to overturn ROE v. WADE every year.
Plenty of federal/state dollars to get things done...the question is still: Where's it going? Shad White knows, but play along.
9:38 - Although there are thousands of program-sucking liberals in this state, there are not nearly enough for this to survive a ballot based on the referendum process. Sorry...try again. Your initiative is off the rails.
I’m not sure this is as widely opposed by republican voters as some think. There’s a large number of healthcare related jobs in the area and additional resources are hard to turn down.
This is a very complicated issue. Mr. Salter’s article is lacking in substance and subject matter expertise. While our politicians “reasons” for objecting expansion seem to be political on its face, it’s actually financially prudent to do what has been done. Why? Because Mississippi. If you don’t like it, please feel free to move to the State of New York. A state where the expansion has cost an absolute fortune and has been regulated to the point of being ineffective. Do we have a comparison of a successful state’s expansion (similar size, population, rural spread, economy, annual revenues, etc.) to clearly show how Mississippi has mishandled things?
It’s funny how people will say this is a “political” issue while ignoring the fact Mississippi is stuck in its own world. Outdated laws for worker’s compensation. Think the “lifetime” payout is still stuck at $100k. That’s correct, $100k for a lifetime’s work. How about one of the worst states for employment protections in the U.S.? If there isn’t a federal law on the books the State has to meet; there are no employee protections.
Very hostile environment we have created for educated people or “hi-tech” companies to either create businesses or invest. If you’re looking for a place to set down roots that supports business owners from their cheap labor force...well you’ve come to the right place. If you’re looking to settle someplace and setup shop where there is a strong economy, high earners aren’t taxed beyond recognition, and likeminded entrepreneurs and progressive thinkers....this isn’t the place for you.
Same thing with tort reform. Medical negligence non-economic is capped at $500k. The awards for medical care and economic damage are historically just as paltry. Our state leadership (decades) has always treated its citizens as second class. Why would expansion of healthcare benefits for the working poor be any different?
7:44 - You should celebrate (not decry) the fact that Mississippi is the only state without a (redundant) Department of Labor and one of the few states that allows an employer to terminate an employee out on Work Comp. Go ahead and celebrate with the rest of us...well, other than those drinking beer out of a paper sack on the porch.
I'm willing to bet you've never held a management job, never met a payroll and never created or staffed a business. Your only knowledge of employment law, business and investment you either learned from a professor or on liberal web-pages. You're just a blogger who hangs out in The Fondren.
Well I for one have decades of filing my taxes with a P&L summary 2:37. And I find it deplorable that the state of Mississippi has such little regard for those scratching out an existence at the bottom. While certainly I am in the minority it seems very apparent that I am not alone in my opinions on that situation.
And Mississippi's true deplorables are not the poor but rather those who denigrate the poor.
" This is a very complicated issue. Mr. Salter’s article is lacking in substance and subject matter expertise. "
Well 7:44, I don't know how long you've being reading Mr. Salter's columns ... but that seems to be his standard approach to any issue that he writes about.
@2:37
“I'm willing to bet you've never held a management job, never met a payroll and never created or staffed a business. Your only knowledge of employment law, business and investment you either learned from a professor or on liberal web-pages. You're just a blogger who hangs out in The Fondren.”
Wrong on every single assumption.
Seventh generation Mississippian. Top 1% of the earners in this lovely state. Pay more than my fair share of taxes. Have held multiple management positions and still do. Have started and sold businesses. Grew up in a family run business. Knew how to do inventory and count change before 1st grade. Understood if we didn’t treat our customers well; we didn’t eat. Have extensive knowledge of business law (multiple states/federal/international).
It’s okay to be successful and still see how broken our system is. For someone to have a clear understanding why the latest generation is moving out in droves. It’s also okay to speak out over injustices we keep heaping on our working poor. There is a reason Mississippi ranks in the bottom of just about every measure of success and high in the least desirable.
Forgot to point out that the only compensation we offer those that have been found guilty and imprisoned in error is $500k. Imagine, spending 20 years of your life incarcerated for a crime you didn’t commit and the most you will see is $500k for this atrocious injustice. You haven’t been able to work and contribute to SS... no retirement for you either. We treat the most vulnerable like their lives don’t matter.
Again, okay to have an opinion and do your best to bring about change.
BTW... have never been to Fondren. What am I missing? Only people that live in the Jackson metro area think the entire world revolves around the center of the state. The rest of us experience a much richer and abundant life.
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