Wednesday, February 7, 2024

Sid Salter: Medicaid Remains Widely Misunderstood as Legislators Seek to Help Working Poor

 Discussing Medicaid and the role the program plays or should play in expanding healthcare opportunities for Mississippi’s working poor produces the kind of headache usually reserved for those who eat ice cream and wash it down with hot coffee – or those who watch TV news coverage of the Medicaid expansion issue on Fox News and MSNBC back-to-back.

With Mississippi legislators in both the House and Senate encouraging consideration of varying degrees of partial Medicaid expansion during the 2024 session, that discussion is relevant and necessary. From Lt. Gov. Delbert Hosemann and House Speaker Jason White, there have been what I interpret as very since expressions of concern and frustration about gaps in healthcare availability for Mississippians who are regularly and gainfully employed.

But there remains a hard partisan and philosophical division among lawmakers over how Mississippi advances any substantial expansions of the Medicaid program and second-term Gov. Tate Reeves has remained adamant in his opposition to Medicaid expansion.

On the left, Democrats in the Mississippi Legislature and allied special interest groups seek full Medicaid expansion. On the right, legislative Republicans holding a supermajority and their allies range from flat opposition to Medicaid expansion to varying appetites for forms of Medicaid expansion with work requirements and other factors designed to limit program growth or impede “lifetime” expanded Medicaid eligibility like renewals, income-linked premiums and other strategies.

In December, the Mississippi Division of Medicaid (DOM) reported 802,529 Mississippians enrolled in Medicaid or the Children’s Health Insurance Program or CHIP. The Kaiser Family Foundation estimates that about one in four Mississippians are eligible for these programs under current rules.

Medicaid is a joint federal-state program, but at present the federal government pays 77% of the cost of traditional Medicaid and the state pays 23%. Some 62% of Mississippi adults on Medicaid are working. DOM reported in a 2020 legislative report that state Medicaid enrollees segment as follows: 56% are children, 23% are disabled, 9% are elderly/Medicare eligible, 7% are low-income parents/caregivers, and the remaining 5% are family planning/pregnant women.

One element that may prove key to any expansion of Medicaid in Mississippi is the status of the Section 1115 waivers from the Social Security Act granted by the Centers for Medicare and Medicaid Services. As various states attempted to integrate work requirements into Medicaid expansion efforts, this waiver program became a frequently used mechanism to accomplish that.

Section 1115 waivers have figured prominently in partial Medicaid expansions in states that Mississippi lawmakers are studying like Arkansas, Georgia and Kentucky. And these waivers have been politicized over the last several years.

As reported by the Kaiser Family Foundation, distinct partisan differences have emerged:

“The Trump Administration’s Section 1115 waiver policy emphasized work requirements and other eligibility restrictions, payment for institutional behavioral health services, and capped financing.” and,

“The Biden Administration has signaled a shift in policy to emphasize waivers that expand, rather than restrict, Medicaid coverage and access to care. The Biden Administration has withdrawn work requirement approvals and started to phase out premium requirements, and has instead encouraged states to propose innovative Section 1115 waivers that expand coverage, reduce health disparities, and/or advance whole-person care.”

One fundamental thing for Mississippi taxpayers to understand is this – if you pay federal taxes, you are already paying for Medicaid expansion in 40 other states. But none of your taxes spent for expanded Medicaid benefits your fellow Mississippians.

Section 1115 waivers for work requirements may well prove a deal maker or deal breaker in getting partial Medicaid expansion enacted in Mississippi. Just how the 2024 presidential election impacts the partisan aspects of those work requirements will be impactful in the ten states that have not expanded Medicaid under the Affordable Care Act.


 Sid Salter is a syndicated columnist. Contact him at



Tip O’Neill said...

Hey Sid pro tip, next to the last paragraph, just because 40 states are jumping off a financial cliff doesn’t mean Mississippi needs to follow them over it.

Anonymous said...

I fully understand it. More freebies for non-productive residents.

Anonymous said...

Ole Sid being a closet liberal democrat is certainly in favor of putting more people on welfare and that is exactly what it is; however,it is not promoted as such. Hang tuff tater, don't give in to those tax and spend folks.

Anonymous said...

If Medicaid is so great and good for the economy, why don’t we put ALL Mississippians on it? Answer: Because it’s not free, it’s very expensive for honest working taxpayers to pay for it, and it would put every hospital out of business because it doesn’t pay them enough for their services to keep the doors open.

Anonymous said...

An 1115 Waiver does nothing other than provide an exemption for pulling the wagon while ensuring a 'whole person', lifetime seat to ride in the wagon.

As Jackie Gleason might say..."How sweeeet it is!"

Anonymous said...

If it's really the "working poor," then teach them how to budget and prioritize their spending. No rental wheels, no Dodge Charger, no Titanium iPhone, no expensive hair extensions, etc.

Anonymous said...

9:22, you’re correct that Medicaid doesn’t reimburse enough to cover the cost of provided care, but you have to realize that the patients will not be turned away and the care will still be provided with no reimbursement whatsoever. The Medicaid funds might just be enough to allow the hospital to keep their doors open.

Anonymous said...

My tax dollars go towards Biden's wag-the-dog effort in Ukraine and that benefits zero states Sid. Your condescension is noted.

Anonymous said...

I wish the governor and the opposition to expansion would publish a pamphlet or something explaining their rationale. In my business I recently had lunch with two gentlemen who work full time in the sanitation business. They are high school grads and both raise their families. They asked me to explain the present limitations of medicaid. I have trouble explaining to these hard working guys that "working-poor" is no entitlement and that other states are just coddling lazy-ass people like themselves and Mississippi simply wants them to stop burdening the real taxpayers. I need a pamphlet or something to help me explain. Thanks in advance Tater.

Anonymous said...

I fully understand it. More freebies for non-productive residents.

Actually, you don't understand it

If we did Medicaid expansion, it would give people who work for small business owners, and service industry jobs - that make between $13k and $28k - the opportunity to receive affordable healthcare.

It would definitely benefit small business owners and low-income workers who fall under that $28k threshold

Anonymous said...

@10:00am, you have to realize that every low income worker in Mississippi can go to and buy subsidized health insurance today if the wanted to? But they’d rather keep all of their income, go uninsured and let the taxpayers pay for their healthcare. You do realize that right? They choose every day to be uninsured. Us folks working, paying taxes and paying for our own healthcare are tired of pulling this wagon of shiftless freeloaders who don’t take responsibility for themselves or their family!

Anonymous said...

10:00am - Where the fuck do you get that shit? They may not have used to turn them away but we're living in a different world, different time. They'll let you die in the waiting room.

Anonymous said...

... you have to realize that every low income worker in Mississippi can go to and buy subsidized health insurance today if the wanted to?

Plainly obvious that Obamacare was a gigantic failure.

Anonymous said...

Time to face the cold hard facts that medicaid expansion isn't going to stop population loss and the economic decline that results. Why hasn't Bennie brought home from the Federales payments in lieu of population-loss to compensate the hospitals? The Congressman is a failure.

Saltwaterpappy said...

For all of you good Christians, I think it was Jesus who admonished his disciples that just as you treat the children and the poor, you are also treating him.

Anonymous said...

We don't need Medicaid expansion. It's obvious that while we thumb our noses at "those" federal dollars (but still lap at the trough of others) everything here is fine. Our kids are leaving for places with ahem better access to healthcare, better wages, roads, better public education options and so on. Nothing to see here. We good. We will just keep on doing what we have always done and if you don't like it leave. It's been working for us.

Anonymous said...

1:40, Saltwaterpappy, poor people can buy subsidized health insurance at, that’s taking care of them. But alas, they want everything for free without paying a dime for it.

Anonymous said...

February 7, 2024 at 1:40 PM, that's true, he did say that, and I do my best to live by it. What I ask you is, to show me where he said use tax money collected by a government to do it. Can you help me with that?

Anonymous said...

As with EVERYTHING, there cannot be a BLANKET that applies to everyone. Unfortunately, some people are just dishonest and think that they're entitled. They take away from poor, hardworking people or the elderly or disabled who just cannot make ends meet in spite of all that they do for themselves. People should have to qualify.

Anonymous said...

Po'folks is strange people. No state has been meaner, more dangerous for po'folks than Mississippi yet no state has a larger percentage of po'folks than Mississippi. Somebody ain't payin' attention. Just sayin'

Anonymous said...

My (unanswered) question remains:

Supposin' fifty thousand manage to get this coverage as a gift from the state. Then supposin' 25,000 of them quit their low-paying jobs.

Who gonna cut all them kids off their medicaid insurance since dad or mom gotta be low-paid-employed to qualify? CNN and MSNBC trucks be parked at the governor's mansion before sundown!

Episcopalians be clutchen them Christian pearls then for sure!

Anonymous said...

Can we all just stop the constant debate and let families sign up for cradle to grave government benefits so they can sit on their collective asses and do drugs all day?

Anonymous said...

We might as well give it to Americans. Biden is giving every single illegal alien Medicaid and college tuition.

Anonymous said...

I’ve always been curious about medical folks saying that the Medicaid reimbursements don’t cover their costs. Are they really saying that they just aren’t making the profit they want to make, and paying the support people the high salaries they want to pay?

Anonymous said...

Bless your heart Sid.

Anonymous said...

When it comes to Medicaid expansion, I get a kick out the so-called conservatives bitching about the “freebies,” “tax and spend,” etc., but only when it comes to “poor people.”

Yet, almost every single one of these so-called conservatives posting/bitching about Medicaid expansion, either got PPP money that they did not deserve, has a relative that got PPP money they did not deserve, has a friend that got PPP money that they did not deserve, or has an employer that got PPP money that they did not deserve.

Here’s a quote for the ill-informed AND the hypocrites: “Despite a global pandemic and economic downturn, the total wealth of the world's richest has increased by more than $5 trillion.”

And here’s a pop quiz for the ill-informed AND the hypocrites: How much $$$ did they Federal Government print from thin air and pump into the so-called free market (what a F’ing joke) economy?

So, to the ill-informed that have no clue how much “freebies” your so-called “conservative relative,” your so-called “conservative friend,” or your so-called “conservative employer” received, come up with a new/real argument against Medicaid expansion; because giving rich people free money while their businesses were booming, and the total wealth of the world's richest increasing by more than $5 trillion……….while poor and middle class folk deal with inflation,

makes you look really Dumb.

Anonymous said...

7:35am must’ve gotten his Medicaid termination letter this week.

Anonymous said...

February 8, 2024 at 7:35 AM, what are you trying to say, and who's the hypocrite? You used a lot of words, which is your style, with a condescending tone, which is also your style. Whenever you give to someone, that has the ability to earn it for themselves, it makes that person weak.

There's no one on this board that has the power to change the things you're bitching about. The theft of this nation's wealth, along with the labor of its citizens, was codified into law with the establishment of the Federal Reserve, and the income tax swindle. Your problem is with the government you love so much, not the people.

Anonymous said...

7:35, the ones who won't admit the level of Farm Welfare, Corporate Welfare, PPP scams, and so on could look it up at, or at the PPP database:

But, they won't. They'll turn on 103.9 and listen to Bubba spitting tobacco over them "lazy" disabled and minorities," after he's either gotten PPP millions or gets Earned Income Tax Credit handouts- getting a tax "refund" when he pays NO Federal Income Tax.

That's a large part of this blog's base. "Wealth managers" (tax dodgers), NorthEast Jerkson guys talented enough to emerge from the birth canal of a rich white woman and grow up 70 years ago, and ignorant LiberaLtarians. Period.

Yes, the Covid Scam delivered 9 TRILLION Dollars to the already rich, including at least 11,000 Mississippi affluent families. Totally free. A "loan" that was instantly forgiven. Millions. Then the employment scam on relief. Then the Infrastructure Bill. Etc Etc. Yet they bleat for even more GubMint money- Pump Money, Swamp Subdivision Money,.... Never satisfied and never admitting their addiction to GubMint Welfare while decrying Medicaid or PERS or the other little people who pay taxes.

Over a BILLION Dollars in Farm Welfare.

Look for the "Cotton" or Beef tags on their mud free SUVs and pickups.

Just like Tater gave the farm away to Bezos, to Japanese car companies, and others, to get 15 dollar an hour jobs at best, while most businesses pay 8 bucks. Anything a Rich Guy's Lobbyists ask for, Tater signs.

But, but, somebody might get relieved from suffering or be able to work or do better, Jesus wouldn't want that!!!! Hypocrites. And, YES, I am VERY conservative. Just with a brain, a heart, and math skills.

Anonymous said...

February 8, 2024 at 10:03 AM, another one, maybe even the same one as 7:35, with many words and a condescending tone, bitching to people that can change nothing. I would like to know the amount of charitably donations 7:35, and 10:03 give in a year's time. Probably cheapskates, the both of them.

Anonymous said...

If Mississippi wants to lower costs for working poor people, one option is eliminate the Certificate of Need requirements. They are nothing more than state sponsored monopolies for health care providers. Competition lowers prices and the state has no business picking winners and losers.
Senate Bill 2064 will eliminate the Certificate of Need program and will allow competition, lower prices, and promote better services by health care providers. Please encourage your legislators to approve it.

Anonymous said...

Feb 7 at 8:25 PM,

You've clearly never worked in any medical field if you think that. Medicaid reimbursement sucks when compared to other private insurance companies, when you take into account all the variables. Not only that, but the patients are sicker, more obese, unlikely to be employed, they have shitty priorities, less likely to take care of themselves, and generally less likely to show up for appointments and take any sort of minimal responsibility for their own well-being. Most of them smoke, drink, smoke weed daily, have poor transportation, don't take their meds and don't exercise. Tell me which population you'd rather try to care for and get paid less for it. It's not being mean or greedy, it's just reality.

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