Wednesday, May 8, 2024

Sid Salter: Missed Opportunity, Yes, but Medicaid Expansion's Prospects Changed This Session

While not an absolute, it’s been my experience that political change comes slowly in Mississippi – as slowly as molasses on a cold biscuit.

That’s my take on the disappointing failure of Mississippi lawmakers to reach a consensus on a plan to expand Medicaid coverage to our state’s working poor. The working poor are those fellow Mississippians with jobs who don’t make enough money to afford health insurance.

All of us who pay federal taxes in Mississippi are already paying for expanded Medicaid in 40 other states and providing healthcare opportunities for the citizens of those states. But not here, not for our own people.

But one thing is certain, the Mississippi Legislature in 2024 saw and heard an effective demonstration of the depth and breadth of public support for an expanded Medicaid program that provides a path to health care for working Mississippians.

And it would be disingenuous to suggest that likewise state lawmakers saw and heard that there is also broad-based taxpayer support for some form of work requirement in that expanded program. The disappointment of the 2024 regular session is that the Legislature came so close to getting it right before negotiations got stuck in the political mire.

A decade ago, Medicaid expansion in Mississippi was politically dead on arrival at every level in this red state – including the Governor’s Mansion, the House and the Senate. All one had to do to see the shadow of the political Grim Reaper was whisper the word “Obamacare.”

But as time passed, COVID struck, and inflation followed. Rural hospitals continued to struggle and some shuttered. The lack of availability of rural healthcare is a real danger.

Donald Trump was elected president and his policy change on implementing work requirements for expanded Medicaid programs impacted the political logjam as red states began to find ways to make Medicaid expansion politically palatable.

Trump’s policy change on work requirements for Medicaid expansion was more than a policy change. It was political white smoke coming from the White House giving Republican state legislators permission of a sort to seriously kick the tires and hold meaningful discussions about Medicaid expansion.

When current President Joe Biden was elected, his administration rejected the work requirement changes Trump had put in place and Republican state lawmakers in non-expansion states again faced roadblocks in trying to implement Medicaid changes.

But early in the 2024 Mississippi legislative session, new House Speaker Jason White led the Mississippi House by a margin of 98-20 to pass legislation that would have expanded Medicaid benefits to individuals aged 19 to 64 who earn no more than 138% of the federal poverty level. The bill contains a work requirement – which everyone knew the feds under Biden were likely to disapprove – but even so, the bill expanded Medicaid coverage in Mississippi for four years before a legislative repealer kicked in.

That action came even after White’s predecessor, former House Speaker Philip Gunn, had consistently opposed any expansion of the Medicaid program.

The initial reaction from the State Senate was mixed, but the two sides were negotiating. Late in the game, Senate negotiators offered a plan whereby a person who makes less than 138% of the federal poverty level must work 100 hours a month to receive expanded Medicaid. If federal officials denied the work requirement, the state could reapply later if CMS switched stances and approved another state’s work requirement, but there would be no access to expanded care without federal approval.

The House countered with a voter referendum offer, but by that point, negotiations turned contentious. That’s where the plan died for this year.

After the measure died, Lt. Gov. Delbert Hosemann suggested that the outcome of the 2024 presidential election may determine the fate of Medicaid expansion in Mississippi. It well might.

The Medicaid fight also reminded voters that they can no longer impact public policy through the referendum process without legislative permission. Lawmakers will hear about both issues from their constituents moving forward.

The proposed referendum would have asked: “Should Mississippi expand Medicaid? If so, should the expansion include a work requirement?”

It would seem most Mississippi voters would answer “yes” to both questions – which complicates finding a legislative solution.

Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.

18 comments:

Anonymous said...

Interesting that Delbert campaigned on M.E. But dropped the ball this session. I keep hearing he doesn’t have control of the Senate !

Anonymous said...

Lt. Governor wants a work requirement. Speaker does not want a work requirement. Which is conservative and which is liberal ?

Anonymous said...

“…working poor…”? Non-working poor is a more accurate description of those that would benefit.

Anonymous said...

8:09 Nice try-Lt. Gov. has total control . He is obviously a staunch conservative who runs the adult side of the legislature. This is why he recived more votes than any other state wide elected Republican in our state. People respect his integrity and honesty.

Anonymous said...

All the political posturing and righteous indignation regarding who works and who does not will fade away after the presidential election and Trump makes his pronouncement. The welfare of "the people" never mattered anyway.

Anonymous said...

Salter has never opposed any expansion of the Welfare State. On one hand he'll tell you that Mississippians are funding welfare state payments in other states and on the other, when it suits his narrative, he reminds Mississippi of its net Federal largesse beneficiary status and why that demands our kowtow to Uncle Sam. Are there any truly honest conservative columnists remaining in Mississippi? I think not.

Anonymous said...

Things do change slowly in Mississippi. That’s a big part of why the state’s still 2-3 generations away from general prosperity, and emerging from the last decile in every measure of quality of life.

First come the unskilled jobs (and a bigger tax base), then come the skilled jobs, and the prosperity grows and continues so.

Tater is doing a great job in this important area. But it’s still more than two generation away from impacting the general populace. So everybody chill.

Anonymous said...

When you put all the politics aside, we are still talking about giving money away. That's what this is. It's Mississippi taxpayer dollars matched up, according to some formula, with federal taxpayer dollars. But a lot of people had to work to pay those taxes that the politicians, and columnists, are now talking about giving away. Is this the proper role of government - to deduct money from a lot of paychecks just so career politicians can keep their leather chairs by giving that money away?

Anonymous said...

Our federal government “gives away” billions of dollars to other countries. I believe that is part of America’s world role. So is providing health care to the poor.

Anonymous said...

How this played out in the Senate is confirmation that Inglebert is already a lame duck with Watson waiting in the wings.

Anonymous said...

11:13 why is that America's role? Why is giving stuff away anyone's role? If I wanted the government to give me my house, or my car, would you say that's a legit role for government? After all, we all need shelter and a way to get to our jobs and other places. Where does it end? When does taking money from some people and giving it to others stop being the role of government?

Anonymous said...

Rukia woulda got it done

Anonymous said...



I disagree Sid; expansion would NEVER pass if voted on-
the silent majority out there would rise to vote it down.

Anonymous said...

If you could fund Medicaid without raising taxes on working folks or if Medicaid reimbursement rates were high enough to keep rural hospitals open, I might be for it. But you can’t and they aren’t, so I’m a no on any kind of Medicaid expansion. I’m tapped out on already on paying for other people’s free shit.

Anonymous said...

11:55
That is HILARIOUS! Keep wishing.

Anonymous said...

Sid talks politics but hasn't spent any meaningful time at the Capitol since the Musgrove administration.

Anonymous said...

4:40 - That's because Sid is comfortably bunkered-up in the safety of a public-employment cubicle at State College....checking daily on his PERS account.

The taxpayers are just a few short years from providing him with a nice, lifetime retirement. Then he can spend his remaining years hosting 'the working poor' at his Neshoba cabin.

Anonymous said...

medicade may not have been expanded but you can bet your ass all the administrative agencies of the state were given a healthy expansion to be filled with more government workers and Law enforcement wannabe badasses who will draw a good salary and full benefits and get paid to sit on their butts and not do anything all day.


oh and lets not forget all of the new boards, commissions, agencies, districts, and other government glee clubs that were created by the legislature this year so that politicians can hand out do nothing jobs to their chums. remember , this is mississippi .........




and the only growth industry is government.


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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

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