Mississippi Rejects Medicaid Expansion: Wise Move for America’s Least Healthy State?

For the tenth year in a row, Mississippi has placed last in America’s Health Rankings, an annual report issued by United Health Foundation. With an increasing portion of the state’s population (19.2 percent) lacking any type health insurance coverage and a 21.3 percent poverty rate, also making it the poorest state in the union, Mississippi appeared to many as the state that would benefit most from extra federal funding for its Medicaid program; however, Governor Phil Bryant vehemently disagrees.

In his October 1, 2012 editorial in the Washington Post, Governor Bryant declared that he would fight against any efforts to expand the state’s Medicaid program. His stance makes Mississippi the sixth state in the Union, in addition to FL, GA, LA, SC, and TX, to officially reject Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). Some critics believe that these states, all led by Republican governors, are merely politically posturing for the upcoming November elections, in which PPACA repeal is a popular stance of Republican candidates.

Those in support of the expansion cite Mississippi’s population, poor in both health and finances, as a key example of why the Medicaid expansion is essential to health reform. They criticize the governor for turning down “free money” from the federal government that would allow the state to raise the ceiling for income eligibility for the program, with the federal government paying 100 percent of the expansion cost until 2017, when the state would be required to cover 10 percent of the bill. It is estimated that Mississippi could subsequently provide coverage for 400,000 additional residents. Hospitals have also voiced concern that refusing the expansion will stick them with unpaid medical bills of uninsured persons they are required by law to treat.

Governor Bryant is quick to caution his critics that free money is not truly free. He stated, “People tend to forget that government has no dollar that it has not gained through taxation or borrowing” and cautioned readers that in order to pay for health care reform, the federal government was “raiding funding from other programs and levying taxes against the American people.” He warned his residents that in order to even come up with the 10 percent contribution toward Medicaid expansion, Mississippi would have to divert funding away from education, public safety, and the creation of jobs in the states–all higher priorities than feeding a program that would be growing out-of-control to cover one of every three Mississippi residents.

The governor emphasized the importance of personal responsibility among the state’s residents to choose lifestyles that include exercise and healthy food choices and do not include smoking and teen pregnancy–choices that contribute to the state’s epidemic health problems. They main objective for state government, he said, was to provide a climate where business is successful, creating jobs for residents who can then obtain their own health insurance on the private market.

State Governors Elect Not to Implement Parts of PPACA

After the United States Supreme Court’s ruling last week that states cannot be forced to expand their Medicaid programs to receive federal funding, states are given the tough decision to make whether they will indeed expand their Medicaid rolls as suggested by the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148).

Thus far, five states have made it clear that as a result of last week’s decision, they do not plan to expand their Medicaid programs: Florida, South Carolina, Louisiana, Mississippi and Wisconsin.

All of those five states, which have Republican governors, participated in the lawsuit against the bill, which was the subject of last week’s ruling. In addition, six states have publicly raised doubt as to whether they will participate: Iowa, Missouri, Nebraska, Nevada, New Jersey and Texas. Currently, only ten states have affirmatively pledged to participate in Medicaid expansion, which leaves nearly two-thirds of the states in question.

Wisconsin Governor, Scott Walker issued a statement on the same day the Supreme Court released their decision on PPACA, indicating, “Wisconsin will not take any action to implement ObamaCare.” (Obama Care is a casual term commonly used to refer to PPACA and its provisions.) Walker emphasized his concerns that the bill would cost his state’s tax payers to “pay more money for less healthcare” and that both quality of and access to care would be reduced under the bill. He expressed his hope that this year’s elections would ultimately result in the repeal of the bill at a federal level.

Governor Bobby Jindall of Louisiana announced that his state will not be expanding its Medicaid program in response to PPACA; nor will it be setting up private health insurance exchanges called for by the bill. Under the provisions of PPACA, if Louisiana or any other state fails to establish a fully operable exchange by January 1, 2014, the federal government will implement an exchange for that state. Jindall agreed that reform of the health care system is necessary, but that an “expensive, unsustainable entitlement program is not the solution to our problems.”

In Florida, Governor Rick Scott similarly announced that his state will neither set up exchanges nor expand its Medicaid rolls to comply with PPACA. Approximately 20 percent of Florida residents are uninsured, however, Scott pointed out that it would cost Florida taxpayers $1.9 billion to add those residents to the Medicaid program. He raised concern over the rapidly increasing Medicaid program in the state, which he said is growing “three and a half times as fast as Florida’s general revenue.”

South Carolina Governor Nikki Haley declared that her state will opt out of expanding its Medicaid program and that block grants, which offer flexibility to states as to how they will use the money, offer the best solution to state-specific problems. She referred to PPACA’s changes as a “broken system that further ties our hands.”

Lt. Governor Tate Reeves of Mississippi “is not inclined to drastically expand Medicaid” as called for by PPACA. He explained that such an expansion, which would add nearly 400,000 residents to the program, would cost the state nearly $1.7 billion over ten years. He maintained that “(t)rue health care reform should look at reducing costs for services not increasing the burden on taxpayers.”