Is the Mississippi Legislature prepared to roll the dice again on a voter-supported effort to overrule its inaction?
Based on the beating it received at the polls last year on medical marijuana, it should worry about taking that chance on Medicaid expansion.
Six initiative drives are currently gathering signatures in Mississippi, or soon will be, to put constitutional amendments on the ballot in 2022 or the year after. Extending the government health insurance program to the working poor might have the best odds of being successful.
The proposal has the same two things going for it as did medical marijuana: grassroots support and the financial backing it takes to gather enough signatures to force a statewide referendum and to later turn out the vote.
The Mississippi Hospital Association, whose members include most of the state’s hospitals, is leading the push for Initiative No. 76. It has formed a nonprofit group to raise the money and coordinate the effort.
It is doing so after being repeatedly frustrated by the obstinacy of the Republican leadership in Jackson to do what all but 12 states have done: accept the federal government’s offer to pay for the vast majority of the cost of expanding Medicaid.
The intransigence at the Capitol has entered the realm of the absurd in the past couple of years.
When GOP lawmakers balked because they said Mississippi couldn’t afford to put up its 10% share, the Mississippi Hospital Association proposed a plan to shuffle that cost onto the hospitals and those who would be covered by the expansion. No dice, was the GOP response.
Then this year, with Democrats in control of the White House and Congress, yet another sweetener was added. The $1.9 trillion coronavirus relief plan included a provision that would increase for two years the already generous reimbursement Mississippi gets for its traditional Medicaid enrollees if the state would get on board with expansion. The change makes expansion an even bigger no-brainer. For every dollar Mississippi spent to cover new enrollees, it would save an estimated $2.38 on the cost of covering the existing ones. Still, the most excitement that could be stirred from the Legislature is that it would have to think about it.
It’s beyond the point of reasoning with the Republican majorities in the Legislature and Tate Reeves, who has been especially mulish in his decade-long opposition to Medicaid expansion as lieutenant governor, as candidate for governor and now as governor.
Reeves and GOP lawmakers have passed up $10 billion and counting from the federal government, have left several rural hospitals on the brink of going under as a result, have rejected what could be one of the largest job creators in state history and have left a couple hundred thousand citizens uninsured, all because Medicaid expansion is too closely associated with the Democrats in Washington.
There are so many avenues through which Medicaid expansion can be sold to the public. All it takes is someone with the resources to make the case statewide. The Mississippi Hospital Association and other groups coalescing around the effort should have the financial backing to do just that.
Supporters of Initiative 76 have lots of successful blueprints to follow. Since 2017, six states have used ballot measures to expand Medicaid over the opposition of statehouse Republicans. In only one state has a ballot measure failed — Montana. Its Republican-majority Legislature had adopted Medicaid expansion in 2016 for a three-year trial period, but in 2018 voters rejected a plan to remove the repealer and raise the tax on cigarettes by $2 a pack to pay for any state costs related to the expansion. Before the government insurance program was rolled back, however, Montana lawmakers voted to continue the program through at least 2025.
Other than that outlier, the trends are pretty clear. When an organized, sufficiently funded effort puts Medicaid expansion before the voters, it’s more likely to win approval than not, even when the states are staunch Republican strongholds. Not only is Mississippi looking to test that pattern next year, so are Florida and South Dakota.
Maybe the Mississippi Legislature will see the writing on the wall, adopt Medicaid expansion in early 2022 and assemble a large enough bipartisan coalition to override Reeves’ likely veto. They could wait, of course, to put their plan on the ballot as an alternative to a publicly petitioned one, but the nearly 3-to-1 spanking they took on medical marijuana should discourage them from that course.
All of this, though, presupposes that the Mississippi Supreme Court will not invalidate the state’s initiative process in a last-ditch effort by opponents to derail medical marijuana.
Should the court nix the initiative process on a technicality, the momentum that’s building for Medicaid expansion would most likely be undone.
- Contact Tim Kalich at 581-7243 or tkalich@gwcommonwealth.com.
