STARKVILLE — Mississippi faces both short-term and long-term decisions on the state Medicaid program. Those decisions are beginning to be focused more intently on what the real debate has been about all along — whether Mississippi hospitals can deal with the problem of uncompensated care while state government resists a quick expansion of the Medicaid program through the Affordable Care Act or “Obamacare.”
First, the Mississippi Legislature has yet to deal with legislation authorizing the state’s existing Medicaid program for the fiscal year that begins July 1. That’s the short-term challenge. Second, Mississippi faces a broader question about whether or not to expand the Medicaid program through the Affordable Care Act — a move that Republicans say would increase the state’s portion of the program to fiscally untenable levels and Democrats say would both exponentially expand health care and be an economic boon to the state.
In Mississippi, the primary bone of contention as legislators continue to sort through the mountain of competing data either favoring or opposing Medicaid expansion is the Disproportionate Share Hospitals (DSH). The Medicaid DSH program provides funding allotments to states to subsidize certain hospitals for the unreimbursed costs they incur treating uninsured and Medicaid patients.
Mississippi’s DSH hospitals say they need these reimbursements since their patients usually can’t afford the full cost of their care, and the DSH payments help make up for their resulting high uncompensated care costs. But Obamacare cuts these payments beginning in 2014 and will cut current DSH payments in half by the year 2019.
When Congress first passed Obamacare, they assumed that the Medicaid expansion contained in that law would be mandatory and that the increased ranks of Medicaid recipients would reduce the federal government’s need to dole out DSH payments.
The Supreme Court decision that rendered state adoption of Medicaid expansion voluntary had a profound impact on that now-flawed assumption. Without Medicaid expansion, the DSH hospitals may actually be delivering the same amount of uncompensated care or more with far less federal revenue.
But does a reduction in DSH payments by the Obama administration equate to punitive action against those states that relied on the Supreme Court’s ruling in not choosing to expand Medicaid? The high court ruling held that the feds couldn’t take punitive actions against states that didn’t expand Medicaid.
Gov. Phil Bryant believes cuts in DSH payments to states that chose not to expand Medicaid would violate the Supreme Court ruling. Proponents of Medicaid expansion believe the federal government can’t require states to expand Medicaid, but can choose to fund public health care as they deem appropriate.
Mississippi is no stranger to political stalemate over Medicaid, so settle in for another long battle.
• Sid Salter is director of the Office of University Relations at Mississippi State University. Contact him at sidsalter@sidsalter.com.
