STARKVILLE — The-top drawer political reaction to the Supreme Court’s decision upholding the health care reforms known as “Obamacare” is one founded deeply in the 2012 federal election cycle and the inexorable grind of partisan politics.
But in Mississippi, the central focus of the decision for state policymakers in both the executive and legislative branches of government is what the majority of the Supreme Court said about how the federal government can enforce the expansion of the Medicaid program dictated by the Obama health care reforms.
On Medicaid, the court said that the federal government can’t threaten or withhold funding for the state’s existing Medicaid program simply because the state fails to expand Medicaid as dictated by the Obama health care reform act. That part of the ruling got the Mississippi Legislature’s attention.
Medicaid in Mississippi is nearly a $5 billion annual proposition, utilizing both federal and state dollars, that serves some 641,454 Mississippians. Currently, the state offers Medicaid to citizens with an income up to 100 percent of the federal poverty level, or $23,050 for a family of four.
It is also the most heavily subsidized Medicaid program in the nation. In the fiscal year that ended June 30, 2011, for every $1 the state spent on medical care for the poor, the federal government spent $5.61. In the fiscal year that ended June 30, the ratio dropped to $3 in federal funds for every $1.
For Mississippi, the court’s ruling mitigates what many Mississippi legislative leaders have predicted was the most expensive and difficult portion of the reforms for state government to finance — the expansion of the Medicaid program in the poorest state in the union.
The Affordable Care Act (ACA) mandates that starting in 2014, all states would be required to offer all citizens Medicaid if their income is below 133 percent of the federal poverty level, or $30,650 for a family of four. Estimates vary between 250,000 and 400,000 as to the number of Medicaid recipients such an expansion would add to Mississippi’s Medicaid rolls.
Republican leaders have predicted that a Medicaid expansion coupled with Mississippi’s estimated 618,000 uninsured residents could cost state taxpayers north of an additional $200 million annually in taxes just to fund the state’s portion of Medicaid alone.
Back in 2011, former Gov. Haley Barbour told Congress: “The federal act would require us to increase the (Medicaid) rolls by about two-thirds, or about 600,000 people to a million, a third of our population. Because the costs are back-loaded, it would be $1.3 billion to $1.7 billion over 10 years. We are going to have to raise taxes or cut spending, and more likely, we will have to do both.”
The ACA empowered the federal government to withhold funding of a state’s existing Medicaid funding if the state refused to expand the Medicaid program by the ACA’s dictates. The high court ruled that Congress can’t do that. Essentially, that single judicial caveat makes Medicaid expansion by the states under ACA an option rather than a requirement.
Under the ACA, federal taxpayers will pay the full cost of covering the new Medicaid enrollees for three years, from 2014 to 2016, and the federal share would then gradually decline to 90 percent in 2020. In poor states with large Medicaid populations such as Mississippi, state officials worry that future costs will be shifted to the states to pay for the increased enrollments.
Supporters of the Obama reforms say that in no state are public health care needs more pronounced than in Mississippi and that expansion of Medicaid is the only means to address the growing problem of hospitals providing uncompensated care to the uninsured who visit hospital emergency rooms for rudimentary health care.
nSid Salter is journalist-in-residence at Mississippi State University. Contact him at sidsalter@sidsalter.com.
