This marks the first time that Medicaid expansion will be substantively debated on the House floor. Democratic lawmakers have pushed to expand the program for over a decade, but this is the first legislative session in which the policy has had bipartisan support in both chambers.
“I just keep pinching myself,” Democrat House Minority Leader Rep. Robert Johnson said. “And it’s not a bad bill. It's a bill that probably needs a little work, but it's a bill that is quite more ambitious than I thought I'd ever see come out of a Republican House of Representatives.”
House Bill 1725 expands Medicaid coverage to people making up to 138 percent of the federal poverty level, or $20,120 annually for an individual. The measure could extend coverage to around 250,000 Mississippians.
Proponents of expansion say it will help Mississippi improve its poor public health metrics. Mississippi leads the nation in the rate of preventable deaths, infant mortality, and maternal mortality.
“Our health metrics will improve, we’ll see greater access to care, and hopefully start to see a healthier Mississippi where our folks are getting treatment earlier rather than later,” Republican Rep. Missy McGee, chair of the Medicaid committee and the bill's co-author, said.
The financial benefits of expansion have also been touted by its proponents on both sides of the aisle. Federal funds cover 90% of expansion costs and Congress included an additional financial incentive for the ten remaining non-expansion states in the American Rescue Plan Act. That provision would bring over $600 million in additional federal funds into the state over the first two years of expansion. During Tuesday’s committee meeting, McGee said the additional federal dollars would cover the state’s share of expansion costs for four years.
“It would more than pay for itself,” McGee said. “You almost have to look at it like the federal government is giving us a free pilot program to run for four years.”
Even without that extra funding, the bill makes expansion revenue-neutral for the state through a 4% tax on managed care organizations and hospitals.
The bill also includes provisions that address a common criticism from expansion opponents: that people with private health insurance through their employers or the federal marketplace established under the Affordable Care Act would drop that coverage in droves and get on Medicaid.
The House bill would not cover anyone that has access to an employer-sponsored health insurance plan, and anyone that drops ACA coverage would be ineligible for Medicaid for one year.
An additional limitation included in the bill is a requirement that people work at least 20 hours per week, or be enrolled in college or a work training program full-time to qualify for coverage under Medicaid expansion.
Implementing that work requirement would require approval from the Centers for Medicare and Medicaid Services, which is unlikely. The Biden Administration revoked the waivers that allowed 13 states to impose work requirements on some Medicaid recipients in 2021.
Though work requirements are included in the House bill, the inability to implement them would not prevent expansion from going into effect if the bill becomes law. One provision of the bill states that if the state’s request or a work waiver is not approved by Sept. 30, 2024, Medicaid will still be expanded.
“The goal of the plan is to provide health insurance for working Mississippians,” McGee said. “We believe that at least 75-80% of this population is working, so we certainly don’t want to not help them just because we might be helping another population who might not be working or able to work at the time.”
The bill also includes a provision to repeal Medicaid expansion in 2029 unless lawmakers renew the program. McGee called the repealer a “guard rail” to assuage lawmakers that are unsure that expansion would help the state.
“I believe in four years that we will absolutely see that the program has been a success, that we are on our way to a healthier Mississippi and hopefully moving off some really bad lists that we tend to be at the top of,” McGee said.
