Mississippi Medicaid Expansion
Mississippi is one of the poorest states in the nation; it has one of the highest mortality rates, lowest life expectancies and a high percentage of bad birth outcomes. It is one of ten states that have still not enacted the Medicaid expansion to cover its working poor citizens. The state’s rural hospitals are in danger of closing because of intolerable financial pressures due to the decisions of state lawmakers to oppose Medicaid expansion. The state’s Supreme Court has ruled that the state’s ballot initiative is unconstitutional, thus depriving its citizens of their opportunity to vote on and enact the Medicaid expansion. The state’s Governor is adamantly opposed to Medicaid expansion even in the face of growing Republican sentiment to enact expansion in Mississippi.
Mississippi’s age adjusted death rate is well above the national average, and it is increasing. https://usafacts.org/topics/health/state/mississippi/#:~:text=In%202020%2C%20Mississippi%20ranked%20the,expectancy%20in%20the%20US%20overall. The state has the second highest death rate in the nation after West Virginia, and it is nearly twice as high as Hawaii, the state with the lowest age adjusted death rate. Ibid. Heart disease is the top cause of death in Mississippi, and it is nearly 50% higher than the national average. On nearly every health indicator, Mississippi is getting worse. Ibid. Life expectancy in the state is the lowest in the nation at 72 years, and nearly 7 years lower than states such as California, Minnesota or Washington. Mississippi has the worst infant mortality rate in the nation. https://mississippitoday.org/2022/09/29/mississippi-remains-deadliest-state-for-babies/ It has one of the worst maternal mortality rates in the nation, and it is rapidly getting worse; it is 400% worse for black women than for white women. https://mississippitoday.org/2023/01/26/maternal-mortality-rate-worsens/
Mississippi has an uninsured rate of about 12%; it joins Texas, Oklahoma, Georgia, and Florida as the states with the highest uninsured rates in the US. https://aspe.hhs.gov/sites/default/files/documents/e06a66dfc6f62afc8bb809038dfaebe4/Uninsured-Record-Low-Q12023.pdf Mississippi reduced its uninsured rate from 17% to 12% due to the passage of the Affordable Care Act (Obamacare or ACA) and the enhanced Marketplace subsidies built into Biden’s American Rescue Plan, but it has still not implemented the ACA’s “optional” Medicaid expansion. Ibid. By contrast in neighboring states that implemented the Medicaid expansion, like Arkansas, the state’s uninsured rate fell from 16% to 9.2%, and in neighboring Louisiana, the state’s uninsured rate fell from 16.6% to 7.6%. Ibid. In comparably impoverished West Virginia which implemented the Medicaid expansion, the state’s uninsured rate fell from 14% to 6%. Ibid.
The ACA offers states a 90/10 federal match for coverage of adults with an income below 133% of the federal poverty level plus a 5% income disregard. This provision includes coverage for parents and single adults. The federal matching rates are phased down from 95% to 90% by 2020. For a family of four, the 133% of FPL income levels with the 5% disregard amount to $41,400 annually or $3450 monthly in 2023
Mississippi has not availed itself of the exceedingly generous federal match for adults. Its current maximum income eligibility levels for parents living in a family of four are $587 monthly ($7044 annual incomes or less). By contrast, Mississippi covers children (ages 6-19) in families with incomes up to $3450 monthly ($41,400 annual income). It excludes all adults who are not parents or caretaker relatives of minor children. https://medicaid.ms.gov/medicaid-coverage/who-qualifies-for-coverage/income-limits-for-medicaid-and-chip-programs/ If it opted for the Medicaid expansion, the parents and the other adults (the working poor) would be covered under Mississippi’s Medicaid program with annual incomes up to $41,400.
According to the Commonwealth Fund’s analyses, the state’s Medicaid expansion would cover about 230,000 uninsured low-income Mississippians. Over 5 years, it would cost the state $878 million; it would produce $1.2 billion in savings, producing a net state savings of $212 million. https://www.commonwealthfund.org/blog/2022/medicaid-expansion-mississippi-whats-stake#:~:text=Mississippi%20would%20realize%20substantial%20savings,instead%20enroll%20through%20the%20expansion. It would save about 540 lives of Mississippi citizens over a four-year period. https://mississippitoday.org/2023/05/28/medicaid-expansion-mississippi-deaths/
According to the leading economists from the University Research Center of the Mississippi Institutions of Higher Learning, Medicaid expansion will increase state GDP between about $719 million and $783 million and it would add an estimated 11,300 jobs a year in Mississippi. http://www.mississippi.edu/urc/downloads/urcmedicaid2021.pdf It would increase its citizens personal incomes and attract new residents to the state. Ibid
According to a recent study by the Center for Health Quality and Payment Reform, nearly half of Mississippi’s rural hospitals are at risk of closing, and 1/3rd are at immediate risk of closure. https://ruralhospitals.chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf The Center recommends private sector payment reform for rural hospitals. Ibid. The Mississippi Hospital Association recommends the federal Medicaid expansion. https://www.beckershospitalreview.com/finance/mississippi-hospital-leader-urges-medicaid-expansion-with-46-of-rural-hospitals-in-danger-of-closure.html
Governor Tate Reeves is adamantly opposed to Medicaid expansion; instead, he recently proposed increasing hospital Medicaid reimbursements by almost $700 million annually. https://medicaid.ms.gov/governor-reeves-proposes-nearly-700-million-in-additional-hospital-funding-through-medicaid/ His Democratic election opponent, a growing number of Republican legislators, and most Mississippians support the Medicaid expansion. https://www.mississippifreepress.org/30720/as-mississippi-hospitals-fail-leaders-kill-medicaid-expansion-efforts-again However, their ability to take it to the ballot has been blocked by a recent ruling of the state’s Supreme Court.
A 6-3 divided Mississippi Supreme Court ruled in 2021 that the state’s initiative process was unconstitutional because when enacted in 1992, it was based on 5 congressional districts, and due to declines in the state’s population, the state now had only 4 congressional districts. https://www.nbcnews.com/politics/politics-news/mississippi-supreme-court-overturns-voter-approved-marijuana-initiative-n1267472 and https://courts.ms.gov/Images/Opinions/CO154253.pdf Efforts to reinstate citizen initiatives have run into sharp legislative and gubernatorial opposition as it dilutes their own powers; the initiative process, direct democracy in action, is strongly favored by Mississippi voters from both parties. https://mississippitoday.org/2023/03/23/mississippi-ballot-initiative-dies-again-without-vote/
A newly elected Governor working with a new state legislature might be able to enact the Medicaid expansion in 2024; however, the GOP super-majorities would make this challenging. https://mississippitoday.org/2023/08/23/expand-medicaid-brandon-presley-tate-reeves/#:~:text=Just%2021%20of%20the%20House,said%20they%20outright%20opposed%20it.