Jackson Free Press

EMILY WAGSTER PETTUS, Associated Press

JACKSON (AP) — Mississippi's Medicaid director told lawmakers Thursday that expanding the program under the federal health care law could cost the state a cumulative $1.6 billion over 10 years.

The figure prompted Republican House and Senate leaders to reiterate their opposition to the expansion.

But it appears to be the most expensive scenario, based on other available research.

Dr. David Dzielak, the Medicaid director, said the $1.6 billion figure comes from a 2010 study that that state commissioned from a Wisconsin-based consulting group, Milliman Inc., and it's based on all potentially eligible people enrolling by 2020 — a situation that critics say is highly unlikely, based on participation in other public programs.

The Kaiser Family Foundation, a nonpartisan national group that evaluates health trends and statistics, estimated in a separate 2010 report that Mississippi would have to pay $429 million, total, for a more modest growth in Medicaid enrollment by 2019.

In August, 640,427 Mississippians were on Medicaid, the government health program for the poor.

Medicaid is funded by the federal and state governments. The federal government pays at least 50 percent of expenses in all states, and poorer states get a higher federal share. Mississippi is the poorest in the nation and gets the most generous federal share — currently, just over 73 percent.

The federal Affordable Care Act that President Barack Obama signed into law in 2010 included an expansion of Medicaid to people at 133 percent of the federal poverty level. The U.S. Supreme Court upheld most of the law in June, but said the expansion would be optional rather than mandatory.

The federal government would pay 100 percent of the expansion costs between 2014 and 2017 for the newly eligible people who enroll. The federal share would then phase down to 90 percent for those people by 2020.

State leaders say they're skeptical about what the federal government will do after 2020.

Dzielak said even for the years when the federal government is supposed to pay all costs, Mississippi would still face millions of dollars a year in administrative expenses to enroll new people.

Mississippi's Republican leaders — Gov. Phil Bryant, Lt. Gov. Tate Reeves and House Speaker Philip Gunn — say they believe the state can't afford to expand Medicaid under the federal law. Gunn said expanding Medicaid is a move toward "socialized medicine."

"You're putting a third of the citizens of this state on Medicaid if you do what it calls for. We've already got a fourth," Gunn said. "I'm just philosophically opposed to it."

Ed Sivak is director of the Mississippi Economic Policy Center, a group that advocates policies to help people with low or moderate incomes. He said expanding Medicaid "gives us the opportunity to bring in billions of dollars that would create jobs while making our workforce healthier."