Jackson Free Press

JACKSON, Miss. (AP) — Democrats in the Mississippi Legislature say they're trying a new approach to push for Medicaid expansion—an issue they support and Republican leaders oppose.

Democrats hold a minority of seats in the House and Senate and they've pushed unsuccessfully this legislative session to bring up Medicaid expansion for debate in either chamber. They sent Republican Gov. Phil Bryant a letter Wednesday, saying they want to file a bill specifying that the state will expand Medicaid only if the federal government cuts "disproportionate share" payments to hospitals.

The payments are compensation for treating uninsured patients, and hospital executives fear millions of dollars will disappear.

"Without disproportionate share payments, many rural hospitals and hospitals that treat a disproportionate share of uninsured Mississippians will close," Sen. David Blount, D-Jackson, said during a news conference that two dozen Democrats had in the Capitol rotunda. "People will lose jobs and people will lose access to health care, particularly in our rural communities."

Bryant said in an interview a short time later that he doesn't believe the federal government will eliminate disproportionate share payments.

"We believe that they would be in violation of the United States Supreme Court decision, which said you can't punish a state for not expanding Medicaid. And they certainly would be punishing us by doing that. So, I don't think that ought to be a trigger," Bryant told reporters in an office next to the House chamber, where he'd been having closed-door meetings with Republican lawmakers.

The U.S. Supreme Court last summer upheld most of the federal health overhaul that President Barack Obama signed into law in 2010. However, justices said states have an option, not a mandate, to expand Medicaid to people making up to 138 percent of the federal poverty level, or about $15,000 a year. In Mississippi, the current cutoff is about $5,500 a year, though the state's Medicaid program does not cover many able-bodied adults within that income group.

The 2010 law originally was designed to reduce the number of uninsured Americans by requiring people to buy private coverage, some of which is government-subsidized, or by putting more low-income people onto Medicaid. As more people became insured, the federal government was supposed to decrease its payments to hospitals for providing care for the uninsured.

Bryant said states could find out later this year what the U.S. Department of Health and Human Services will do about the disproportionate share payments — whether they'll be maintained, reduced slowly or reduced quickly.

The governor has said for months that Mississippi, one of the poorest states in the nation, can't afford to add an estimated 300,000 people to a program that already covers more than 640,000. The state's population is about 3 million.

The 2010 law says the federal government would pay 100 percent of medical expenses for the newly qualified Medicaid enrollees from 2014 to 2017. The federal share would be reduced to 90 percent by 2020, with each state paying the balance.

"I don't trust the federal government to pay 100 percent of Medicaid for the next three years," Bryant said Wednesday.

Lawmakers have to find a way to keep Mississippi's Medicaid program in business, with or without expansion, once the current budget year ends June 30. State programs come up for renewal every few years, and this is the year for Medicaid.

Bills that would re-authorize the existence of Medicaid died before a Tuesday deadline. Now, there are two options. Bryant could call a special session for Medicaid renewal, or legislators could try to get approval from two-thirds of all House members and senators to file a new bill to handle during the regular session, which is scheduled to end in April.

Getting the two-thirds margin to file a new bill could be difficult, given the partisan rift over whether Medicaid expansion should even be part of the debate.