Jackson Free Press

JACKSON, Miss. (AP) — If there's one thing Mississippi Gov. Phil Bryant makes perfectly clear, it's this: He doesn't like the federal health overhaul.

Whether you call the law by its official name, the Patient Protection and Affordable Care Act, or by what Republican Bryant calls it, "Obamacare," the governor says it's too invasive and expensive.

During an interview with The Associated Press this past week, Bryant reiterated his opposition to the law, but in a way that raised almost as many questions as it answered.

Bryant said he thought that if Mississippi had set up a state-run health exchange, some low-level employees or volunteers with the exchange could unilaterally force the state to expand Medicaid, the longstanding federal-state health insurance program for the needy. This, despite the fact that the Legislature, which controls just about every aspect of what Medicaid offers or covers, has not voted for expansion.

"Nobody will tell me that's not possible," Bryant said.

An exchange is an online marketplace where people can buy health insurance. Under the health law signed by President Barack Obama in 2010 and mostly upheld by the Supreme Court in 2012, each state is required to either operate its own exchange or have the federal government do the job. A few states have exchanges that are run in partnership with the federal government.

Mississippi's exchange is federally run, because of Bryant's opposition to a state-run system.

On Oct. 1, exchanges opened nationwide, and people could start shopping for coverage that takes effect in January.

In each state, workers or volunteers called "navigators" are available to help people understand various levels of coverage available through an exchange. Among other things, a navigator will determine whether a consumer is eligible for a federal tax credit that will pay for part of the insurance policy. To qualify for the government subsidy, one person could have an income of up to $45,960 or a family of four could have an income of up to $94,200.

During the AP interview, Bryant said he thought if Mississippi had a state-run exchange, the navigators could unilaterally decide to sign people up for Medicaid, even if they earn too much money to qualify.

Regardless of the fact that the Legislature has not expanded Medicaid?

"Regardless of what the Legislature would have said," Bryant said.

But how would that be possible?

"I have gotten no assurances that that would not be the case," Bryant said.

Under the federal health law, states have the option to extend Medicaid coverage to people making up to 138 percent of the federal poverty level, or about $15,000 a year for one person. In Mississippi now, the income cutoff is about $5,500 for one person, and many able-bodied adults aren't eligible for Medicaid coverage, regardless of how little they earn.

Mississippi is one of the poorest states in the nation. About 644,000 of the state's nearly 3 million residents are enrolled in Medicaid. Earlier this year, Bryant and other Republicans blocked Democrats' attempts to expand Medicaid to another 300,000 people.

The 2010 law says the federal government would pay 100 percent of medical expenses for 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.

Democrats say Mississippi is leaving billions of dollars on the table — and leaving the working poor uninsured — by refusing Medicaid expansion. Bryant points out that Mississippi's Medicaid budget has grown exponentially in the past two decades, and he says Mississippi can't afford to put more people on the program, even with the feds paying most of the cost.