Jackson Free Press

JACKSON, Miss. (AP) — Mississippi lawmakers appear unlikely to do an about-face and vote to expand Medicaid this year.

Leaders of the Republican-controlled House and Senate say they still oppose expansion of the program, even with the federal government paying most of the cost in the first few years. They're backed by Republican Gov. Phil Bryant, who fears Mississippi could be stuck with a huge health care bill if the federal government backtracks on funding.

Many Democrats, as well as advocates for the working poor, say expanding Medicaid could bring billions of federal dollars to one of the poorest states in the nation, making health care more readily available and supporting jobs in hospitals and clinics.

Medicaid expansion is an option under the federal health overhaul President Barack Obama signed into law in 2010. Mississippi is among about two dozen states, led by Republican governors, that have rejected the expansion so far. Lawmakers here argued about it throughout the 2013 session, but nothing happened.

"It appears Obamacare is a debacle. I cannot believe anybody would continue to advance it," House Speaker Philip Gunn, R-Clinton, said in an interview about the 2014 session.

Sen. David Blount, D-Jackson, said Mississippi has "an opportunity to do something smart" by expanding Medicaid. He said for a relatively small investment of state money, Mississippi could bring in billions of federal dollars to create jobs and improve health care.

"In the 2014 legislative session, I hope we can set aside the partisan politics, look at the dollars and cents," Blount said.

In October, the nonpartisan Kaiser Family Foundation released a study that shows 137,800 low-income Mississippians fall into a health insurance coverage gap and are uninsured. They earn too much to enroll in Medicaid but too little to qualify for government subsidies that would reduce their cost of buying private health insurance. The number represents 37 percent of uninsured Mississippi adults who are younger than 65. Mississippi has the highest percentage of residents in the coverage gap.

A family of three can earn no more than about $5,600 to qualify for Medicaid in Mississippi. So, the coverage gap for a family of three would be for those earning more than $5,600 but less than $19,530, which is 100 percent of the federal poverty level for that size family.

"People in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences," the Kaiser Family Foundation report said.

Under the health overhaul law, federal subsidies are available for people to purchase health insurance from private companies on government-run exchanges, or online marketplaces. The subsidies are for people who earn between 100 percent and 400 percent of the federal poverty level — $19,530 to $78,120 for a family of three.

The health overhaul law originally would have made states expand Medicaid to people earning up to 138 percent of the federal poverty level. The U.S. Supreme Court upheld most of the law in 2012 but ruled that Medicaid expansion is optional. Medicaid is a federal-state health insurance program for needy, aged, blind and disabled people and for low-income families with children.

Kim Robinson, a program associate for the Children's Defense Fund in Jackson, is a "navigator" who is trained to help people shop for private health insurance on an exchange, or online marketplace, run by the federal government. She said many of the people she has helped, so far, fall into the "coverage gap."

"So, we're having to tell these hardworking people that we don't qualify for anything," Robinson said. "Unfortunately, the ones that do fall under 100 percent of federal poverty level and we are able to offer them rates on the exchange, they can't afford the rates because they are the working poor. So, Medicaid expansion would be not only an economic driver in this state, it would be something that would help people working hard every day to have access to affordable health care coverage."

Mississippi Health Advocacy Program, which supports wider availability of medical coverage, released a study in December that showed Medicaid expansion would generate more than $14 billion in new economic activity in the state, create about 20,000 new jobs and provide a net increase of $848 million in state and local tax collections.

That's based on a scenario of 217,000 people being added to Medicaid from 2014 to 2020 — the middle level in a study that also presented numbers for higher and lower levels of new enrollment. About 644,000 of the Mississippi's nearly 3 million residents are already enrolled in Medicaid, and the governor has said repeatedly that he doesn't want to increase people's dependence on government programs.