Supporters from across the state gathered at the state Capitol for a rally urging Medicaid expansion, Tuesday, April 16, 2024 in Jackson. Credit: Vickie D. King/Mississippi Today
Below is a political opinion column by Bobby Harrison:
Mississippi was not the only state where a Medicaid expansion work requirement was a hot topic during the 2024 legislative session.
South Dakota — a more conservative and more Republican dominated state than even Mississippi — debated the work requirement issue during the 2024 legislative session and came to a much different conclusion.
In Mississippi, of course, efforts to expand Medicaid to provide health care coverage for the working poor with the federal government paying most of the costs were unsuccessful. While there were several nuanced reasons the Mississippi Legislature did not expand Medicaid, perhaps the primary reason is the insistence of Lt. Gov. Delbert Hosemann and a majority of the Senate where he presides that any expansion plan include a requirement Medicaid enrollees had to be employed.
It should be pointed out, though, that it is not clear Medicaid expansion would have passed the Mississippi Senate even with a work requirement provision. But the fact that the Senate demanded a work requirement doomed Medicaid expansion efforts in Mississippi. Since the federal government has rejected approving Medicaid expansion work requirements, many argued there was no reason to pass a Mississippi proposal that would never go into effect because of the stringent work requirement.
The South Dakota legislature also debated a work requirement earlier this year and came to a much different conclusion than did lawmakers in Mississippi. Granted, the issues in South Dakota were different than those in Mississippi, but the fact that the two legislatures reached a different conclusion on a work requirement might say a lot about how policymakers from the two states view the importance of a good health care system.
South Dakota legislators decided having Medicaid expansion was more important than having a work requirement. On the other hand, Mississippi legislators — at least the Senate leadership — viewed having a work requirement as more important than providing health care coverage for the poor. They decided having the federal Medicaid expansion stream of money (more than $1 billion annually) for financially strapped hospitals and other health care providers was too important to pass up.
South Dakota already had Medicaid expansion when the work requirement was debated there. It was placed on the ballot through a citizen-sponsored initiative and approved by voters. This past session, the South Dakota legislators opted to put on the November 2024 ballot a proposal to allow voters to weigh in on a work requirement.
But here is the kicker: Even if voters approve the work requirement, that does not mean it goes into effect.
The proposal would give state officials the option to impose the work requirement. And, if the state officials imposed the work requirement and it was rejected by federal officials, then Medicaid expansion still would remain in effect in South Dakota.
Under the proposal offered by Hosemann and his leadership team, Medicaid in Mississippi would not have been expanded if the federal government did not approve a work requirement.
Many cite the work requirement as a logical fallacy or false issue. After all, Medicaid expansion provides health care coverage for people earning up to 138% of the federal poverty level or about $20,000 annually for an individual or $43,000 per year for a family of four. It is common sense that most people getting health care through Medicaid expansion in the 40 states that have expanded Medicaid are working or they would not be earning money.
The federal government has determined that it is a wasteful endeavor to try to enforce a Medicaid expansion work requirement. Studies have shown that Georgia officials, for instance, spent more money enforcing a work requirement than on providing health care coverage.
Most of the 10 states that have not expanded Medicaid are Republican-led states in the South. Many Republican-led states in other parts of the country have expanded Medicaid.
And many of those states are much more Republican than Mississippi. The Mississippi Senate is composed of 36 Republicans and 16 Democrats, while the House consists of 79 Republicans, 41 Democrats and two independents.
By contrast, the South Dakota Legislature is composed of 28 Republicans and only four Democrats with one vacancy, and the House consists of 63 Republicans and a mere seven Democrats with one vacancy.
Yet, despite that overwhelming Republican majority, the South Dakota Legislature opted not to mandate people be working to receive health care coverage through Medicaid expansion.
-- Article credit to Bobby Harrison of Mississippi Today --
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FAQs
Under the ACA, the federal government paid 100 percent of the cost of expansion coverage from 2014 to 2016, with the federal share then dropping gradually to 90 percent for 2020 and each year thereafter, leaving states to cover the small remaining share.
How many states have accepted Medicaid expansion? ›
To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.
What are the disadvantages of Medicaid expansion? ›
Residents of states that accept the Medicaid expansion will still face challenges in accessing needed services due to important deficiencies in essential health benefits, financial strain resulting from cost-sharing provisions targeted at Medicaid beneficiaries, and decreased access to specialists relative to those ...
How many states did not expand Medicaid in 2014? ›
By the end of 2014, twenty-eight states and the District of Columbia had expanded access to their Medicaid programs, while twenty-two states had not. Overall, an estimated 17 million previously uninsured Americans gained insurance in 2014.
Who benefits the most from Medicaid expansion? ›
Expanding Medicaid helps low-income families' health and financial well-being, especially those in which someone has lost a job. In states that expanded Medicaid under the Patient Protection and Affordable Care Act (ACA), unemployed workers experienced large gains in coverage.
Was the Medicaid expansion unconstitutional ACA? ›
A majority of the Court also found the ACA's Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary's enforcement authority.
What state has the best Medicaid? ›
The top five best states in terms of Medicaid quality was completed by California, Massachusetts and Oregon. At the other end of the scale South Dakota received the lowest overall score and was also ranked third-worst for access to coverage, for which neighbouring North Dakota finished bottom.
What state has the highest Medicaid limit? ›
The state with the highest Medicaid income limit is Alaska, where households of eight people must have a maximum income of less than $77,526.
Will Florida expand Medicaid? ›
On the first day of the 2024 legislative session in Florida, Senate President Kathleen Passidomo noted “We have had the debate several times over the last decade. Medicaid expansion is not going to happen.”
Why are some political leaders resistant to Medicaid expansion? ›
Medicaid makes a convenient target for conservative governors and legislators because it represents many of the ideological right's lightning rods for outrage: federal control, major government spending, a means-tested program that can be seen as rewarding poverty, and now a manifestation of health care reform.
Importantly, simply expanding Medicare eligibility does not guarantee premium affordability. The current design of the Medicare program could lead to some low-income beneficiaries—particularly those who switch from subsidized exchange coverage—spending more on premiums in Medicare than they currently spend.
Which is a reason some states have not expanded Medicaid to cover more of their needy residents following passage of the ACA? ›
States have not expanded Medicaid to cover more needy residents following the passage of the ACA due to various reasons: Financial burden: State governments face high costs providing Medicaid services, which strain their budgets and lead to cutbacks in optional medical services.
What states refused Medicaid expansion? ›
But GOP critics in the non-expansion states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming — say it's too expensive, question its effectiveness or remain ideologically opposed to government-funded health care.
Was Medicaid expansion worth it? ›
Prior research found that Medicaid expansion has improved the financial performance of hospitals and other providers, though these effects may vary somewhat by hospital type. Studies show that expansion contributed to increased hospital revenue overall and from specific services.
Why doesn t Tennessee expand Medicaid? ›
Current Tennessee law prevents the governor from expanding Medicaid unilaterally, without the consent of the legislature, but Tennessee Governor Bill Lee has remained opposed to Medicaid expansion, so legislation simply removing the current ban on governor-directed Medicaid expansion might not change anything even if ...
What is the effect of ACA state Medicaid expansions on medical out of pocket expenditures? ›
Research also suggests that Medicaid expansion results in significant reductions in out-of-pocket medical spending, and multiple studies found larger declines in trouble paying as well as worry about paying future medical bills among people in expansion states relative to non-expansion states.
Did the ACA Medicaid expansion save lives? ›
The Affordable Care Act's (ACA) expansion of Medicaid to low-income adults is preventing thousands of premature deaths each year, a landmark study finds. It saved the lives of at least 19,200 adults aged 55 to 64 over the four-year period from 2014 to 2017.
Did Florida expand Medicaid under ACA? ›
ARI SHAPIRO, HOST: Only 10 states have not expanded Medicaid eligibility under the Affordable Care Act. Florida is one of them. Advocates say that leaves more than a million people in a loophole, earning too much money to qualify for Medicaid and too little for federal insurance subsidies.
Did California expand Medicaid under ACA? ›
California adopted Medicaid expansion through the Affordable Care Act (ACA).
