Mississippi Today

Experts dispel fears that Medicaid expansion is too costly for Mississippi

Published

2 weeks ago

April 26, 2024

mississippitoday.org – Kate Royals and Sophia Paffenroth – 2024-04-26 10:58:24

National studies and experts in Medicaid expansion states refute concerns voiced in Mississippi's legislative conference committee that costs to the state would exceed projections.

Among those dispelling that fear are experts and a former governor in Kentucky – one state Mississippi conferee and Senate Medicaid Chairman Kevin Blackwell referred to as an example of where expansion has been expensive.

One study in the National Bureau of Economic Research that analyzed state budget data over an eight-year period found that changes in state spending were “modest and non-significant” after Medicaid expansion, and “state projections (of cost) in the aggregate were reasonably accurate, with expansion states projecting average Medicaid spending from 2014-2018 within 2 percent of the actual amounts, and in fact overestimating Medicaid spending in most years.”

Senate negotiators on Tuesday said they fear more people than estimated would enroll in Medicaid under expansion, and that this would result in higher-than-estimated costs to the state.

House Medicaid Chairwoman Missy McGee, R-Hattiesburg, reiterated that multiple studies – including one done this month on expansion's potential impact in Mississippi by a nonpartisan research organization – found that traditional expansion would result in savings to the state, not increased costs.

Rep. Missy McGee, R-Hattiesburg, in talks regarding Medicaid expansion during a public meeting at the state Capitol, Tuesday, April 23, 2023. Credit: Vickie D. King/Mississippi Today

The study found that traditional expansion – insuring those making up to 138% of the federal poverty level or about $20,000 annually for an individual – would cost the state nothing in the first four years of implementation, and roughly $3 million the following year. It would stimulate the economy, putting about $1.2 billion into circulation that the state would not see otherwise and creating 11,000 new jobs in Mississippi, in addition to providing health insurance for poor working people and cutting uncompensated care costs for state- and locally owned hospitals by 60% each year.

While Medicaid enrollment after expansion could exceed projections, that possibility was taken into account by Hilltop's report, which estimated 95% of enrollees would be newly eligible. According to the study, about 200,000 Mississippians would enroll in Medicaid post-expansion.

Sen. Brice Wiggins, R-Pascagoula, said he believes the Senate's original plan is a pragmatic proposal that offers savings – “whereas 44 other states have not been that,” he said, referencing the 40 – not 44 – expansion states. The original Senate plan covers fewer people than the House plan, includes a stringent work requirement unlikely to be approved by the federal government, and doesn't qualify for increased federal funding.

Blackwell also made a similar comment, asking his House counterpart “Have any of (the states) – I guess how many exceeded the number of population they estimated at onset? I think 40.”

Blackwell later offhandedly told a reporter he heard from a fellow lawmaker in Kentucky expansion had been expensive.

Asked what their sources were regarding their statements about Medicaid expansion costs, Wiggins referred questions to fellow conferee Sen. Nicole Boyd, R-Oxford, who declined to comment. Blackwell said he was unable to provide any sources because they “are still working on the bill” and suggested the reporter read an opinion piece by a conservative columnist whose past views have aligned with those of Gov. Tate Reeves, a Medicaid expansion opponent.

Dr. Ben Sommers, a health economist and primary care physician based in Boston, is the author of the National Bureau of Economic Research study that found minimal changes in state spending in expansion states. He shared three additional publications with Mississippi Today that show there is no evidence of expansion negatively impacting state budgets.

“There's a difference between saying that enrollment was higher than expected and that the state budget impact was worse than expected. More people enrolling than projected doesn't mean that states lost money … expansion states were able to bring in 90% federal funding which often replaced things like behavioral health and uncompensated care spending that the state was previously paying for with 100% state dollars,” Sommers told Mississippi Today.

Morgan Henderson, one of the authors on the Hilltop report, echoed Sommers. And even with a lower matching rate from the federal government in current years, Henderson, who has a PhD in economics, believes the costs to states are still offset by other benefits.

“Higher enrollment than expected in the expansion group can lead to higher costs than expected, but this relationship likely won't be one-for-one. More new enrollees can also mean more cost offsets – such as premium tax revenue and other state tax revenue due to the increased economic activity in the state – which significantly mitigate the costs of expansion,” he told Mississippi Today.

Experts and a former governor in Kentucky – one state Blackwell referred to as an example of where expansion has been costly – said that Sommers' and Henderson's characterizations are accurate for what their state experienced post-expansion.

A study published by the University of Louisville Commonwealth Institute of Kentucky found that while Kentucky did experience an increase in its Medicaid budget, the increase has been offset by other benefits, such as savings in general state funds “related to care for vulnerable groups who were ineligible for Medicaid prior to expansion.”

Expansion funneled $2.9 billion into the state's health care system within the first two years, which reduced costs of charity care and collections for medical debts, the study said.

Even if the number of enrollees is higher than originally estimated, that doesn't necessarily bode poorly for the state's budget, Sommers said. On top of the 90% federal match and the increased federal incentives for newly expanded states, the leftover portion the state is responsible for under expansion is mitigated by increased tax revenue, reduced uncompensated care costs to hospitals, and other program cost offsets, Sommers explained.

While the state does put up a small amount of money for each new enrollee under expansion, it is less expensive than the amount of money the state pays pre-expansion to cover uninsured individuals who seek care in emergency rooms and inpatient hospital settings – the most expensive places to receive care and often the only option for uninsured people.

Mississippi hospitals incur around $600 million in uncompensated care annually. Kentucky's hospitals saw a 64% decrease in uncompensated care costs from 2013 to 2017, according to the Center on Budget and Policy Priorities.

“Everybody's got heartburn over people ‘getting something they don't deserve,'” Dr. Dustin Gentry, a rural physician from Louisville, Mississippi, and self-described conservative, said. “But they're getting it anyway. They go to the ER, they get free care, they don't pay for it, but that doesn't bother anybody. But if they get Medicaid, which will actually pay the hospitals for the work they do, all of a sudden everybody's got heartburn.”

One report estimates that nearly half of all Mississippi's rural hospitals are at risk of closure.

And while the original House and the Senate plans both cover those in the coverage gap – those making too much to qualify for Medicaid currently but too little to afford private insurance plans – the House proposal would draw down $1 billion federal dollars the original Senate plan would not, since it is not considered true “expansion” according to the Affordable Care Act. That means the state would have to shell out more money, receiving its typical 77% federal match instead of 90%, and would not qualify for the additional funds that would make expansion free to the state for the first four years under the House plan.

In the last 10 years, as 40 states have chosen to expand Medicaid to cover the working poor, the poorest and sickest state has held out.

After leaving House conferees alone at the negotiating table Thursday afternoon, the Senate announced its own compromise plan Friday morning. The option extends coverage to those making up to 138% of the federal poverty level and draws down the maximum amount of federal dollars available.

Lawmakers have until Monday to pass a final bill, according to current deadlines.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Some notable bills that died in the 2024 Mississippi legislative session

Published

4 hours ago

May 7, 2024

Staff Editor

mississippitoday.org – Taylor Vance – 2024-05-07 05:30:00

As the Mississippi Legislature adjourned its 2024 regular session on Saturday, only a fraction of the thousands of bills introduced by legislators survived to become law.

The most notable item that died during the session was Medicaid expansion, a policy that would have allowed thousands of Mississippians to receive health coverage and potentially give struggling hospitals a needed financial boost.

But several other pieces of legislation such as early voting and overhauling the way the state restores voting rights to people convicted of certain felony offenses also died during the session.

Unless Republican Gov. Tate Reeves calls legislators into a special legislative session, lawmakers will now have to wait until their 2025 session next year to introduce any more legislation this year.

Here are some other bills that died after the 2024 legislative session adjourned on Saturday:

Judicial redistricting

House Bill 722 and Senate Bill 2771 would have redrawn the state's circuit and chancery court districts, but negotiations stalled between the House and the Senate on adopting a final map.

The current court districts have largely remained unchanged for 30 years. Senate Judiciary A Committee Chairman Brice Wiggins, a Republican from Pascagoula who was the Senate's lead negotiator, believed the Legislature should use population data and the number of active court cases in each district to substantively redraw them.

Wiggins sent the House a plan that passed the Senate 32-13. But the House didn't agree to the Senate plan, and it did not reveal its own redistricting proposal.

House Judiciary B Chairman Kevin Horan, a Republican from Grenada and the main House negotiator, said he wanted to agree on a plan this year, but he thought there were too many stakeholders, such as judges, whom he believed did not have their opinions considered in how the new districts should look.

“This issue is too important for them to not have their voices heard,” Horan said.

Both committee leaders told Mississippi Today they intend to conduct hearings in the summer or the fall to hear from judges, district attorneys and officials from the Administrative Office of Courts on what metrics should be considered for new districts.

Lawmakers have until 2025 to agree on a set of new maps. If the two chambers cannot reach a compromise by early next year, Mississippi Supreme Court Chief Justice Michael Randolph will be tasked with redrawing the new chancery and circuit court districts.

Mobile sports betting

House Bill 774, the Mississippi Mobile Sports Wagering Act, would have legalized mobile sports betting and allowed Mississippi to join more than two dozen other states where the practice is legal.

Sports wagering has been legal in Mississippi for years, but online betting has remained illegal in part from fears the move could erode profits of the state's brick and mortar casinos located along the Mississippi River and the Gulf Coast.

The initial proposal would have required betting companies to contract with casinos, but some lawmakers raised concerns that the legislation did not offer any incentives for major betting companies to partner with smaller casinos.

The two chambers passed different versions of the same bill, and they couldn't reach an accord during the conference committee process.

Senate Gaming Chairman David Blount, a Democrat from Jackson, told Mississippi Today that there was division among casino owners on how the legislation would impact physical casinos and their employees and offered little protection for people who struggle with gambling addiction.

Blount said he hopes casino owners and lawmakers will continue to discuss the issue during the off season and debate the issue more next year.

Replacing Mississippi's white supremacist statues in Washington

Senate Bill 2231 and House Concurrent Resolution 12 would have replaced Mississippi's statutes of J.Z. George and Jefferson Davis, two white supremacists, in the U.S. Capitol in Washington.

Other Southern states such as Alabama, Florida and Arkansas, have replaced their statues of white supremacists, but Mississippi remains the only state in the nation with two Confederate leaders in the National Statuary Hall Collection in Washington.

Federal law allows for states to replace their statues, but a majority of lawmakers in both legislative chambers must vote to approve the replacement, and the state is required to pay for the costs of replacing the statues.

House Rules Chairman Fred Shanks, a Republican from Brandon, previously said he did not know much about the National Statuary Hall Collection, but that he would study the issue.

Early voting

Senate Bill 2580 would have established in-person early voting and let Mississippi join 47 other states that authorize the practice in some form.

The bill would have allowed 15 days of no-excuse early voting before election day and required voters to submit a valid photo ID to cast a ballot. It would have replaced in-person absentee voting.

The bill passed the Senate overwhelmingly, but House Elections Chairman Noah Sanford, a Republican from Collins, said he received concerns about the proposal from some county circuit clerks, the local officials who administer elections.

Instead, Sanford said he would like to conduct some hearings in the summer or fall to examine the issue further and allow circuit clerks and others to present information. He said that after the hearings he would be more open to passing early voting legislation.

Restoring a ballot initiative

For the third straight year, lawmakers could not agree on a way to restore Mississippi's ballot initiative process.

House Concurrent Resolution 11 and Senate Bill 2770 would have created a process for voters to bypass lawmakers and place issues directly on a statewide ballot for consideration. The process would only allow voters to amend laws and not the constitution.

The House passed a proposal that would have created an initiative process that organizers to gather signatures from 8% of the number of registered voters during the last governor's race, which the Secretary of State's office estimated to be around 166,000.

Senate leaders proposed a plan that would have required petitions to gather signatures from 10% of the registered voters from the last presidential election – more than 200,000 signatures of registered voters – to place an issue on the ballot. The Senate chamber rejected that proposal.

Both the House and Senate plans would have restricted voters from considering any initiative related to abortion.

Mississippians have not had an initiative process since 2021, when the Mississippi Supreme Court ruled it invalid because of a technicality over the state's congressional districts.

Felony suffrage overhaul

House Bill 1609 would have automatically restored voting rights to people convicted of nonviolent felony offenses, as long as they had not committed another felony within five years of completing the terms of their sentence.

The legislation passed the House by a bipartisan majority, but Senate Constitution Chairwoman Angela Hill killed the measure by not bringing it up for a vote.

Under the Mississippi Constitution, people convicted of any of 10 felonies — including perjury, arson and bigamy — lose their voting rights for life. A 2009 opinion from the Mississippi Attorney General's Office expanded the list of disenfranchising felonies to 22.

The constitutional provision stems from Jim Crow-era policy where the framers of the 1890 constitution chose disenfranchising crimes thought to be more likely committed by Black people.

Mississippi is one of only a handful of states that does not automatically restore voting rights to people who complete their sentences. Instead, two-thirds of lawmakers in both chambers must agree to restore the suffrage to individuals in a piecemeal fashion.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Bill increasing tax credits for private schools defeated at end of session

Published

5 hours ago

May 7, 2024

Staff Editor

mississippitoday.org – Bobby Harrison – 2024-05-07 04:12:00

Legislation that would have increased the proceeds from state tax credits available to private schools died a quiet death late in the just-completed 2024 session.

The proposal to increase the tax credits available through the Children's Promise Act was defeated in the 52-member Senate with 21 yes votes and 16 no votes. Since the proposal dealt with taxation, it needed a three-fifths majority to pass.

Since 2020, private schools have been receiving money through the tax credits with limited state scrutiny or accountability, according to the Department of Revenue, which certifies schools that can participate in the program.

In response to written requests from legislators, the Department of Revenue recently reported, “DOR does not know how the funds were used.”

When asked the number of children served through the Children's Promise Act, DOR said, “This information may be provided with the original application but is not updated annually or maintained by DOR.”

In the original application, “DOR reviews the information provided and issues a letter ruling advising whether they qualify or not. The original request is covered under confidentiality statues.”

Under the Children's Promise Act, a person or corporation can make a donation to one of the private schools certified by the Department of Revenue and receive a dollar-for-dollar tax credit for up to 50% of the donor's state tax liability.

The maximum a private school currently can receive through the program is $405,000 a year.

The program was initiated in 2019 and billed as a mechanism to provide additional money to non-profits that care for foster children. But a provision to provide tax credits to private schools was tucked into the bill.

Currently under the law a total of $9 million a year in tax credit money can be doled out to private schools.

Original legislation filed during the 2024 session by House Ways and Means Chairman Trey Lamar, R-Senatobia, would have significantly increased the amount of the tax credit money the private schools could have received. The original House plan would add another $6 million for the current year and then would reach a total of $24 million for 2025.

But in negotiations with Senae leaders during the final days of the session, an agreement was reached where the private schools would have been able to receive an additional $3 million, for a total of $12 million. But that compromise was voted down in the Senate. After it was defeated in the Senate, Lamar did not bring up the compromise for a vote in the House.

Under the current law, private schools are eligible for the tax credits if they educate:

Children in the foster care system.

Children who have a chronic illness or physical, intellectual, developmental or emotional disability.

Children eligible for free or reduced meals.

Nancy Loome, executive director of the Parents Campaign, said technically if the school has one student with a speech impediment, for instance, it could receive the tax credit money.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Read Mississippi Today’s Pulitzer Prize finalist series ‘’Unfettered Power: Mississippi Sheriffs”

Published

18 hours ago

May 6, 2024

Staff Editor

Mississippi Today's “Unfettered Power: Mississippi Sheriffs” investigation has been named a finalist for the 2024 Pulitzer Prize for Local Reporting.

The 2023 investigation from the Mississippi Center for Investigative Reporting at Mississippi Today and The New York Times' Local Investigations Fellowship revealed how Mississippi sheriffs rule like kings, wielding vast power, exploiting and abusing the very people they are called to protect with no one stopping them.