The Mississippi Senate has insisted that if the state is going to expand Medicaid, there must be a work requirement for most of those who become newly eligible for the government-provided health insurance.
Philosophically, that seems reasonable.
Medicaid expansion has been promoted for years by supporters, including me, as a way to provide health insurance to the “working poor” — those who make too little to be able to afford private insurance and too much to qualify for traditional Medicaid.
If that is the intent, then it logically follows that it is not asking too much for these new beneficiaries to prove that they are, in fact, working.
But what seems reasonable in theory sometimes doesn’t work all that well in practice. A line-in-the-sand attitude toward tying work to Medicaid expansion is probably one of those.
First off, it’s unlikely to fly as long as Joe Biden is president. His administration has made it clear that it does not agree with tying the insurance benefit to work. By doing so, Mississippi would almost guarantee that expansion would hinge on whether Donald Trump beats Biden in November — a less than 50/50 bet at this point.
Even if Trump wins, having a work requirement may be more trouble and expensive than it’s worth. The Senate bill says that to be eligible — but for a couple of family-related exceptions — the beneficiary has to work at least 120 hours a month, or roughly 30 hours a week. Such a requirement would require initial verification and constant monitoring. That means either adding more employees in Mississippi’s Medicaid division or contracting some of this work out, as has been done in Georgia, the state that the Mississippi Senate’s plan most closely emulates.
Georgia is presently the only state of the 40 that have expanded Medicaid with a work requirement. Its law stipulates that beneficiaries in the expanded classification must work at least 80 hours a month — 40 less than Mississippi’s Senate is wanting. As with the Senate plan, Georgia limits expansion to those with a household income of no more than 100% of the federal poverty level, rather than the 138% that Obamacare richly incentivizes states to adopt.
Georgia’s expansion plan kicked in last July, and it has been underwhelming in accomplishing the goal of reducing the number of uninsured, according to the reporting of KFF Health News. Only 3,500 people signed up in the first eight-plus months, well below the state’s projections. And more than 90% of the state’s $26 million in outlays went to administration and consulting costs.
Critics of the Georgia plan say so far the biggest beneficiaries of Medicaid expansion have been the consultants.
One has to wonder if that is also motivating the Mississippi Senate’s version, using the work requirement as a back-door way to funnel business to some of the lawmakers’ corporate supporters.
But even if that’s not what’s going on, the Senate plan would dramatically reduce the potential health and economic impacts of Medicaid expansion and the help it might give to the state’s struggling hospitals.
My back-of-the-envelope math estimates that instead of getting an extra billion dollars a year from Washington that full expansion would bring, the state would get more like $350 million under the Senate’s scaled-down version. It would also leave on the table another $700 million that Mississippi would receive in the first two years if it adopted full expansion.
The Senate is kidding itself if it thinks Gov. Tate Reeves is going to be less of an obstacle to Medicaid expansion if it waters the plan down. Reeves is no less mule-headed about the subject today than he was when the Affordable Care Act was passed in 2010 and first put Medicaid expansion into play.
He is going to veto any effort to add to the Medicaid rolls. He’s going to throw water on Republican lawmakers’ silly attempt to make it sound more palatable by referring to expansion as a “waiver.” And it’s going to take two-thirds of the members in both chambers to overcome his opposition.
The Legislature can put the governor in his place with the Senate version, which is unlikely to be approved in Washington or, even if it is, will have a much more limited impact on reducing the ranks of the uninsured, helping the state’s hospitals and boosting the economy.
Or it can put him in his place with the House version, which has the potential to significantly improve Mississippi’s health-care outcomes and its GDP.
If Republicans in the Legislature are willing to cut this tie with Reeves and face a possible backlash from the right, they should make the move worth the risk.
- Contact Tim Kalich at 662-581-7243 or tkalich@gwcommonwealth.com.
