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A seat at table for Democrats might have gotten Medicaid expansion across the finish line

The Mississippi Capitol is 171,000 square feet, granted a massive structure, but when it comes to communication between the two legislative chambers that occupy the building, it might as well be as big as the cosmos.

Such was the case in recent days during the intense and often combustible process that eventually led to the death of Medicaid expansion and with that the loss of the opportunity to provide health care for 200,000 working poor Mississippians with the federal government paying the bulk of the cost.

Democrats in the state House came under intense pressure and criticism for blocking a Medicaid expansion compromise reached by Republican House and Senate negotiators.

First of all, it would be disingenuous to argue that Democrats, who compose less than one-third of the membership of either chamber, blocked any proposal. Truth be known, Republicans should be able to pass anything they want without a solitary Democratic vote.

But on this particular issue, the Republican legislative leadership who finally decided that Medicaid expansion would be good for the state needed the votes of the minority party, which incidentally had been working for 10 years to pass Medicaid expansion. The reason their votes were needed is that many Republicans, despite the wishes of their leaders, still oppose Medicaid expansion.

The breakdown in the process could be attributed to the decision of the two presiding officers, House Speaker Jason White and Lt. Gov. Delbert Hosemann in the Senate, not to appoint a single Democrat to the all-important conference committee.

Conference committees are formed of three senators and three House members who work out the differences between the two chambers on a bill. Considering that Democratic votes were needed in both chambers to pass Medicaid expansion, and considering Democrats had been working on the issue for a decade while Republicans blocked it, it would have made sense that they had a seat at the table in the final negotiations process.

One Democrat from each chamber on the conference committee could not have altered the outcome of the negotiations. But the two Democrats could have provided input on what their fellow legislative Democrats would accept and vote for.

In the eyes of the Democrats, the compromise reached without their voice being heard was unworkable and would not have resulted in Medicaid expansion.

The Republican compromise said Medicaid would not be expanded until the federal government provided a waiver mandating those on Medicaid expansion were working. Similar work requirement requests by other states have been denied. Under the compromise, if the work requirement was rejected by federal officials, Medicaid expansion would not occur in Mississippi.

After voicing strong objections to the work requirement, House Minority Leader Rep. Robert Johnson, recognizing the Senate would not budge from the work requirement, offered a compromise. The Johnson compromise to the compromise was to remove a provision mandating the state apply annually with federal officials for the work requirement.

Instead, under Johnson’s proposal, state Medicaid officials would be mandated to apply just once for the work requirement. If it was rejected, Medicaid expansion would not occur, but hopefully that would compel the Legislature to take up the issue of the work requirement and perhaps remove it.

“We just want the Legislature to come back and have a conversation next year if the federal government doesn’t approve the work requirement. It’s as simple as that,” Johnson said.

Senate leaders agreed that Johnson’s proposal was a simple ask and something they might consider.

But Lt. Gov. Delbert Hosemann, who presides over the Senate, said he never heard Johnson’s proposal until late in the process — too late in the process, as it turned out.

Speaker Jason White, R-West, also said he never heard the proposal, though Johnson said he repeatedly discussed it with House leaders. He certainly was relaying the information to the media during the final hectic days before Medicaid expansion died.

And perhaps if Johnson or one of his Democratic colleagues had been on the conference committee, that information would have been heard by the right legislative people and perhaps Medicaid expansion would not have died.

After all, a conference room or an office where negotiators are meeting to hammer out a compromise is much smaller than the massive state Capitol, where communications often get lost in the cosmos.

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