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A solution to the Republican impasse on Medicaid expansion

Kathleen O’Beirne knocked loudly on Sen. Kevin Blackwell’s office door in the basement of the Mississippi State Capitol on Saturday morning.

O’Beirne, a Ridgeland resident and mother of two boys, has been closely tracking the back-and-forth debate on Medicaid expansion, which Blackwell, as chairman of the Senate Medicaid Committee, is leading for the Senate. She and a group of other concerned citizens simply wanted a word with the Republican leader.

But there was no answer at the door, and there would be no conversation. So O’Beirne and the others took blank sheets of copy paper and began writing letters. When they finished writing, they taped the letters to Blackwell’s door.

“I’m here because of the human cost of not expanding health care coverage to poor Mississippians,” O’Beirne said outside Blackwell’s office. “But I’m also here because I’m a taxpayer. And I see that our senators are about to pass up literally billions in federal tax dollars that you and I and most other Mississippians already pay. We have the chance to bring all of that money back to the state of Mississippi, but we’re about to walk away from it for no good reason.”

Kathy Knight, left, of Madison, and Kathleen O’Beirne of Ridgeland, hold a sign urging lawmakers to fully fund a Mississippi Medicaid expansion plan, while Jack Reed Jr., a former Tupelo mayor and a long time northeast Mississippi businessman, right, joins a group of small business owners who urged the same during a Tuesday, April 23, 2024, news conference at the state Capitol in Jackson, Miss. (AP Photo/Rogelio V. Solis)
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Kathy Knight, left, of Madison, and Kathleen O’Beirne of Ridgeland, hold a sign urging lawmakers to fully fund a Mississippi Medicaid expansion plan, while Jack Reed Jr., a former Tupelo mayor and a long time northeast Mississippi businessman, right, joins a group of small business owners who urged the same during a Tuesday, April 23, 2024, news conference at the state Capitol in Jackson, Miss. (AP Photo/Rogelio V. Solis)

As O’Beirne and other Mississippians have closely followed, Blackwell has been as dug-in as any lawmaker during the Medicaid expansion fight. This week, after agreeing to hold public conference committee meetings to debate Medicaid expansion, he refused to meet a second time with his House counterparts. He has seldom engaged with House Republican leaders in private, either.

He did, however, choose to speak to a gaggle of reporters on Friday after the Senate sent a compromise plan to the House for consideration. In the interview, he drew hard lines against any additional compromise with the House, specifically around a work requirement, and even doubted whether his own plan had the necessary support from his Republican Senate colleagues.

READ MORE: Blackwell says Senate won’t budge on Medicaid work requirement

Blackwell and some Republican senators have long maintained that any expansion deal must include a requirement that Medicaid recipients work, which is a conservative policy desire that the federal government has struck down in 13 previous expansion states. Including a stringent work requirement, health care advocates and legal scholars believe, would effectively kill any expansion plan.

But in the plan the Senate put forward on Friday, they would still mandate the requirement. It would also force the state’s attorney general to sue the feds over any rejection and hope that a conservative 5th Circuit Court of Appeals allows the work requirement to go into effect. Unless a work requirement was granted by either the federal Medicaid agency or the federal courts, expansion could not go into effect under the Senate plan.

READ MORE: The unlikely Mississippi politician who could tank Medicaid expansion

However, an earlier House proposal also included a work requirement but would allow expansion to go into effect if the state could not convince the federal government to allow it. House leaders have not yet publicly responded to the Senate plan they received on Friday, but the work requirement piece has been the main topic of deliberations on that side of the building. 

The House and Senate Republican remained at an apparent impasse as of midday Saturday and adjourned for the day without giving any public updates on expansion negotiations. Both chambers were working into the evening Saturday and will work again Sunday to hammer out final agreements on a $7 billion state budget.

None of that sat right with O’Beirne, inspiring her to come back to the Capitol on Saturday and make the unannounced visit to Blackwell’s office. When asked what message she was trying to deliver to Blackwell, she said: “Well, a compromise.”

O’Beirne then summed up what she wrote in her note to Blackwell:

“I’m a recovering lawyer, so I’m used to resolving litigation. I think there’s a very obvious compromise that the Senate and the House could come to if they were willing to do the work. 

My suggestion is to keep the Senate’s work requirement. Keep the provision that says if CMS kicks back the work requirement, then the AG has to sue the feds. But also, keep the House provision that will allow Medicaid expansion to go into full effect, even if CMS kicks back the work requirement.

So you go on and you start pulling down those billions of federal dollars that help the state and people get health care coverage. Then in the meantime, let the lawyers and government officials sort out the work requirement business. To me, that’s a win-win-win. 

Now, I’m sure Lt. Gov. Hosemann, Sen. Blackwell and other leaders are mulling that over. Maybe they’ve already had that thought. To me, it’s such an obvious compromise that takes full advantage of our tax dollars. It’s not wasting our tax dollars. It’s helping communities. It’s helping hospitals. It’s helping doctors. It’s helping needy patients. It is just an all around win that I sure hope they can get to.”

Kathleen O’Beirne

Such a compromise would require some careful drafting of the legislation, experts say, and whether it checks enough boxes for Blackwell and the hard-line senators is anyone’s guess. But O’Beirne, a self-described “pragmatist,” felt led to share it with Blackwell on Saturday.

“I really do think there’s a path here,” O’Beirne said. “It seems like a very simple solution right under our noses that Senate leaders are about to pass up. How frustrating would it be to come all this way to get nothing?”

READ MORE: These Republicans wanted a Medicaid work requirement but couldn’t get approval. So they got creative.

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