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Medicaid expansion negotiators still far apart after first public meeting

Kevin Blackwell, the main Senate negotiator trying to reach agreement on expanding Medicaid to provide health insurance for primarily the working poor, urged his House counterparts Tuesday to accept the Senate’s scaled-down version of Medicaid expansion.

“Both chambers are off the porch” in terms of passing bills to expand Medicaid, Blackwell said. “… Both have taken a step forward. But if your position is my way or the highway, it is going to put us right back on the porch.”

House negotiators, meanwhile, offered a compromise expansion plan to the Senate on Tuesday, but Blackwell and his Senate negotiators did not reciprocate, saying only they would take the House counter back to Lt. Gov. Delbert Hosemann and other Senate leaders for consideration and casting doubt that they can gin up more Senate support.

Blackwell made his warning Tuesday near the end of the first open-to-the-public conference committee meeting, which was packed to capacity with onlookers eager to witness a key meeting of the Legislature’s first-ever earnest debate of Medicaid expansion.

The issue has become the major focus of a contentious 2024 legislative session, with hundreds of Mississippians, top state business leaders, health officials and even religious leaders publicly advocating at the Capitol for full Medicaid expansion that stands to significantly help the poorest, unhealthiest state in the nation.

In the meeting on Tuesday, three House negotiators and three Senate negotiators met to try to hash out the differences between the two chambers on expanding Medicaid as is allowed by federal law and covered largely with federal funding.

House Medicaid Chairwoman Missy McGee, the lead House negotiator, said her chamber’s goal is to expand Medicaid to cover the maximum number of poor Mississippians allowed under federal law and to draw down the maximum amount of federal dollars.

READ MORE: Experts analyze House, Senate Medicaid expansion proposals, offer compromise plan

She said the Senate plan did not do that. The House would expand Medicaid to cover those earning up to 138% of the federal poverty level or about $20,000 annually for an individual.

The Senate plan would cover those earning less than 100% of the federal poverty level or about $15,000 annually for an individual. McGee pointed out under the Senate plan there would be much less federal money available to pay for expansion. She said the goal should be to cover as many people as possible at the most affordable cost. She said the House plan does that.

But as a compromise, she offered “a hybrid plan” where those earning between 100% and 138% of the federal poverty level would receive health care coverage through private health insurance policies offered on the federal exchange. The costs of the policies, though, would be covered through federal-state Medicaid funds. But under the plan, the federal government would pay 90% of the costs.

Under the Senate plan, the federal government would pay 77% of the costs.

McGee said the House is offering the compromise to cover people through private insurance after Senate leaders said expanding Medicaid to 138% of the federal poverty level would damage the marketplace in Mississippi by moving people from the marketplace to Medicaid. While senators said they did not want to damage the marketplace, in reality, the marketplace provides polices for people earning much more than 138% of the poverty level and exchanges in the 40 states that have expanded Medicaid have not been harmed.

After McGee and the two other House negotiators offered the “hybrid plan” as a compromise, she urged Blackwell and his two Senate colleagues to take the proposal back to Senate colleagues and to come back in the coming days to possibly offer a counterproposal.

“We feel this is a major compromise,” she said.

As the meeting ended, Senate conferees said they would take the House’s proposed compromise back to Hosemann and other Senate leadership. They urged McGee to also go back and talk with the House speaker and leadership.

“But if your position has not changed, or you haven’t offered anything, then I don’t have anything to take back,” McGee responded.

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

Blackwell said the Senate wanted to take slow steps while the House was moving forward with “a Ferrari plan.”

He said he does not believe the Senate would agree to such rapid movement after the two chambers had refused for the past decade to even consider Medicaid expansion.

Blackwell said that in other states, the number of people insured through Medicaid expansion and the costs have come in higher than initially estimated.

When asked after the meeting if he could point to any other state that had seen a great detrimental effect — financially or otherwise — from Medicaid expansion, he paused for a moment.

“I can’t answer that,” Blackwell said. “I’m not in those other states,” although he said he met a lawmaker from Kentucky who told him the program had been expensive.

If the House would accept the Senate proposal, Blackwell said in the coming years the two chambers could work to expand upon it.

The first full conference committee on the pivotal issue occurred less than a week before the deadline for the conference committee to reach an agreement to offer to the two chambers for possible passage during the scheduled final week of the 2024 session.

McGee pointed out 40 other states, many governed by Republicans, have expanded Medicaid and none of those have tried to repeal the program. Blackwell argued that the expansion has cost more in those states than initial studies said it would cost.

McGee said the House plan had a four-year “repealer” and would be cost neutral through that time, according to various studies, which also indicate little or no cost to the state after those initial four years. After those four years, the two chambers would have to vote to continue the program or it would be repealed.

“It is almost as if we have a four-year pilot program paid for by the federal government,” McGee said.

But Blackwell warned that if the Legislature is unable to pass any version of expansion this year, he did not believe it would be possible in upcoming years.

“If it dies this year, it gets harder next and then it becomes almost impossible after that,” Blackwell predicted.

The two sides also at odds on other issues. For instance, the Senate does not want to expand Medicaid if the federal government will not allow a work requirement.

READ MORE: Top Mississippi business leaders endorse full Medicaid expansion

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