STARKVILLE —     How simple it would be if the legislative battle in Mississippi over the future of the Obama health care reforms were merely a battle between Republicans and Democrats.

    On the surface, that’s the rub. The Republican leadership – Gov. Phil Bryant, Lt. Gov. Tate Reeves, and House Speaker Philip Gunn – all say they oppose a Medicaid expansion in Mississippi because of state budgetary concerns. Bryant said funding a Medicaid expansion would likely require substantial budget cuts in education and transportation. Reeves said adding 400,000 people to Medicaid would cost about $1.7 billion over a decade. Gunn called the expansion a “budget-buster” for the state.

    But Democrats and public health care advocacy groups say Mississippi can’t afford to turn down additional federal dollars available for public health care in a state with a high percentage of uninsured citizens.

    Seeking to influence both sides in the partisan battle over the proposed expansion of Medicaid in Mississippi will be the state’s hospitals. After the recent Supreme Court ruling that sparked public opposition to Medicaid expansion by Bryant, Reeves and Gunn, the Mississippi Hospital Association released a statement that contained this ominous scenario:

    “Failure to expand Medicaid eligibility will leave just under 200,000 Mississippians with no health care coverage at all. These Mississippians will be left ‘in the gap’ - not eligible for Medicaid and not eligible to purchase health insurance through the health insurance exchange. The result could be devastating. Hospitals cannot be expected to treat such a large volume of people with no expectation or prospect of payment for those services. The result could very well mean the closure of many of our community hospitals,” the MHA statement claimed.

    The hospitals are expected to hang their political hats on the estimated annual $315 million costs of uncompensated care (the cost of treating uninsured patients that is not reimbursable by any federal program) as justification for the Medicaid expansion. Hospitals nationwide are taking the same course, particularly in states like Mississippi that have relatively large uninsured populations and extensive poverty.

    Mississippi’s Medicaid expansion debate is likely to renew an old political division that engendered a three-year battle between the MHA and the then-Democratic Party-controlled House of Representatives on one side and former Gov. Haley Barbour, the state Senate and the Division of Medicaid on the other over the so-called “hospital tax.”

    The fight began in 2006 when the federal government disallowed the state’s Medicaid Disproportionate Share Hospital funding plan. That action left the state Medicaid program short $90 million that had previously been used to draw down another $270 million in federal matching funds.

    MHA president Sam Cameron and the House leadership called the proposed “hospital tax” a “tax on the sick.” Barbour, the state Senate and the Division of Medicaid contended that the funding assessment was in place prior to Barbour taking office in 2004 and that the basic assessment plan had been created and approved by the association in conjunction with the Division of Medicaid and the Legislature.

    After a protracted and politically bloody three-year fight, the “hospital tax” was adopted by lawmakers. Now, in the wake of the Supreme Court decision on the Obama health care reforms, the state’s hospitals and the Legislature are again on a collision course with the influential MHA.

    The stakes are high for the state’s hospitals that provide Medicaid coverage and emergency room treatment for the indigent. And the stakes are perhaps just as high for the state’s GOP legislative leadership who see controlling state spending as their primary objective.



    Sid Salter is a syndicated columnist. Contact him at 601-507-8004 or sidsalter@sidsalter.com