Dr. Michael Forster

Can Mississippi afford not to expand Medicaid coverage?

So, Gov. Bryant says Mississippi is definitely not going to expand Medicaid, as intended by the Patient Protection and Affordable Care Act (aka “Obamacare”).  Expanded health care coverage for the poor and near-poor is unacceptable because it will require a state match – true, not now, but down the road a few years from now – and Mississippi is just too poor to afford it.  “There’s no such thing as free money,” the governor reminds those who might mistake a program funded 100% by the feds ‘til 2016, and 90% after that, as, if not quite free, pretty close to it.

Let’s hope the governor and other anti-expansion stalwarts are just indulging in pre-election posturing, and will come to their political-economic senses if Obama is re-elected.  Expanding Medicaid coverage in Mississippi makes a lot of sense, for at least three reasons:

First, it’s an incredibly good deal.  According to the non-partisan Congressional Budget Office (CBO), the federal government will in fact cover about 93% of the cost of expansion from 2014-2022, with a match cost probably a lot lower than projected by opponents.  At most, additional cost to the states will be 2.8% higher than likely costs in the absence of health care reform.  Some independent analyses in fact show the states saving money as a result of the reforms, in part because of a reduction in the exposure to currently uncompensated costs.

Second, expanded health care is such a potent economic driver that any drain related to matching requirements will be more than offset by the tax revenues generated by the economic growth stimulated by the expansion.  (The biggest problem confronting an expansion would likely be workforce shortages, not making the match; indeed, Mississippi is already experiencing major challenges in producing an adequate supply of qualified health care professionals.)  Mississippi’s leadership reportedly wants to gin up the economic engine of health care throughout the state; expanding Medicaid needs to be part of the picture.

Finally, and most important, it’s quite simply both the smart thing and the right thing to do.  Most estimates suggest that an additional 400,000 Mississippians currently without health care coverage would receive it under Medicaid expansion.  How can Mississippi – not only the poorest state in the nation, but arguably the most unhealthy, with a virtual health outcomes apocalypse facing us if we don’t turn things around, and fast – leave health care money on the table when there’s clearly such a desperate need?  Can Mississippi afford to expand Medicaid, asks Gov. Bryant, and answers in the negative.  But Governor, can Mississippi really afford not to expand Medicaid?

Dr. Michael Forster
Dr. Michael Forster

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