Mississippi’s Roadblocks to health-care reform
The Black AIDS Institute
The road to the Affordable Care Act (ACA) is smoother in some states than in others. In Mississippi the journey to health-care reform has been particularly turbulent. State leaders and lawmakers have clashed over key tenets of the law, leaving Mississippi residents in limbo.
Under the ACA, each state will have a health insurance exchange, a marketplace where Americans will be able to shop for more affordable insurance. The states have the option of running their own exchange or partnering with the federal government to get the exchange ready to enroll consumers by Oct. 1, 2013. If a state doesn’t choose either option, the Department of Health and Human Services (HHS) will set up that state’s exchange.
Mississippi’s Republican commissioner of insurance, Mike Chaney, opted to set up a state-run exchange and set about doing so. However, Mississippi Gov. Phil Bryant opposed the exchange and sent a letter to HHS secretary Kathleen Sebelius stating that it was in “my own opinion and my attorneys’ opinion that the [Mississippi Insurance Department] lacks the necessary statutory and constitutional authority to establish and operate an exchange.” Furthermore, Bryant said that Mississippi would not link its state Medicaid program to the state-run exchange, meaning that the people most in need of affordable health insurance would be unable to participate in the exchange.
In response to Bryant’s stance, HHS rejected Mississippi’s application to open a state-run exchange. In a letter to Chaney, Gary Cohen, director of the federal Center for Consumer Information and Insurance Oversight — the HHS division that’s charged with implementing the ACA — wrote: “We completed our review and have determined that we will not be able to conditionally approve your application at this time, because of the Mississippi Governor’s stated intent to oppose implementation of a State-based exchange.” Instead, HHS will set up the exchange for Mississippi.
After the HHS decision, Bryant reiterated his position: “[T]he health insurance exchanges mandated by Obama-Care are not free-market exchanges. Instead, they are a portal to a massive and un-affordable new federal entitlement program. . . . I firmly maintain my position that Mississippi will not willfully implement a mechanism that will compromise our state’s financial stability.”
The Question of Medicaid
The state-run health insurance exchange isn’t the only aspect of the ACA that Bryant opposes. He is also against the Medicaid expansion, a part of the act that would enable states to expand Medicaid so that it covers Americans making up to 133 percent of the poverty level, which isapproximately $29,000 for a family of four. While an estimated 313,000 adults would be newly eligible for Medicaid in Mississippi between 2014 and 2016, according to a report by the Mississippi Institutions of Higher Learning’s University Research Center, Bryant has said that he opposes the expansion because it’s not in the best interest of his state.
However, many disagree. And with Mississippi being the state with the largest percentage of African Americans, some say that Mississippi’s Black community would particularly benefit from the Medicaid expansion. “Expanding Medicaid in Mississippi provides an opportunity to improve the overall health status and health outcomes for African Americans living in Mississippi,” says Derrick Johnson, president of the Mississippi NAACP. “In addition, increased access to health care will help to reduce racial disparities of health that exist in Mississippi,” he adds.
There is currently no resolution to the issue; state lawmakers ended the legislative session April 4 without voting on the Medicaid expansion or the approval and funding of the current Medicaid program. State Republicans have been vocal in their opposition to the Medicaid expansion, while Democrats have largely supported it.
A special session will be held to vote on the current Medicaid program and the expansion, says Jarvis Dortch, program manager for the Mississippi Health Advocacy Program. The date of the session is uncertain but will likely be before July 1, which is when the current Medicaid program must be reauthorized.
With the state Legislature controlled by Republicans, Medicaid expansion looks unlikely in Mississippi, but Dortch remains hopeful that lawmakers who are against it will have a change of heart by the time the special session takes place. “Our position and the position of health-care advocates and supporters of Medicaid expansion is that we can’t maintain the status quo in Mississippi, where we just have a Medicaid program that leaves so many Mississippians without health care and without health insurance,” says Dortch.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes about health, wealth and
