After two terms as lieutenant governor and nearly one as governor, Tate Reeves on Thursday is expected to make his first major proposal to address Mississippi’s health care crisis.

Reeves is announcing his plan less than two months before the Nov. 7 general election, when he’ll face Democrat Brandon Presley, who has made a key part of his campaign expanding Medicaid to help alleviate the ongoing health care crisis. Reeves also is making his announcement as more Republicans have warmed to the idea of expanding Medicaid as proposed by Presley, but opposed by Reeves for the past decade.

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Tim Moore, president of the Mississippi Hospital Association, said the state’s struggling hospitals would be appreciative of any financial help.

“At this time I am not familiar with any plan the governor may be presenting,” Moore said on Wednesday. “Considering the ongoing desperation of our health care system, I am hopeful the governor has developed a plan to mitigate the health care crisis in our state. I am trying to be optimistic that CMS (the federal Medicaid authority) would consider a significant plan or waiver that does not include increasing the number of covered lives. With that said, the hospital industry will be appreciative for any financial assistance that can be achieved. Mississippi health care for all Mississippians is on a critical path if left unaddressed.”

The Mississippi hospital crisis — and potential solutions to it — has been one of the main focuses of the 2023 campaign for governor.

Mississippi is one of 10 states to refuse federal tax dollars to expand Medicaid coverage to the working poor. Brandon Presley, the Democrat who is challenging Reeves in the November general election for governor, has endorsed Medicaid expansion. Reeves, on the other hand, has long opposed expansion in the state.

Meanwhile, leaders in one of the poorest, unhealthiest states are leaving more than $1 billion a year in federal funding on the table with the refusal, even as people and hospitals statewide struggle. More than half of the state’s rural hospitals are at risk of closure, and even larger hospitals have been forced to slash services for budget reasons.

While Reeves and other GOP leaders have adamantly opposed Medicaid expansion, they have offered few other specific solutions, and none approaching the magnitude of Medicaid expansion. Reeves, when questioned recently about the state’s health care crisis, has said more free-market competition for health services would help, and that he wants more Mississippians to have good jobs that provide health benefits.

In 2022 legislative hearings, lawmakers and health officials kicked around other ideas in lieu of Medicaid expansion to help hospitals. These included eliminating or temporarily halting the state “bed tax,” which hospitals pay to cover the state’s share of Medicaid costs.

Moore said eliminating this tax would help, and that the amount hospitals pay yearly runs from about $185 million to $300 million.

Another idea was to switch hospital reimbursements for the Medicaid care they now provide from a rate based on Medicare to a standard “commercial rate.” In other states, such as Louisiana, this change has resulted in much larger amounts paid to hospitals.

But Moore said this move, implemented last year, provided little benefit because Mississippi’s commercial rates for health services are so low.

“We picked up $40 million last year on outpatient, but because our inpatient rates are so low, we didn’t pick up anything,” Moore said. “… There’s just not that big a gap between what Medicare pays and the commercial rate.”

At the 2022 hearing, it was incorrectly estimated that the change would provide hospitals about $360 million annually. That was incorrect, Moore said, because the commercial rates are so low in Mississippi. In Louisiana, which has expanded Medicaid, the change produced about $900 million annually.

The only way to make the change more effective in Mississippi would be to pay hospitals more for Medicaid than they get for commercial rates. Moore said it is not likely that the federal government would approve such a scheme.

Quentin Whitwell, an executive with several rural Mississippi hospitals, said he is anxious to see the governor’s proposal Thursday.

“It’s no secret rural hospitals are struggling right now and we need all the help we can get,” Whitwell said. “It’s obvious that some form of Medicaid expansion, even if it is privatized, would be useful. But any other negotiations with CMS or Health and Human Services to forgo bed taxes or get more supplemental payments would be great, and we look forward to seeing any solutions proposed and look forward to the opportunity to provide positive input.”

The Mississippi Hospital Association, which is supporting Presley’s candidacy, and most other medical groups and providers in Mississippi have long supported Medicaid expansion as a major step toward fixing Mississippi’s ailing health care system and helping hundreds of thousands of uninsured, working-poor Mississippians receive care.

The political action committee for the state’s largest organization of doctors, the Mississippi Medical Association, has endorsed Reeves. In January of 2023, the medical association released commentary saying it supported a “raise in the income eligibility for Medicaid,” which is the definition of Medicaid expansion. It also said “the Arkansans model” should be considered where the funds the state received for Medicaid expansion would be used to help low income people purchase private health insurance. The Arkansas plan was approved by the federal government as a form of Medicaid expansion.

When asked if the medical association still supported some form of Medicaid expansion after endorsing Reeves, Dr. James Rish, chair of the group’s political action committee, responded: “We look forward to further discussion and engagement with Gov. Reeves to address the many healthcare challenges in our state, including improving accessibility, affordability, and the overall statewide healthcare delivery system for all Mississippians.”

On Wednesday morning, Mississippi Today asked the Reeves campaign about any proposals the governor might put forth to deal with the health case crisis, which includes multiple struggling hospitals across the state in danger of closing and the highest percentage of unhealthy people in the nation.

The Reeves campaign did not respond to the Mississippi Today inquiry, but instead announced intentions on Wednesday afternoon to unveil his plans in a Thurday press conference.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.