Mississippi Today

House Democrats unveil Mississippi’s first major Medicaid expansion plan

Published

9 months ago

February 5, 2024

House Democrats unveil Mississippi’s first major Medicaid expansion plan

Democratic representatives will file a bill to expand Medicaid eligibility to working-class Mississippians — after years of failed attempts and as rural hospitals reach their breaking point.

Though Democrats have fought for years to expand Medicaid, they hope their more pragmatic proposal this session and the new House speaker’s pledge to seek a bipartisan solution on health coverage will finally yield a realistic plan to expand coverage.

“I think a majority of people in Mississippi would like to see … coverage for working Mississippians who don’t have coverage and providing the uncompensated care funding that hospitals need to stay open,” House Democratic Leader Robert Johnson III said.

The bill, the first major Medicaid expansion proposal this year, would expand traditional Medicaid coverage eligibility and includes a private insurance option for Mississippians who make up to twice as much as the federal poverty level.

There’s also a component that would help subsidize premiums for people who are on or are offered insurance through their jobs.

It’s a plan that, Democrats say, favors women and small businesses. It would cover more people than traditional expansion because it’ll be easier to qualify for coverage, but more people would be partially paying premiums in a tiered system, dependent on income.

The Affordable Care Act passed in 2010, increased health insurance coverage for millions of low-income people across the country by expanding eligibility to qualify for Medicaid, a federal-state program that provides health coverage to millions of people.

Since 2014, states have had the option to expand Medicaid eligibility even further to the working poor. In states that have not done so, it’s challenging to qualify for Medicaid coverage solely based on income. In Mississippi, non-disabled adults without children are not eligible for Medicaid coverage, regardless of their income. Parents in Mississippi are eligible only if their incomes don’t exceed 24% of the federal poverty level — for context, that’s at most $587 monthly for a family of four, according to the Mississippi Division of Medicaid website.

Mississippi is one of 10 states that has not expanded Medicaid coverage to the working poor. Meanwhile, the state’s hospitals are foundering.

One report puts nearly half of Mississippi’s rural hospitals at risk of closure, largely due to uncompensated care costs, or money spent treating patients who are uninsured. Because emergency rooms cannot legally turn down patients, regardless of their insurance status, it’s often the only resort for health care for uninsured people.

That means without health insurance, preventative care is generally out of reach.

Research shows expansion would insure the approximately 250,000 people who fall into the state’s coverage gap, meaning they make too much to qualify for Medicaid now but too little to afford private insurance. The policy’s adoption would also generate billions of dollars for Mississippi, directing much-needed money to the state’s struggling hospitals, and allow for more timely health care, likely improving health outcomes in one of the country’s sickest states.

Despite most Mississippians’ support of Medicaid expansion, Republican Gov. Tate Reeves and former Republican House Speaker Philip Gunn staunchly opposed the policy over the last four years. Even as medical experts sounded the alarm over the financial future of hospitals, Reeves has ignored the policy’s benefits, reducing expansion to “welfare.”

Democratic Rep. Zakiya Summers of Jackson said that Mississippi’s abysmal health outcomes are well documented, and the state cannot afford to “kick the can down the road” any further on expanding coverage to more people.

“I think we’ve heard a lot of talk about wanting to do something around Medicaid expansion, but we haven’t actually seen pen being put to paper,” Summers said. “What we have developed is a really good opportunity to say, ‘Here is something that we can take a look at and have conversations about.’”

But the Democrats’ latest plan is not a typical Medicaid expansion bill.

The measure both expands eligibility for traditional Medicaid coverage and includes a private insurance option for people who fall into a certain federal poverty level threshold. If passed, the hybrid policy would cover more Mississippians than a traditional Medicaid expansion bill, which usually covers people up to 138% of the federal poverty level.

“Our program is going to incorporate people up to 200% of the federal poverty level,” Johnson said.

Rationalizing the private option, he said, “Asking the government to pay all of the funds to make sure we cover people up to 200% of the poverty level is I don’t think reasonable and I don’t think it’s acceptable or winnable.”

The bill would:

Expand Medicaid coverage eligibility for all adults who are at or below 95% of the federal poverty level. In 2024, that is $14,307 gross annual income for a childless individual.
Allow adults with no children who make more than that, up to 200% of the federal poverty level or $30,120 gross annual income, to qualify for private health plans through the federal marketplace or offered by the state.
If they’re employed and make between 96% and 200% of the federal poverty level, their premiums would be covered at varying degrees by the division.

Democratic leaders are hopeful the plan — which includes incentives to join the workforce — will gain traction in the Capitol, but they know the Republicans who hold a supermajority in both chambers won’t outright adopt their bill in the coming weeks.

Instead, Johnson hopes that Republicans will at least realize the minority party’s proposal is sensible and include portions of it in a final version and pass it.

“If it ever gets passed in its final form, it’ll probably have my name nowhere near it,” Johnson said. “But if it means that we get a plan that really provides coverage to people in the state of Mississippi, I don’t care what they call it or whose name is on it.”

The person who wields the most immediate power over the Legislature’s solution to giving health insurance to more Mississippians is House Speaker Jason White, a Republican whose rural district is majority-white and financially disadvantaged.

The speaker has been candid about the need for Mississippi, one of the poorest and sickest states in the country, to consider expanding Medicaid and has said state Republicans deserve criticism for refusing to debate the merits of the program.

Johnson told Mississippi Today that he and the speaker have maintained an open dialogue this session about Medicaid policy, and he believes White truly wants to shepherd meaningful legislation through the House.

White told Mississippi Today last week that he and other House leaders are forming a Medicaid plan of their own, but he intends to examine Johnson’s plan to see where the two parties can agree.

“I think we’ll find bipartisanship,” White said. “I’m going to be disappointed if we don’t.”

Arkansas in 2013 voted to adopt a version of Medicaid expansion that includes a private insurance option. As other Southern states consider expansion, the Arkansas model is often referenced.

Though echoes of Arkansas’ version of Medicaid expansion are obvious in the Democrats’ proposal, Johnson said their bill caters to Mississippi’s specific health care and population factors.

Adam Searing, an associate professor at Georgetown University’s McCourt School of Public Policy’s Center for Children and Families whose work focuses on Medicaid, said the Democrats’ bill is a “perfectly reasonable starting place.”

“Expanding Medicaid is a political debate,” he said. “In states that haven’t already done it, there are going to be some compromises.”

Searing said that while Georgia’s initial attempt at expansion only covered part of the population in their coverage gap — subsequently making them ineligible for full federal financial rewards — Mississippi’s bill takes everyone into account.

The federal government will pay 90% of the cost to expand Medicaid to people who are at or below 138% of the federal poverty level, and for people up to 200%, they will pay the federal medical assistance percentage match of the expansion costs. Mississippi has the highest FMAP in the country at 76.9% because of the state’s high poverty rate.

Additionally, the federal government would pay Mississippi more than $600 million over two years as an incentive for expanding Medicaid.

There’s no estimate yet for how much the Democrats’ plan would cost the state because the bill hasn’t made it to the Legislative Budget Office, but researchers estimate that Medicaid expansion would generally bring in $1 billion a year in federal money to Mississippi.

“What I look for in these plans, what makes this one nice, is that the goal is to cover everyone in the coverage gap,” Searing said. “This is where you want to start. I think it’s exciting that someone is putting in a plan, and it’s realistic.”

A significant part of this coverage gap is small business owners who sometimes cannot afford to provide health insurance to their employees.

Democratic Rep. Bryant Clark, D-Pickens, believes if the proposal were to become law, it would save business owners in his district, most of which is in the impoverished Delta, from paying hundreds of dollars each month in an employer-sponsored health plan.

“That might not mean much to Amazon or Nissan, but for a mom-and-pop business, that can make a difference in whether you’re in the black or in the red,” Clark said. “If you raise the limit up to 200% in my district, that will probably cover the vast majority of people that are employed in District 47.”

Democrats said their proposal gives special consideration to women’s health.

Mississippi is one of the most dangerous states in the country to give birth, both for mothers and their babies. A lack of timely preventative and prenatal care is a driving cause of these abysmal outcomes.

Democrats say upwards of 20,000 more women would be eligible for Medicaid under their plan compared to traditional Medicaid expansion.

“Instead of only addressing women’s health when it comes to taking away their choice, or saying the issues they face aren’t real, let’s come together on a bipartisan level and say we’re going to prioritize women this time … and make sure they have their needs met in this state,” Summers said. “We want to make sure women don’t just survive in Mississippi, but they thrive in Mississippi.”

As evidenced by the Medicaid expansion bill, maternal, infant and reproductive health remain a top issue for lawmakers. But the head of Medicaid, an agency under Reeves’ purview, and other political allies have tried to thwart those efforts.

An additional bill the Democrats are filing could shift that power — the legislation seeks to establish a commission that would manage the agency, allowing it to be run in a way that’s “apolitical,” Johnson said.

The proposal is currently being vetted by attorneys in the Legislature. Once the bill is introduced, the speaker will refer it to a legislative committee for consideration.

It’s unlikely legislative leaders will embrace the Democrats’ plan, and White has suggested Republicans will introduce a Medicaid plan of their own. The process for the House and Senate to agree on a final Medicaid expansion bill will likely take months if they agree at all.

Mississippians’ health and financially bleeding hospitals can’t wait much longer, Johnson said.

“It’s a broken record, but we have the worst health outcomes in the country … we ought to be flooded with doctors because there’s such a need,” he said. “We’re losing population and losing opportunity.”

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

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Mississippi Today

Senate panel weighs how much — or whether — to cut state taxes

Published

9 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Taylor Vance – 2024-11-04 15:42:00

A group of state senators on Monday grappled with how much to slash state taxes or if they should cut them at all, portending a major policy debate at the Capitol for next year’s legislative session.

The Senate Fiscal Policy Study Group solicited testimony from the state government’s leading experts on budget, economic and tax policies to prepare for an almost certain intense debate in January over how much they should trim state taxes while balancing the need to fund government services.

Senate Finance Chairman Josh Harkins, a Republican from Flowood whose committee has jurisdiction over tax policy, told Mississippi Today that he wanted senators to have basic facts in front of them before they help decide next year if Mississippi should cut taxes.

“We’re getting a tax cut the next two years whether we do anything or not,” Harkins said. “I just want to make sure we have all the facts in front of people to understand we have a clear picture of how much revenue we’re bringing in.”

Mississippi is already phasing in a major tax cut. After a raucous debate in 2022, lawmakers agreed to phase in an income tax cut. In two years it will leave Mississippi with a flat 4% tax on income over $10,000, one of the lowest rates in the nation.

However, the top two legislative leaders, Lt. Gov. Delbert Hosemann who oversees the Senate and House Speaker Jason White, have both recently said they want legislators to consider new tax cut policies.

Hosemann, the Republican leader of the Senate, has publicly said he would like to see the state’s grocery tax, the highest of its kind in the nation, reduced, though he hasn’t specified how much of a reduction or how long it would take for the cut to be implemented.

White, a Republican from West, said last week that he would like to see the state’s 4% income tax phased out and have the state’s 7% grocery tax cut in half over time.

“We are hoping to construct a tax system that, yes, prioritizes certain needs in our state, but it also protects and rewards taxpayers,” White said last week.

But it’s difficult to collect accurate data on the state’s grocery tax, and state lawmakers must grapple with a laundry list of spending needs and obligations based on testimony from state agency leaders on Monday.

Mississippi currently has a 7% sales tax, which is applied to groceries. The state collects the tax but remits 18.5% back to cities. For many municipalities, the sales tax is a significant source of revenue.

If state lawmakers want to reduce the grocery tax without impacting cities, they could pass a new law to change the diversion amounts or appropriate enough money to make the municipalities whole.

State Revenue Commissioner Chris Graham said the Mississippi Department of Revenue, the agency in charge of collecting state taxes, does not have a mechanism in place for accurately capturing how much money cities collect in grocery taxes. This is because the tax on groceries is the same as non-grocery items.

However, Graham estimates that the state collects roughly $540 million in taxes from grocery items.

The other problem lawmakers would have in implementing significant tax cuts is a growing list of spending needs in Mississippi, a state with abject poverty, water and sewer and other infrastructure woes and some of the worst health metrics in the nation.

Representatives from the Legislative Budget Office, the group that advises lawmakers on tax and spending policy, told senators that lawmakers will also be faced with rising costs in the public employee retirement system, the Medicaid budget, public education, state employee health insurance, and state infrastructure projects.

State agencies, including the employee retirement system, also requested $751 million more for the coming budget year.

“That’s the billion dollar question, I guess,” Senate Appropriations Chairman Briggs Hopson, a Republican from Vicksburg, said. “How we’re able to fund basic government services?”

Harkins and Hopson said the committee would likely meet again before the Legislature convenes for its 2025 session on January 7.

A House committee on tax cuts has also been holding hearings, and White in September held a summit on tax policy.

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

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Mississippi Today

Already dire lack of affordable housing for low-income Mississippians on verge of worsening

Published

13 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Simeon Gates – 2024-11-04 11:00:00

In Mississippi, where there’s already a dearth of 50,000 or more affordable homes for extremely low-income residents, that number could grow in the next five years.

Housing units available under the federal Low Income Tax Credit program could lose their affordability by 2030 –a number estimated nationwide to be 350,000 with 2,917 in Mississippi, alone; 496 in the state already have.

The federal program responsible for most of the nation’s affordable housing is expiring.

The Low Income Housing Tax Credit, introduced as part of the Tax Reform Act of 1986, provides for developers to buy, build and restore low-income housing units. Under the deal, the housing only needs to stay low-rent for 30 years. Construction began in the early 1990s.

Some LIHTC housing will remain affordable due to other subsidies, nonprofits, state law and individual landlords.

“I think the low-income housing tax credit has done everything that it can to address the need for affordable housing around the state,” said Scott Spivey, executive director of the Mississippi Housing Corporation, a state office that administers the program and works with the state government and those in the affordable housing industry to create and support affordable housing

Spivey supports the proposed Affordable Housing Credit and Improvement Act, a federal bill that would expand upon the low-income housing tax credit in several ways, including giving developers more credit for certain projects for low-income households and changing tenant eligibility rules.

The bill was introduced in the House and the Senate last session, and is co-sponsored by Mississippi Sens. Cindy Hyde-Smith and Roger Wicker and in the House by Reps. Mike Ezell, and Michael Guest. As of this spring, both bills are in committee.

While housing has become a major issue for Americans, getting legislation passed has been challenging. “Everybody knows that housing is an issue, but it gets caught up with everything else…and it kind of gets lost in the shuffle,” said Spivey.

This issue is especially important in Mississippi, where demand for housing is high across all incomes.

“All the market studies that we see that come with the applications tell us that there’s a huge need for affordable housing across the state at all the income bands” said Spivey.

According to the National Low Income Housing Coalition, almost a third of Mississippi renters are extremely low income; 65% of them are severely cost burdened, meaning they spent more than half their income on rent. The majority of these households are seniors, disabled people, single caregivers of young children, people enrolled in school, or other.

Director of Housing Law at the Mississippi Center for Justice, Ashley Richardson said housing problems worsened after Mississippi stopped participating in the federal rental assistance program in 2022.

MCJ’s work on housing includes a statewide eviction hotline, investigating instances of housing discrimination, and more.

Richardson praised the LIHTC program, but echoed Spivey’s concerns. “Even with the affordable housing we do have in Mississippi, we are still at a lack,” she said.

The National Housing Preservation Database estimates Mississippi is short 52,421 affordable and available rental homes for low-income people. The National Low Income Housing Coalition puts the figure at 49,478.

Richardson wants the state to deal with issues like providing more tenant protections and rental assistance. There’s also a need to improve homes that are rundown or in poor condition, and many housing nonprofits are running out of funding.

Spivey said people should talk to their property managers and learn about their rights. MHC’s website has resources for homebuyers and renters.

As the housing crisis goes on, there are options for people struggling to find and keep affordable housing and an effort to take action at the federal and state levels.

Some aspiring low-income homeowners may qualify for Habitat for Humanity, a program that builds homes for families in need. Families who qualify work on the homes alongside volunteers, pay an affordable mortgage and receive financial literacy education.

New applicants must meet the qualifications, including a good debt-income ratio, 125 hours of sweat equity and taking classes on financial literacy, home repairs, and being a good neighbor.

Merrill McKewen, executive director for Habitat for Humanity Mississippi Capital Area, emphasized the importance of housing to individuals and communities.

“There are untold studies that have been done that, you’ve gotta have a safe, decent, affordable place to live. The children are better students, the parents are better employees…it grounds you to a community that you can contribute to and be a part of. It is the American dream, to own a home, which is what we’re all about,” she said.

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

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Mississippi Today

Mississippi Election 2024: What will be on Tuesday’s ballot?

Published

14 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Bobby Harrison – 2024-11-04 10:00:00

Mississippians will go to the polls on Tuesday, Nov. 5, to elect federal and state judicial posts and some local offices, such as for election commissioners and school board members.

Polls will be open from 7 a.m. to 7 p.m. on Tuesday. To find your polling place, use the secretary of state’s locator, or call your local county circuit clerk.

The following is a list of the candidates for federal and judicial posts with brief bios:

President

Kamala Harris, current vice president and Democratic nominee for president. Her running mate is Tim Walz.
Donald Trump, former president and current Republican nominee. His running mate is J.D. Vance.
Robert Kennedy Jr. remains on the ballot in Mississippi even though he has endorsed Trump. His running mate is Nicole Shanahan.
Jill Stein is the Green Party candidate. Her running mate is Rudolph Ware.
Five other candidates will be on the Mississippi ballot for president. For a complete list of presidential candidates, see the sample ballot.

U.S. Senate

Ty Pinkins is the Democratic nominee. He is a Rolling Fork native and attorney, representing, among other clients, those alleging unfair working conditions. He served 21 years in the U.S. Army, including combat stints, other overseas deployment and posts in the White House,
Roger Wicker is the Republican incumbent senator. He resides in Tupelo and has served in the U.S. Senate since late 2007 after first being appointed to fill a vacancy by then-Gov. Haley Barbour. He was elected to the post in 2008. He previously served in the U.S. House and as a state senator. He is an attorney and served in the United States Air Force.

House District 1

Dianne Black is the Democratic nominee. She is a small business owner in Olive Branch in DeSoto County.
Trent Kelly is the Republican incumbent. He was elected to the post in a special election in 2015. He previously served as a district attorney and before then as a prosecuting attorney for the city of Tupelo. He is a major general in the Mississippi Army National Guard.

House District 2

Bennie Thompson is the Democratic incumbent. He was first elected to the post in 1993. Before then, he served as a Hinds County supervisor and as alderman and then as mayor of Bolton.
Ronald Eller is the Republican nominee. He grew up in West Virginia and moved to central Mississippi after retiring from the military. He is a physician assistant and business owner.

House District 3

Michael Guest is the Republican incumbent and is unopposed.

House District 4

Mike Ezell is the Republican incumbent first being elected in 2022. He previously served as Jackson County sheriff.
Craig Raybon is the Democratic nominee. Raybon is from Gulfport and began a nonprofit “focused on helping out the community as a whole.”

Central District Supreme Court

Jenifer Branning currently serves as a member of the state Senate from Neshoba County.
Byron Carter is a Hinds County attorney and previously served as a law clerk for Supreme Court Justice Armis Hawkins.
James Kitchens is the incumbent. He has served on the state’s highest court since 2008.
Ceola James previously served on the Court of Appeals.
Abby Gale Robinson is a Jackson attorney. She previously was a commercial builder.

Southern District Supreme Court

Dawn Beam is the incumbent, having been first appointed in 2016 by then-Gov. Phil Bryant and later winning election to the post. She is a former chancellor for the Hattiesburg area.
David Sullivan is an attorney in Harrison County and has been a municipal judge in D’Iberville since 2019. His father, Michael, previously served on the state Supreme Court.

Northern District Supreme Court seats

Robert Chamberlin of DeSoto County is unopposed.
James Maxwell of Lafayette County is unopposed.

Court of Appeals 5^th District seat

Ian Baker is an assistant district attorney in Harrison County.
Jennifer Schloegel is a Chancery Court judge for Harrison, Hancock and Stone counties.
Amy St. Pe is a Municipal Court judge in Gautier.