Mississippi: Gov. Reeves floats desperate last-minute scheme to resolve hospital crisis he helped create

Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have.

A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While GOP Governor Tate Reeves and the Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.

Unfortunately, just a few weeks later, the Mississippi Supreme Court crushed that effort:

In May 2021, the Mississippi Supreme Court ruled invalid a citizen-sponsored initiative to approve medical marijuana. In doing so, the 9-member elected Supreme Court also ruled invalid the entire initiative process. That decision halted the effort of Medicaid expansion supporters, including the Mississippi Hospital Association, to garner the required number of signatures needed to place the initiative on the November 2022 ballot.

Legislators said during the 2022 session they would fix the language that led to the Supreme Court ruling the initiative process invalid and reinstate it. But in the end, legislators could not agree on that fix and the session ended without legislators restoring the initiative process.

And so, Medicaid expansion in the Magnolia State appeared to be dead: The only way to make it happen is now via legislation...and Republicans have a complete lock on the legislature. While Democratic Gubernatorial nominee Brandon Presley has made Medicaid expansion one of the cornerstones of his campaign, there's debate over whether he'd be able to do so legally under state law, and of course he'd have to win this November regardless, which isn't considered likely in this state.

Then, just a few days ago, the near-certain incoming GOP Speaker of the Mississippi House announced that he'd be bringing Medicaid expansion to the floor of the legislature for debate after all. He didn't promise it would pass, of course, but he at least is willing to discuss it, which is...something.

Well, it sounds to me like Presley's campaign attacks combined with the presumptive Speaker's announcement have put enough pressure on Tate to completely reverse himself on the very same "save the hospitals!" plan his own administration opposed just a few months earlier:

After being criticized for months by his Democratic opponent for not having a plan to address Mississippi’s health care crisis, Gov. Tate Reeves on Thursday unveiled what he called “sweeping Medicaid reimbursement reforms.”

Reeves’ proposal, announced less than two months before the November election, includes pulling more federal dollars to increase Medicaid reimbursement to hospitals — a plan that Reeves’ own Medicaid administration advised GOP lawmakers and hospital leaders last year wouldn’t work.

Hospitals under the plan would pay an increase in “bed taxes,” but this would allow more federal dollars to be drawn down for a net to hospitals of $689 million, Reeves said. His plan also includes a measure to allow speedier prior insurance authorization of drugs or procedures, a measure lawmakers had passed but Reeves vetoed earlier this year.

To reiterate: Last year the GOP legislature proposed it but Tate opposed it. This year the GOP legislature passed it but Tate vetoed it. And now he's suddenly supporting it.

Of course the simplest & most effective way to resolve Mississippi's hospital woes would be to simply expand Medicaid via the ACA, with the federal government paying at least 90% of the cost, but...

Reeves’ plan does not include Mississippi accepting more than $1 billion a year in federal dollars to expand Medicaid to cover the working poor as 40 other states have done.

Oh.

The governor’s plan was immediately panned on Thursday by supporters of Medicaid expansion and of his opponent, who dubbed his proposal, “too little, too Tate.” State political observers speculated Reeves’ new plan is a result of polling and of Mississippi’s GOP legislative leadership warming to the idea of Medicaid expansion.

Well, there you go.

...Reeves reiterated his opposition to Medicaid expansion, which he referred to as “welfare,” as he gave a press briefing on his new plan, which would have to be approved by the federal Centers for Medicare & Medicaid Services. Reeves said the plan was submitted to CMS on Thursday, and that approval or disapproval could take months.

That's pretty rich considering that Mississippi already receives more than 2.5x as much money from the federal government than it contributes. I guess that doesn't count as "welfare" for some reason.

Oh, and as for the $689 million that his sudden bright idea would supposedly bring to the state...

Republican legislative leaders and the hospital association starting last year pushed a similar proposal to increase Medicaid reimbursements to hospitals, but were told by Reeves’ Medicaid administrators that it wouldn’t work — and would only bring in about $40 million — because the state’s rate of commercial insurance payments are so low.

Oh.

When asked about this on Thursday, Reeves deferred the question to Medicaid Director Drew Snyder, who cryptically answered that the difference in projections this year versus last year is because, “We got the right people in the room.”

Imagine that.

According to KFF, roughly 147,000 uninsured Mississippians would become eligible for Medicaid if ACA expansion were to go through; there's also another ~100,000 or so MS residents currently enrolled in heavily-subsidized ACA exchange plans (over half the total ACA exchange enrollment in Mississippi) who would be shifted over to Medicaid instead.