JACKSON, Miss. — Mississippi’s Republican governor is considering Medicaid expansion, the first sign that long-held GOP opposition could be wilting in the Deep South after an election that was a big winner for the Obamacare program.
Republican Gov. Phil Bryant, entering his final year in office, has been engaged in quiet talks about adopting expansion after resisting for years, according to two sources familiar with the discussions.
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The behind-the-scenes move comes as a surprisingly viable Democratic gubernatorial candidate is planning to make Medicaid expansion a central issue in the 2019 election. But in an even more unlikely scenario, Republicans could beat him to it and undercut a key Democratic message.
Until now, Medicaid expansion has largely been ignored in the Republican-dominated state, one of the sickest and the poorest in the country. Even Mississippi Democrats have largely dismissed it as politically unviable since a 2012 Supreme Court decision made the program optional for states.
Bryant has been exploring how the state could expand Medicaid to roughly 200,000 low-income adults with a conservative approach adopted in other red states. According to a Mississippi Today report this week that first cited Bryant’s interest in Medicaid expansion, one of the states he’s eyeing is Indiana, which under then-Gov. Mike Pence required enrollees in expanded Medicaid to pay premiums and co-pays.
“The governor’s trying to figure out how to expand Medicaid without calling it expansion,” said one source familiar with the discussions, speaking on background because of the sensitivity of the subject.
Publicly, Bryant’s office is distancing the governor from Medicaid expansion discussions.
“The Mississippi Hospital Association approaches the Office of the Governor each year with a new plan to expand Medicaid,” said Bryant spokesperson Knox Graham in an email. “We don’t expect this to be a part of our legislative agenda.”
Last month’s election showed strong support for Medicaid expansion in deep red pockets of the country — voters in Idaho, Nebraska and Utah all easily approved ballot measures ordering Republican officials to adopt the optional program. However, it also showed there are limits to how far health care can carry Democrats in the South. Gubernatorial candidates Andrew Gillum in Florida and Stacey Abrams in Georgia both ran on expanding Medicaid and narrowly lost in states where hundreds of thousands of low-income adults have been shut out of the program.
Even if Bryant embraced Medicaid expansion, he would still need support from the Republican-dominated legislature — no sure bet, especially after a Texas judge last week ruled Obamacare was unconstitutional. The law remains in effect, but the legal battle could drag into 2020, giving skeptical lawmakers political cover to keep refusing Medicaid expansion.
State Sen. Brice Wiggins, who chairs the Medicaid committee, said the debate over expansion is a “distraction” since the Legislature has never considered it. Instead, he said the state should focus on creative ways of bringing down costs for the existing program — the largest item in the state budget — through expanded telemedicine and emphasizing preventive care, among other ideas.
“Expansion alone is not going to solve the problems that we’re facing,” Wiggins told POLITICO during an interview in his office at the state Capitol. “We have to be creative and find other ways to address our situation.”
In Mississippi, many Democrats thought Medicaid expansion was a lost cause. But four-term Mississippi Attorney General Jim Hood, a rare Democrat holding statewide office in the Deep South, decided to change that. He plans to make support for Medicaid expansion a major plank of his gubernatorial campaign next year — one of the few off-year races in the country.
“You saw what happened in the midterms,” said Michael Rejebian, a senior adviser to Hood’s campaign who’s worked on every one of his previous statewide races. “Health care was the issue, and it will be the issue in this campaign.”
Mississippi is among the unhealthiest states in the country, with high rates of diabetes, cancer deaths and heart disease. For the last five years, the state was last or next to last in a nationwide ranking of health metrics by the United Health Foundation.
The state’s gubernatorial race could test whether the Deep South’s Medicaid expansion firewall will begin to crack. In the region, only Arkansas and Louisiana have expanded Medicaid under Democratic governors.
Hood has already proven he could compete statewide in Mississippi, having won every race for attorney general by double digits. And he’ll make the case that the state’s beleaguered rural hospitals could only survive with the massive infusion of federal cash Medicaid expansion would deliver. Five have closed since Obamacare passed in 2010 and another four are in bankruptcy.
“When a rural hospital closes it destroys an entire community,” Rejebian said. “What can we do to make sure that those rural hospitals stay open?”
Lt. Gov. Tate Reeves, the likely Republican gubernatorial nominee, has staunchly opposed expanding Medicaid, arguing the state already typically struggles to fund the existing $1 billion-per-year Medicaid program. The federal government funds the vast majority of Medicaid expansion costs, but states handle a small portion and will eventually be on the hook for 10 percent.
Reeves has also backed new work requirements encouraged by the Trump administration that would undoubtedly force some poor adults off their Medicaid coverage.
Reeves spokesperson Laura Hipp said he was unavailable for an interview over the course of two weeks because of out-of-town travel. Reeves did not respond to written questions that were submitted at Hipp’s request.
Richard Roberson, the Mississippi Hospital Association’s vice president of policy and state advocacy, argued Medicaid expansion is crucial for the financial viability of hospitals, which have also been hit by Medicare reimbursement cuts in recent years.
“It’s like a driving a car with three good tires,” Roberson said. “At a certain point you’ve got to pull over and fix the tire.”
Rachana Pradhan contributed to this report.