In my column today, “Decision delayed, not avoided, on Medicaid issue,” I focused on the impact of President Barack Obama’s budget recommendation, which included plans to delay cuts in Medicaid Disproportionate Share Hospital (DSH) payments.
The fate of these payments, which under Obamacare are slated to be phased out starting in 2014, have been the biggest hold up for lawmakers in the Magnolia State trying to decide whether or not to expand Medicaid.
While the president’s budget recommends a delay in the cuts, it also provides strong evidence supporting the coming demise of DSH payments. Many Obamacare opponents have argued that the president would eventually back down altogether on cutting DSH payments to the states. That looks as unlikely as Medicaid expansion in Mississippi.
Perhaps even Gov. Phil Bryant picked up on that as well. He provided an uncharacteristically nuanced statement in response to Obama’s proposed budget.
“I have long advocated that cuts to this program should not be used to affect budgets in states that choose not to expand Medicaid,” Bryant said in a release. “This move should give us additional time to make a reasonable decision about any changes to the Medicaid program.”
Additional time for a reasonable decision?
Compare that to Gunn’s full-throated opposition to Medicaid expansion, and you have to wonder if Bryant is looking down the road at other possibilities. The Arkansas model of using Medicaid expansion money to subsidize private insurance for the expanded population is gaining a lot of traction among conservative and liberal groups.
Political editor Geoff Pender took a look at the same issue, though from a slightly different angle. I have to agree wholeheartedly with his premise: “No one to date has done more to stop or slow implementation of Obamacare in Mississippi than President Barack Obama.”
Legislative Democrats have many valid arguments on why Medicaid should be expanded to cover the “working poor” in Mississippi — if the feds are going to pick up most of the tab and if the alternative is crippling cuts to hospitals. What they lack is a valid reason to threaten to shut Medicaid down come July 1 unless the Republican majority broaches the issue now.
They’re playing a short game when they should be playing the long one.
If Obamacare does come to pass roughly as envisioned, Mississippi is going to have to play ball and, at some point, probably have to expand Medicaid.
But if Democrats believe they can stand pat now, block reauthorization of the program and take Medicaid and 640,000 people over a cliff and into a crisis and somehow gain the political upper hand, they are being foolish.
They won’t win the ensuing blame game and public relations battle. They don’t have the machinery to win such a message war. Mississippi Democrats don’t have much of any machinery any more. And Obama doesn’t appear to be helping as he tries to figure out how to implement his monstrous, hastily passed health care program.
Finally, I want to direct your attention to our editorial for Sunday. While it focuses predominantly on Sen. Roger Wicker, R-Miss., voting to end a filibuster and begin debate on a gun control bill, the editorial makes the point that debate over serious and impactful issues should never be prevented for political reasons.
We appreciate Wicker’s vote to end the filibuster and allow debate on this topic. And we hope he will support commonsense measures to strengthen the enforcement of current laws and require more state reporting of mental illness. We also hope he will stand firm against any bans or any further regulations that would infringe on individual rights.
Equally important, we hope that Wicker’s decision to allow debate on a controversial issue with which he ultimately disagrees will stand as an example to Mississippi Speaker of the House Philip Gunn and Gov. Phil Bryant. It’s time to allow debate over Medicaid expansion in the House, and then take a vote on reauthorizing the program. There is no need to wait until July for this to happen. Lawmakers should come back before May, take care of business and then go home until this fall.
Above all, we hope the people will always support the practice of democracy by our elected leaders. Open, honest, spirited and professional debate of issues is essential to sustaining a nation like ours. No lawmaker should ever be derided for supporting such and neither should a democratically elected leader ever seek to prevent elected representatives from practicing such.
The debate over Medicaid expansion is far from over. While the president’s budget proposal is a strong indicator that DSH payments will be delayed by a year, thus all but ensuring Medicaid expansion will not happen during a summer special legislative session, the issue will still come back up in January when the 2014 session bows.
Hopefully we’ll have all the facts about the fate of DSH payments. If so, then lawmakers will have no excuse not to debate this issue and make a decision, once and for all.