Lawmakers buy one more day to reach Medicaid expansion compromise

Facing a late Wednesday deadline, the House and Senate procedurally voted to give themselves at least one more day to deliberate a proposal that could make Mississippi the 41st state to expand Medicaid under the Affordable Care Act.

House and Senate Republican negotiators earlier in the week agreed to a deal that would expand Medicaid only if a strict work requirement for recipients was approved by the federal government. House Republicans, who had previously proposed an expansion program that would go into effect even without federal approval of a work requirement, caved late Monday and agreed to the Senate Republicans’ demand to include the make-or-break work requirement provision.

But House Democrats, who had for weeks vowed to not support any expansion plan that included a work requirement, fulfilled that promise on Wednesday and threatened to vote against the Republican bill on the House floor. The Democrats’ dug-in position against the bill would likely have killed the proposal, which needed a three-fifths majority vote to pass.

With the federal Centers for Medicare and Medicaid Services under the Biden administration unlikely to approve Mississippi’s Medicaid expansion plan with a work requirement, Senate Republican leaders have expressed optimism that Donald Trump would be reelected and that he would approve Mississippi’s plan.

However, the realpolitik is that Trump has loudly voiced his opposition to Medicaid expansion, and his approval of Mississippi’s work requirement would usher expansion in for the Magnolia State over the wishes of Republican Gov. Tate Reeves, whom he supports. When he was president, the Trump administration approved Medicaid work requirements for some states, but only as a means of limiting participation where it had already been expanded, not to help a state implement expansion.

Waiting on approval from CMS under either Biden or Trump could keep Mississippi’s expansion of coverage as it now stands in indefinite limbo.

“We will vote for Medicaid expansion,” Rep. Robert Johnson III, the House minority leader, said after the recommittal on Wednesday. “This is not Medicaid expansion. At least we got a do-over.”

Johnson said that shy of going back to the original House position — or removing the work requirement the Senate demanded — House Democrats want to remove language that says the state would reapply for work requirements each year while expansion remains in limbo until such time as a work requirement is approved. He said the Democrats told the Republican leadership that they would agree to the work requirement, but not reapplying on an annual basis for the work requirement wavier. Instead, he said the state should apply once for the work requirement and if it is rejected by federal officials the Legislature should act to remove the requirement.

“We’re not saying we are against the work requirement,” he said, adding House Democrats oppose it because it would keep Medicaid from being expanded,

Johnson added, “We’re saying fine, we will try that once and show you it will not work, then we move on (removing the work requirement and expanding the program).”

When it was clear the House Democrats’ dissension might kill the expansion program, House Republicans moved to recommit the bill to conference committee. The Senate Republicans followed suit a few minutes later, effectively extending the deadline for a final plan to be hammered out between House and Senate negotiators until 8 p.m. Thursday.

House and Senate Republican leaders declined to comment about what they may bring to the negotiations or what the next few hours may look like. House Democrats claimed a small victory and reiterated their desire to pass an expansion plan that would actually go into effect and provide health coverage to an estimated 200,000 Mississippians.

As news of the recommittal spread quickly through the Capitol on Wednesday afternoon, many people floated the notion of placing a Medicaid expansion issue on a statewide ballot, where voters could mandate what they wanted lawmakers to do.

“I have heard talk about that, but it would confuse voters with a work requirement,” Johnson said, adding he would support placing Medicaid expansion without a work requirement on the ballot.

Rep. Bryant Clark, D-Ebenezer, said he was one of 29 Democrats who would not vote for the agreement as it stood on Wednesday. He said he is unsure whether he would support the issue going to a statewide referendum.

“I think we as a Legislature should do it — that’s what people hired us to do,” Clark said. “I wouldn’t be just totally opposed to that idea, but sometimes the devil is in the details. What would be put before the people? Would it be a clean expansion proposal, or something else? I am 85% sure the citizens of Mississippi would pass something that is a clean Medicaid expansion proposal.”

As the extraordinary politics played out on Wednesday, dozens of clergy and other citizens came to the Capitol to express their support of expansion. Many Capitol attendees specifically said they did not support the compromise plan that included the work requirement.

“There are people in Mississippi who are sick, hurting, in pain and broken,” said the Rev. Dawn Douglas Flowers, a minister at Parkway Hills United Methodist Church. “We have a way to enter into that brokenness and offer healing right away. I hope lawmakers can find a way to compromise and allow Medicaid expansion to happen now because what they’ve come up with is just a delay. The work requirement will not allow us to get help to people who need help today. We can’t just kick the can down the road any longer.”