MS Hospital Association touts Medicaid expansion alternative

Richard Robertson, the vice president of policy and state advocacy for the Mississippi Hospital Association (MHA), spoke in the place of CEO Tim Moore at the West Point Rotary Club (Photo by Ryan Phillips, DTL)
DTL Editor

Few topics have proven as divisive in Mississippi as Medicaid expansion and one state advocacy group made a stop in West Point on Thursday to make the case for its own conservative-leaning alternatives.

Richard Robertson, the vice president of policy and state advocacy for the Mississippi Hospital Association (MHA), spoke in the place of CEO Tim Moore at the West Point Rotary Club, and provided both a developmental history of the organization’s plans, in addition to numbers to tell the story.

Robertson said MHA members have been lobbying politicians in Jackson to pursue Medicaid reform, as opposed to expansion of the state’s current program.

“One of the things we have been working on is different ways to address the Medicaid problem and how we find ways to leverage federal money to fix what is broken in Mississippi,” he said.

He then pointed to the fact that Mississippi has the best match rate — 77% — of any state in the country, meaning Mississippi gets 77 cents from the federal government for every dollar spent on Medicaid. And while Mississippi may get the most bang for its buck as far as Medicaid payouts from the federal government are concerned, the figure highlights a less than positive economic outlook for a state in need of federal aid to fund its current Medicaid program.

But in looking to reform the current system, Robertson said MHA members have been talking with Gov. Phil Bryant and other policymakers in Jackson.

While some progress has been made on issues such as insurance companies paying out claims more promptly, the state continues to lag in health care outcomes, with lawmakers under the Capitol Dome vocally opposed to traditional Medicaid expansion.

Robertson said that last year, MHA lobbyists met with Bryant, informing him that last August, four different hospitals in Mississippi declared bankruptcy in Clarksdale, Batesville, Amory and McGee.

Despite the conservative public opposition to any kind of traditional expansion, Bryant requested MHA provide him a white paper on the proposal upon the realization that Mississippi faced a financial crisis with respect to its rural and community hospitals.

However, the proposal died in the legislative session without any visible consideration from legislators, as infrastructure and the state’s lottery dominated the headlines.

Despite the measure’s demise, though, Robertson said it provided the MHA with an opportunity to fine-tune the proposal.

Robertson said the MHA’s most recent incarnation of Medicaid reform is designed after the practices incorporated in Indiana under then-governor and current Vice President Mike Pence.

“We modeled it off of Indiana, they did it in a way that increased health care coverage without increasing the tax burden on Indiana, through increased hospital taxes and through skin in the game for those people, making people pay a premium.”

The premium is where Robertson said the state can capitalize and where true reform can be made, when there is buy-in from all parties involved, from the state all the way down to the participant in the program.

“In Indiana they make payments to a health savings account, but we’re not going to do it that complex,” Robertson said. “Ours is more of a monthly payment to the state to cover the premium costs for everything.”

For instance, Robertson said one way the Mississippi Cares proposal is different from Indiana is the requirement of a $100 co-pay if the visit to the emergency department at a hospital is not necessary.

Robertson said a recurring problem is that hospitals are required by federal law to take in patients in their emergency departments, regardless of their ability to pay, using the ER in many cases as a primary care clinic, which is paid for by the hospital.

“What we need to start doing is using some levers in there to bend the cultural habits we have gotten into,” he said. “If that person comes in, we are proposing if it can be avoidable, they can come back the next day for a clinic visit and will be charged a $100 co-pay.”


Robertson said uncompensated care is one of the most dire problems facing Mississippi hospitals, with $660 million in uncompensated care costs across the state’s health care industry.

And as the state’s labor force fluctuates, so does the number of those enrolled in Medicare.

“I think the labor force numbers and Medicare numbers have a relationship,” Robertson said. “I think you are starting to see those baby boomer folks starting to retire, leaving the labor force, losing their commercial insurance and moving onto Medicare, that’s what you should do.”

When looking at the economy, Robertson also pointed out that of the state’s small businesses with less than 50 people, two-thirds do not have health care coverage.

He then alluded to a similar Medicaid waiver program in Arkansas, which saw a stop put to rural hospital closures and a 53% decrease in uncompensated care costs.

Robertson explained waiver programs as a way for the state to accept federal aid dollars for its Medicaid programs, while given permission by the federal government to take a more individualized approach.

“If we can decrease [the state’s uncompensated care costs] by $200 million, $300 million, then that’s revenue coming back into hospitals that can be spent on providing services in the community,” he said.

If Mississippi Cares comes to fruition, Robertson and the MHA claim implementing a $5,000 premium for the program would generate more than 9,000 jobs with over $200 million put back into the state’s general fund.

“It costs the state about $50 million to do teacher pay raises,” Robertson said. “You’ve got hundreds of millions of dollars in revenue coming back into the state simply by providing a payment method for folks who need it.”

In order to be approved, state legislators would not only need to amend state law, but the measure would also require approval from the U.S. Centers for Medicare and Medicaid Services. That is where the Indiana connection comes into play, according to Robertson.

“We feel comfortable that this will be approved,” he said. “President Trump’s appointees at the Centers for Medicare and Medicaid Services are Pence’s people who came from Indiana. The people we need to approve this are the architects of the Indiana system.”

As the future remains uncertain for the Mississippi Cares alternative, the MHA believes the majority of the state’s legislators will show support when the chips are down.

Among those who Robertson said have voiced support for the program include: Mississippi Attorney General and Democratic gubernatorial candidate Jim Hood, Secretary of State and Republican lt. governor candidate Delbert Hosemann and his challenger, Democratic state Rep. Jay Hughes.

Current Lt. Governor and Republican gubernatorial candidate Tate Reeves has voiced opposition to Mississippi Cares, according to Robertson.

“The rank-and-file members of the legislature, they know we have to do something,” he said. “Their ask is that we need to do it in a way that won’t damage the state budget. This isn’t going to hurt the state budget but help it and there are a few that won’t support it … but there’s not a whole lot of people saying no to it.”