Mississippi Senate and House haggle over Medicaid expansion as session nears end

Top Mississippi lawmakers started negotiating Tuesday on what could become a landmark plan to expand Medicaid coverage to tens of thousands of people in one of the poorest states in the U.S.

But even with Republicans controlling both the state House and Senate, it's far from clear that they will reach a compromise during the final days of their four-month session that is scheduled to end by early May.

Mississippi is among the 10 states that have not expanded Medicaid coverage to people who work low-wage jobs that don't provide private health insurance. Expansion is an option under the federal health care overhaul signed into law in 2010 by then-President Barack Obama.

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Republican Gov. Tate Reeves has said for years that he opposes putting more people on government programs.

Expansion is getting its first serious discussion in the Mississippi Capitol this year because the new House speaker, Republican Jason White, says it is one of his priorities.

The House voted by a wide bipartisan margin in late February to expand Medicaid coverage to about 200,000 people who earn up to 138% of the federal poverty level, or $20,120 annually for one person. Mississippi has about 3 million residents, and its Medicaid program covered 374,823 people in March.

In late March, the Senate passed its own pared-down version that would extend eligibility to people earning up to 100% of the federal poverty level, just over $15,000 for one person. Senate Medicaid Committee Chairman Kevin Blackwell, a Republican from Southaven, said about 80,000 people would become eligible for coverage but he thought about half that number would enroll.

House Medicaid Committee Chairwoman Missy McGee, a Republican from Hattiesburg, offered a compromise Tuesday. It would allow Mississippi to receive the full amount of federal money possible for Medicaid expansion. People earning up to 100% of the federal poverty level would be covered by Medicaid, while those earning between 100% and 138% of the federal poverty level would receive subsidies to buy insurance through a federal health insurance exchange.

Senators offered no new proposals Tuesday and did not immediately respond to the one from the House. Blackwell said it's significant that the two chambers are discussing expansion, but he cautioned against moving fast.

"In the House’s case, I think you guys want to jump in the sports car and zoom right to expansion — damn the roadblocks and let’s get there," Blackwell said. "Those of us in the Senate want to take sort of a more slower approach to that."

McGee responded: "I don't feel like we have been in a Ferrari very long. I think we have been waiting 10 years. ... We don't need to push this off any longer for our low-income yet hardworking Mississippians."

Mississippi legislators usually meet in private to negotiate final versions of bills, but they agreed this year to hold open meetings on Medicaid expansion. Tuesday's meeting ended up as standing-room only, with some spectators arriving hours early.