Negotiations begin: Where do House, Senate, governor stand on Medicaid expansion? Is there room for compromise?

The Republican-led House wants to expand health care coverage to upwards of 200,000 Mississippians, and accept $1 billion a year in federal money to cover it, as most other states have done.

The Republican-led Senate wants a more austere program, to expand Medicaid to cover around 40,000 people, turn down the federal money, and have the state ride close herd on anyone helped to make sure they are working enough hours.

The Republican governor wants neither. He has vowed to veto any expansion of health care coverage for poor working Mississippians and is lobbying hard against it.

Thus final negotiations on Mississippi Medicaid expansion begin with a standoff. The measure, House Bill 1725 is now in “conference.” The lieutenant governor will appoint three Senate negotiators, the speaker of the House will appoint three, and they’ll try to haggle out a compromise over the final weeks of the legislative session.

READ MORE: Senate passes Medicaid expansion ‘lite’ with veto-proof majority

Is there any common ground to find, and if so, is it common enough to get a two-thirds majority of lawmakers to override a Gov. Tate Reeves veto?

These questions were on full display when longtime Rep. Willie Bailey, D-Greenville, quizzed House Medicaid Chairwoman Missy McGee, R-Hattiesburg, on Wednesday on how strong she was going to push the 52 senators and the lieutenant governor in the conference process to agree to the House’s plan.

“I want a yes or no,” Bailey said. “Are you going to advance and keep to the House position? I want a yes or no.”

“Yes sir,” McGee responded. “We are going to represent the House position on that.” 

But McGee’s challenge in hammering out a compromise is Senate leaders have acknowledged that maintaining the two-thirds support for expansion in their chamber is fragile and any major change could derail the coalition needed to override a potential veto.

McGee’s Senate counterpart, Medicaid Chairman Kevin Blackwell, R-Southaven, hasn’t left much air for negotiations to date with his comments. Neither has the lieutenant governor, who oversees the Senate.

“If no work requirements, no expansion,” Blackwell has said several times. This would appear to be a poisoned pill that would prevent Medicaid expansion at least for now. Federal Medicaid under President Joe Biden’s administration has refused to sign off on work requirements, and rescinded those previously approved in other states.

House leaders said they also want a work requirement, but their expansion would still take effect if the state’s request is denied.

Senate leaders also to date have appeared dead set on “expansion lite,” increasing coverage only to those at less than 100% of the federal poverty level. This move would ensure the state does not receive about $1 billion a year in federal Medicaid dollars, plus nearly $700 million more over the first two years to cover expansion costs.

Senate leaders say this would cause too many people to drop private insurance coverage.

House leaders counter that having state taxpayers cover the cost of expansion — and provide coverage to far fewer people — instead of using federal dollars makes little sense. House Speaker Jason White has reiterated McGee’s vow to stand firm on the House position to cover people up to 138% of the poverty level, and thus draw down billions of federal dollars for the coverage and help upwards of 200,000 people.

The nearly $700 million “signing bonus” of federal dollars over the first two years of the House plan would cover all the state’s expansion costs for four years. White noted the House plan would repeal in four years without further legislative action, so the program would be a “free, four-year pilot program” that could be scrapped if it showed poor results.

One middle ground option would be for Mississippi to create a program similar to Arkansas’ expansion — cover people up to 138% of poverty level, and draw down the extra federal dollars, but do so with subsidized private insurance, using the extra federal money to pay for the subsidies. House leaders say they’re open to such a compromise, and even have a state insurance exchange bill that could be a vehicle for such a plan. Senate leaders have been noncommittal on such an option.