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Mississippi Senate Republicans push Medicaid expansion 'lite' proposal that would cover fewer people

JACKSON, Miss. (AP) — A proposal to expand Medicaid to tens of thousands of residents in one of the poorest states in the U.S. is still alive in the Mississippi Legislature . But Senate Republicans changed the plan Wednesday so it would cover far fewer people and bring less federal money to the state.

Mississippi’s Republican-controlled Legislature is considering expansion after years of opposition to the policy allowed under the Affordable Care Act, a 2010 federal health overhaul signed by then-President Barack Obama. The proposal passed by a committee Wednesday is the only Medicaid expansion proposal still alive after Senate Republicans tweaked a House bill rather than advance a separate bill of their own.

“We have a conservative plan over here," said Senate Medicaid Committee Chairman Kevin Blackwell. "The House version was basically straight-up expansion.”

Dubbing the plan Medicaid expansion “lite,” Blackwell said it would increase eligibility for the government-funded health insurance program that covers low-income people. But it extends eligibility only to those making up to 100% of the federal poverty level, just over $15,000 for one person. That is down from the 138% figure approved by the House, just under $21,000 for one person.

Mississippi has about 3 million residents, and its Medicaid program covered 754,585 people in January. House Medicaid Committee Chairwoman Missy McGee said her proposal could extend benefits to as many as 200,000 people. Blackwell said the new version of the bill approved by his committee could make 80,000 people eligible for expanded coverage, but he projects only about 40,000 would enroll.

Many Mississippi lawmakers have said expansion without a work requirement is a nonstarter. The Senate version would require people to work at least 30 hours per week to become eligible for expanded benefits, up from the 20-hour work requirement approved by the House. Blackwell said the Senate made that change because it ensures able-bodied adults would need to work “basically full time” to receive Medicaid.

Mississippi ranks at the bottom of virtually every health care indicator and at the top of every disparity. Hospitals are struggling to remain open. The state also has one of the nation’s lowest labor force participation rates. Expansion proponents have said the policy could help improve these conditions.

Opponents of Medicaid expansion say the program would foster government dependency, increase wait times for health services and push people off private insurance. Republican Gov. Tate Reeves is among those critics, and is likely to veto any Medicaid expansion.

“It is welfare expansion to those able-bodied adults that could work but choose not to,” Reeves said Wednesday on social media. “And so I will continue to do what I told the voters I would do — fight Obamacare Medicaid Expansion with every ounce of my being!”

Legislators could override his veto with a two-thirds vote from the House and Senate.

Republican legislature leaders have said Georgia offers a model for Mississippi to pass a narrow version of Medicaid expansion.

Among the 10 states that haven’t expanded Medicaid, only Georgia has managed to tie a work requirement to a partial expansion of benefits. But the state only requires people to document 80 monthly hours of work, 40 hours less than what Mississippi senators have proposed. Georgia's program has seen abysmal enrollment. Only 2,350 people enrolled in the program from July 1 to mid-December, far fewer than the 100,000 that Gov. Brian Kemp's administration projected the program might cover.

The Mississippi Senate makes expansion depend on President Joe Biden's administration approving its work requirement. But the administration has consistently revoked work requirement waivers, arguing people should not face roadblocks to getting health care.

In response to the House's proposal, a Center for Medicare and Medicaid Services spokesperson told The Associated Press that the Medicaid work requirements act as barriers to coverage but did not rule out granting a waiver. The Senate version would be an even tougher sell.

The House proposal would have allowed expansion to continue without a work requirement, but the Senate version would disallow Medicaid expansion without one. Blackwell said he is counting on Biden losing in November to a Republican whose administration would welcome a work requirement.

Under the reduced eligibility level approved by the Senate, Mississippi would also lose an additional financial bonus for expanding Medicaid that would be available under the House's version.

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Michael Goldberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.