With Medicaid expansion seemingly being on the verge of passing in Mississippi a year ago, but never making it across the finish line, many believed those talks would seamlessly convey to the 2025 session and pick up there. But now, the federal government and a level of uncertainty surrounding what healthcare as a whole might look like under a new administration is causing lawmakers nearly 1,000 miles away from Washington to virtually stop in their tracks to wait and see what President-elect Donald Trump may do.
Trump, a Republican who attempted to repeal large portions of the Affordable Care Act during his first term but failed to get enough congressional support to do so, will walk back into the White House next Monday with both chambers at his disposal as the GOP won a majority in the U.S. House of Representatives and Senate during the November elections. While Trump did have both chambers on his side from the time of his first inauguration in January 2017 until January 2019 when Democrats bounced back in the midterms, he could never create much headway in changing what government-provided insurance looks like.
Four years and a different president later, Trump will be the second commander-in-chief to serve nonconsecutive terms and with how it relates to the healthcare discussion, the one-time businessman has little to lose as this will be the beginning of his final four years in office – assuming he does not try to overhaul the Constitution’s two-term limit for presidents, as some people on both sides of the aisle have suggested he might.
With a gung-ho attitude and an incoming cabinet shaped to promote his goals, Trump has already begun to propose bold ideas like someone who is unfettered. Putting his stances on buying Greenland and changing the name of the Gulf of Mexico to the side, one of the ideas that has gained traction both on and off the internet is the Department of Government Efficiency – being referred to as DOGE. The proposed presidential advisory commission is set to be chaired by billionaire and new Trump ally Elon Musk alongside former Republican presidential nominee and techie Vivek Ramaswamy.
Musk and Ramaswamy, tasked with serving more or less as a team of government auditors, came out of the gates hot and said they wanted to cut the country’s deficit by $2 trillion before reducing that number to $1 trillion and most recently saying in an op-ed they were to take “aim at the $500 billion plus in annual federal expenditures that are unauthorized by Congress or being used in ways that Congress never intended.”
Say that goal is going to be achieved, there are rumblings that a way to do it would be to completely reshape the $620 billion annual spending object that is Medicaid.
Currently, the Affordable Care Act allows individual states to extend Medicaid coverage to adults with incomes up to 138% of the federal poverty level, essentially providing health insurance to more people who cannot afford private plans. The ACA – which was somewhat of a brainchild of Republican President Ronald Reagan and eventually solidified under Democratic President Barack Obama – is set up for when a state votes to expand, it covers 10% of the cost while the federal government covers the other 90%.
Since the ACA model was opened to the states in 2014, 40 have opted in while 10 have decided to stand back. Mississippi is one of those that has not expanded, leaving billions of federal dollars and thousands of jobs on the table but also avoiding moving further into a society reliant on “welfare,” at least if you ask Republican Gov. Tate Reeves.
Last legislative session, after years of not allowing Democratic-led bills to expand Medicaid hit the floor for a vote, Mississippi’s GOP supermajority decided to have a genuine conversation on whether the potential pros of Medicaid expansion outweigh the potential cons. As a result, the House made history by approving a plan that would fully expand Medicaid to people up to 138% of the federal poverty level but require those insured under it to prove they work at least 20 hours a week or are full-time students. The work requirement was inserted on a tentative basis, meaning if not rubber-stamped by the federal Centers for Medicare and Medicaid Services the plan would still go through.
However, it never got there. The Senate never approved the House plan and was unwavering on a strict work requirement. Some Democrats also verbally withdrew their votes toward the end of cross-chamber discussions and said they would not approve a final package if it was nothing but “Medicaid expansion in name only.”
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Nearly a year later, lawmakers walked back into the state capitol building in Jackson last Tuesday to gavel in for another round of legislating, but optimism surrounding expansion had visibly been deflated. In his press conference the day before the new session began, Republican House Speaker Jason White alluded to the fact there are too many questions on the federal level to immediately move forward with another expansion bill.
“All bets are off until we see where the [Trump administration] wants to go,” White said, not ruling out lawmakers in his chamber passing a trigger bill that would only go into effect if the current system remains intact. “I think it does complicate it.”
Questions that Mississippi lawmakers want answers to include but are not limited to: Is the federal match rate going to go down? Are eligibility requirements going to be tightened? Will work requirements be granted? Will it move to a block grant model? Is insurance going to be completely privatized? Will the Affordable Care Act be repealed in its entirety?
According to Rep. Sam Creekmore, a Republican who serves as chair of the Public Health and Human Service Committee, the best idea would be to allow Trump and his cabinet to settle in and then ask these questions before passing any major legislation.
“Things have changed, and we don’t know what that’s going to look like,” Creekmore said during a recent appearance on MidDays with Gerard Gibert. “Right now, our plan is to let the Trump administration get in place, and let’s go talk to them. Let’s see what requirements or what our Medicaid expansion would like that they will approve.”
As we sit one week away from Trump retaking office and one week into Mississippi’s legislative session, the president-elect has tabbed celebrity physician Dr. Mehmet Oz to run the Centers for Medicare and Medicaid Services. While Dr. Oz has publicly supported the ACA’s goal of providing more health insurance, he has been critical of some of the details and referred to it as a government takeover of the healthcare system.
Like all of Trump’s nominees, Oz’s appointment will require Senate confirmation which could go well into the spring. Whether answers regarding what Medicaid expansion could look like in Mississippi will be available by the time state lawmakers leave the capitol in April, Creekmore had a simple reply: “Probably not.”
