Legislative Update 23

June 29, 2008

Dear Friends,

Medicaid Background

The House and Senate recessed on Friday after the House passed a bill that would disallow any Medicaid cuts until February 1, 2009. Due to the complexity of this issue, I believe a Mississippi Medicaid primer may be in order.

Medicaid provides medical care for the most vulnerable Mississippians. Indicative of the economic uncertainty facing many people in our state, 615,000 individuals or 20% of our state’s population currently qualify for this vital program.

Despite the rising coast of health care in the United States, Medicaid continues to be a sound investment. While the price tag for Medicaid is over $4 billion, the federal government foots 75% of the bill, a good discount by any measure.

As a member of the Mississippi House of Representatives, I take great pride in knowing that the primary political question surrounding Medicaid is no longer whether the program will be funded but how. Despite years of watching politicians hold the program at arm’s length, Mississippi has joined the rest of the country in embracing Medicaid. There can no longer be any question that a state that hopes to remain a viable place to do business and raise families must fund Medicaid. Mississippi’s acknowledgement of this fact, albeit slow, is a matter of significant achievement.

In keeping with its endless fascination for tinkering with federal programs, last year, the United States government changed the rules for Medicaid. The net result of this change for the Mississippi Medicaid program was a $90 million shortfall in the state portion of the Medicaid budget.

Regular Session

When the 2008 Regular Session began, the Mississippi Legislature was saddled with the task of addressing this shortfall. For its part, the House of Representatives promptly passed a product which seemed intuitive in the minds of Mississippi’s health care providers. Recognizing that the state is spending approximately $254 million a year to treat tobacco related illness and that Mississippians use tobacco at a higher rate than its sister states, the House of Representatives passed a bill which would raise tobacco taxes to make up for the Medicaid shortfall. Because of the clear connection between smoking and the rising cost of healthcare, this solution seemed obvious in both its fairness and simplicity. This plan was rejected in the Senate.

Special Session

As many of you know, the legislature was unable to agree on a Medicaid funding solution during the Regular Session and Governor Barbour called members of the House and Senate back to the capitol to address Medicaid (among several other issues) during the Special Session.

When lawmakers returned to Jackson to address Medicaid, the Governor unveiled his hospital tax plan. In its simplest terms, the Governor’s hospital tax would raise taxes on hospitals to cover the Medicaid shortfall, a mechanism that would unquestionably result in increased healthcare costs and a reduction of services. Before lawmakers and healthcare workers had time to formulate questions about the plan, the Governor stated that his plan would be accepted or hospitals and other healthcare providers could prepare for nearly $400 million in Medicaid program cuts.

Medicaid deficits are nothing new for this state or this Governor. Although Governor Barbour has routinely faced larger Medicaid deficits throughout his time in office, this is the first time the Governor has broached the subject of cuts. Despite overwhelming historic and economic evidence that these cuts are unnecessary, Governor Barbour has insisted that we are in the midst of a Medicaid crisis. Whether you agree with the Governor’s crisis theory or not, there can be little question that Mississippi must eventually develop a permanent Medicaid funding solution.

What has become increasingly clear over the course of the Special Session is that neither the Governor’s plan or the tobacco tax has the support necessary to pass both chambers of the legislature. In May, after the Governor’s plan passed in the Senate, a House member offered the Governor’s plan as an amendment in the House. This vote failed to pass by a margin of 45 to 65, 11 votes short of a majority and 22 votes short of the 3/5ths necessary to obtain final passage. To see the vote, visit http://billstatus.ls.state.ms.us/20081E/pdf/votes/house/0100004.pdf. While the tobacco tax plan had greater support in the House (64 to 47), the measure came three votes short of final passage. To see the vote, visit http://billstatus.ls.state.ms.us/20081E/pdf/votes/house/0100006.pdf.

When we returned to the House on Thursday, members of the House gauged support for the two competing plans and realized that little had changed. While a strong majority of the members in the House continued to support a tobacco tax plan, such a plan was unlikely to gain the 3/5ths vote necessary to pass. Armed with this information, a group of House members met with the Chairman of the Senate’s Public Health Committee with a simple message: negotiate a compromise or gridlock will prevail. While this meeting had its promising moments, I and the other meeting participants realized that a funding compromise was unlikely between the two chambers.

In an effort to break the partisan gridlock, on Friday, the House passed a bill that would delay all cuts to the Medicaid program until February 1, 2009. While this measure is not a permanent funding solution, it would allow the legislature to continue to work on a Medicaid bill without the threat of major cuts to the Medicaid program. Thankfully, this bill garnered the necessary bi-partisan support to pass with a 3/5ths majority. To see the vote, visit http://billstatus.ls.state.ms.us/20081E/pdf/votes/house/0380003.pdf.

By passing this bill in its current form, the Senate could postpone all Medicaid cuts until the legislature convenes for the 2009 Regular Session. This would allow the Governor’s Tax Study Committee to complete its work and make its recommendations and allow for a cooling off period between the House and Senate. As you read this remember, the Medicaid program can survive with its current slate of programs until well into next year. The Senate will have its chance to respond on Wednesday when the Special Session resumes.

Lagniappe

In recent days, the Governor, Lieutenant Governor and various legislators have argued that it is unconstitutional to consider a Medicaid bill other than the Governor’s plan. While this will seem laughable to any student of Mississippi’s Constitution, it’s worth addressing. Section 121 of the Constitution gives the Governor the authority to call a Special Session to address the facts or matters he or she believes are in the public interest. While the Governor can determine the issues to be addressed, the Governor cannot determine the solution. For starters, the Governor does not have the constitutional authority to draft legislation. Secondly, if the Governor was able to decide exactly how every Special Session issue was to be resolved there would be no purpose for a legislature during a Special Session. The concept of a separation of powers ensures that this is not the case.

In considering where we stand in the current Medicaid debate it is also worth noting that a group of 23 senators have introduced a bill calling for Medicaid to be funded in part through a hospital tax and in part through a tobacco tax. If these senators remain committed to a compromise, the Senate will not be able to pass the Governor’s plan when the session reconvenes. Their presence may help ensure that a true compromise finally sees the light of day.

How to Contact Me

If you have any questions or concerns, I invite you to call me on my cell phone at 228-326-7649 or e-mail me at bjones@house.ms.gov. Please feel free to forward this report to folks in our district and let me know if I need to add someone to my list.

I will also be posting my updates and House related news on my campaign website at www.electbrandonjones.com.

Thank you for the opportunity to serve.

Brandon