Hospitals, business leaders suffering FOT — Fear of Tate — on Medicaid expansion

Mississippi’s business leaders and hospitals each have formidable lobbies, and neither has been shy over the years about nudging a reluctant state Legislature in one direction or another if it dawdles on an important issue.

But their relative silence (only recently) on the most profound issue before lawmakers in a generation — expanding Medicaid coverage to the working poor — has been deafening.

It could be a life-or-death issue for tens of thousands of people in the poorest of states with many Third World health metrics. It’s a monumental issue for the fiscal stability of foundering rural hospitals. It’s a crucial workforce issue for businesses and economic development. It’s a major financial issue for the state.

FAQ: What is Medicaid expansion, really?

So why are we mostly hearing crickets from two of the most powerful groups in the commonwealth, on an issue in which they’ve both got serious skin in the game?

They appear to be suffering a condition known as Fear of Tate, or FOT. It’s a condition peculiar to the Magnolia State, now into the second term of Gov. Tate Reeves. It usually presents any time there’s a partisan politically charged issue before our leaders. It manifests itself in timidity or political rhetoric replacing thoughtful approach, and bad, sometimes unworkable or downright asinine policy proposals that poorly serve the average Mississippian.

Reeves has worked hard to instill FOT. He plays partisan political hardball. His main policy is “no.” He holds political grudges until the end of time and will get even if possible. And he’s managed to tamp down business lobby influence and darned-near snuffed out the hospital association lobby.

The Mississippi Hospital Association — then including leaders from the state’s largest hospitals — had for years been a vocal advocate for accepting billions of federal dollars to expand Medicaid coverage to working poor and uninsured Mississippians, like most other states have done. Hospitals had grown weary of eating hundreds of millions of dollars a year in costs of treating uninsured Mississippians.

Hospitals did some quick math, and figured $1 billion a year in federal money was more than $0. The hospital association started a ballot-initiative drive to sidestep Reeves and the Legislature and put the issue directly to voters. When the state Supreme Court derailed that drive, the hospital association’s PAC plunked down $250,000 on the campaign of Reeves’ opponent last year, Democrat Brandon Presley, a vocal supporter of Medicaid expansion.

Well, Reeves understandably didn’t like that. It’s unclear what cajoling he did, but the next thing you know, the state’s largest hospitals appeared to catch a case of FOT. They left the Mississippi Hospital Association like it was on fire, and soon thereafter, its longtime director was fired. Just like that, a major political lobby and its efforts at Medicaid expansion were defanged.

But Reeves, steadfast in his opposition to Medicaid expansion, still faced the problem that the proposal was gaining popularity with the public and among some GOP legislative leaders. And despite two terms at lieutenant governor and one as governor, he still had squat for an alternative plan to help poor working Mississippians and struggling hospitals.

Reeves, just 47 days before the 2023 election, came up with a plan to help the hospitals (though his message for uninsured working folks has remained to get a better job with insurance). But he apparently also came to the conclusion that Medicaid and federal help is the only realistic game in town, so he enacted his own Medicaid expansion — expansion of payments to hospitals, and levying a tax on them to cover the state’s share.

Major hospital leaders were pleased with the proposal for them to get about $700 million more in Medicaid money. They appeared to back down on the push for expanded coverage to the working poor.

And since then, some legislative leaders say, hospitals are not coming out strong for the Medicaid expansion because they fear Reeves might taketh away — somehow rescind the increased payments to hospitals. But it would appear, under current state law and federal Medicaid approval for a “waiver” to allow the increased payments, the Reeves administration could not really do that without legislative approval.

Now, after Reeves’ reelection, the Republican-led state House has passed a Medicaid expansion bill. But the Senate, despite Lt. Gov. Delbert Hosemann having expressed openness to expansion for years, has hung fire. Some House and Senate leaders and others at the Capitol say the Senate is seeing an outbreak of FOT on expansion.

The Senate has let its own bill die without a vote, and despite saying it has its own plan forthcoming, it still has not been made public, despite deadlines and the end of the legislative session looming. Reeves has reportedly been threat—er—lobbying senators against expansion, and leaked details of the Senate’s draft plan show it’s pretty much a non-expansion expansion. It would leave hundreds of millions of federal dollars on the table, causing state taxpayers to pay more, and it would insure far fewer Mississippians than the House plan. If enacted, Mississippi would remain on the list of non-expansion states. Some experts and expansion advocates have said it’s likely unworkable and would not receive federal approval.

Now for the business lobby, which itself appears to have developed FOT on Medicaid expansion.

Back in July of 2021, Scott Waller, president of the Mississippi Economic Council — the state’s chamber of commerce — said business leaders were preparing to weigh in on Medicaid expansion, and soon.

He said MEC, which has about 11,000 members from 1,100 companies, would soon begin a research drive, including measuring public opinion and polling MEC business leaders on Medicaid expansion and other health care issues. He said he expected the group would take a position and make policy recommendations on expansion before the 2022 legislative session started, because “a healthy workforce is a vital component of moving our state and economy forward.”

But that didn’t happen then, and it still hasn’t happened.

MEC last week issued a social media statement, ostensibly on Medicaid expansion, that was so milquetoast and timid that many legislative leaders questioned what it meant.

“Providing healthcare for working Mississippians is vitally important. It remains MEC’s stated position that legislative leaders ‘find workable solutions and help shape a plan to increase access to healthcare for working Mississippians that explores all available options.'”

Asked for an explanation of what exactly this statement meant and whether MEC supports the expansion plan the House passed nearly a month earlier, Waller said the statement “stands for itself.” He said, “What was stated is the stated position of our board … that the Legislature find a solution.”

If Republican House leaders were hoping for business backing and cover for the bill they had passed nearly a month earlier, that wasn’t it. Just a vague tweet.

The Mississippi Manufacturers Association showed a little more backbone, and actually appeared to endorse the House plan.

“In late Feb., (Speaker) Jason White and the House passed Healthy MS Works, expanding healthcare access to 200,000 Mississippians,” the MMA statement said. “MMA supports improved access to quality healthcare, especially in rural areas, and efforts to promote a healthier workforce.”

But this wasn’t from a Capitol rally, with MMA members front and present on the rotunda steps to get lawmakers’ attention. It was a social media post on a Friday when most lawmakers had already gone home for the weekend.

To date, the most vocal support for expanding Medicaid coverage has come from the religious community, health advocates and doctors and nurses. Groups of preachers and doctors held rallies last week calling on lawmakers to help the Magnolia State’s working poor and uninsured. Mississippi’s American Cancer Society chapter has done yeoman’s work advocating for expansion, and appears to be the only group spending major resources on a public awareness campaign on TV and radio.

Some House members — and some Senate advocates of expansion — have lamented the lack of robust support from two powerful lobbies, whose members at times past have quietly lobbied them to accept the billions of federal dollars being offered, expand Medicaid and help create a healthier workforce.

But as lawmakers attempt to gather and hold a veto-proof majority for an expansion plan under the governor’s threats, FOT appears to be making that harder.

Geoff Pender