Once Focus of Health Law, Some In Poverty May Be Left Out

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Expanding Mississippi's Medicaid program would "damage this budget beyond repair" and require deep cuts to education and transportation, Republican Gov. Phil Bryant said after the court ruling. State Rep. Sam Mims, the Republican chairman of the House Public Health and Human Services Committee, agreed. "We cannot afford to expand Medicaid, and we are going to do everything we can for that not to happen," Mims told the Associated Press.

Mississippi expects to spend about $822 million on its existing Medicaid program, which is roughly 15 percent of its annual revenue, according to budget documents from the governor's office. Expanding Medicaid would increase the amount Mississippi spends on the program by 4.8 percent, according to the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation).

If the state decides not to expand Medicaid, some adults earning slightly above the poverty line would be able to get federal subsidies to buy private insurance through another part of the health law designed for lower income people who are not completely destitute. But about 183,000 Mississippi adults at the poverty line or below would have no new options, according to Urban's estimates.

Chapman says that a large portion of her uninsured patients work, but their employers either do not offer them insurance or the premiums are unaffordable. Many have low-income jobs or work part-time and do not qualify for insurance. "They make just enough so that they can't get on Medicaid, but too little to buy insurance, so normally what they'll do is use the ER," which is much more expensive, she explains. Expanding Medicaid, she says, would allow the state to "save that money and have a healthier and better workforce."

Angel Greer, who runs the Coastal Family Health Center, a group of community health clinics around Biloxi, adds that many of her uninsured patients lost their jobs in the recession and their health insurance along with it. Others are in coastal industries that don't provide insurance coverage, including tourism, small local restaurants, manual labor, construction and fishing.

Her clinics offer medical care on a sliding scale, but finding specialists willing to treat the sicker patients is difficult. Right now they're "begging local specialty physicians or referring patients to the university hospital in Jackson, which is overwhelming" the hospital, Greer explains.

Roy Mitchell, executive director of the Mississippi Health Advocacy Program, argues that expanding the state's Medicaid program would be a boon to the state by bringing in more federal dollars. "It's a huge economic driver, but it's not recognized as such," says Mitchell. "It's almost like there's this denial."

Mississippi has one of the smallest Medicaid programs in the country. It covers children of lower income families, including the Tagert's three kids. But an adult with children can't earn more than 44 percent of the poverty level, about $6,472 a year for a family of two. Childless adults cannot get Medicaid coverage under any circumstances.

"In Mississippi, we're the poster child of the dire situation in health care," says Greer.

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