Mississippi senators are considering bills designed to keep Medicaid alive and funded beyond this weekend, when the program has been on track to expire.
The Senate action comes Friday, the second day of a special legislative session called by Gov. Phil Bryant.
Both bills passed the House on Thursday but were held on a procedural motion that prevented them from moving immediately to the Senate. The House removed that roadblock Friday morning.
"This is not a political issue to me. This is a life issue," Rep. Steve Holland, D-Plantersville said Friday.
Because of a partisan dispute over whether to expand Medicaid, legislators ended their regular session without funding or the program or authorizing it to stay alive beyond June 30, the end of the current budget year.
Lawmakers now appear to be on track to renew the program without expanding it. Medicaid, the federal-state health insurance program for the needy, already covers about 644,000 of Mississippi's nearly 3 million residents. It's a big source of money for nursing homes, hospitals, pharmacists and other health care providers.
Republicans hold the majority in the state House and the Senate. In the House on Thursday, they blocked Democrats' efforts to extend Medicaid coverage to another 300,000 people. Expansion is an option under the federal health law that President Barack Obama signed in 2010.
There was little said against expansion during the House debate, but Republican leaders, including Gov. Phil Bryant, have said for months that Mississippi can't afford it, even with the federal government paying most of the tab.
House Bill 1, which would keep Medicaid in business, passed the House 96-20. House Bill 2, the budget, passed 114-1, but only after a party-lines vote against an amendment that said no Medicaid money could be spent until lawmakers have a full debate about expansion: 51 members voted yes, and 65 voted no.
Legislators did not immediately consider a way to renew a hospital bed tax that helps pay for the Medicaid program. The governor controls the agenda of the special session, and he'd have to give lawmakers the go-ahead to consider the tax.
Federal law says that starting next January, states can extend coverage to people making up to 138 percent of the federal poverty level, or about $15,000 for one person. In Mississippi now, the income cutoff is about $5,500, but many able-bodied adults below that income threshold still don't qualify.
The federal government would pay 100 percent of medical expenses for the newly qualified Medicaid enrollees from 2014 to 2017. The federal share would be reduced to 90 percent by 2020, with each state paying the balance. Bryant has said he doesn't trust Congress to fulfill its funding promises and he doesn't want state government to be left with large obligations it can't afford.
The bill that the House passed to keep Medicaid alive would remove a repealer provision that requires lawmakers to periodically review and reauthorize the agency. One reason lawmakers find themselves in a bind now is because Medicaid is set to expire this weekend under a repealer.
In the House on Thursday, Democrats broadened the discussion to try to make health care more accessible to hundreds of thousands of uninsured residents by mandating that the state operate a health exchange, an online marketplace where people can buy insurance.
All states are required to have some sort of exchange available by Oct. 1, with coverage to start Jan. 1. If a state doesn't run its own, the federal government will run one.
Federal officials earlier this year rejected Mississippi's exchange proposal, citing Bryant's opposition. Insurance Commissioner Mike Chaney, who's Republican, proposed a state-run exchange and still wants one. He said last week that so far, private insurers plan to cover exchange coverage in only 46 of Mississippi's 82 counties. Unless something changes, 36 counties will have no insurance available through an exchange.
Rep. Bo Eaton, D-Taylorsville, said an exchange would help the people who can't currently afford insurance but make too much money to be on Medicaid.
"You've got bricklayers, carpenters, all kinds of people who work hard every day," Eaton said.
On a party-lines vote, the House rejected Democrats' proposal to create a state-run exchange.
Rep. Robert Johnson, D-Natchez, proposed a separate plan to let low-income people use federal subsidies to buy private health insurance, which would be similar to a plan Arkansas wants to use. Johnson said it would be an alternative to expanding Medicaid, and the exchange would not be tied to Medicaid.
House Speaker Philip Gunn, R-Clinton, ruled the House could not debate Johnson's proposal, saying it was not germane to keeping Medicaid alive.
The House has voted to end the session at midnight Friday, but senators must agree to that.
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