Medicaid and controversy seem inseparable in many states lately. For the most part, the wrangling is about a new wrinkle in Medicaid — the expansion of the health program for the poor and disabled under Obamacare.
Mississippi, though, is raising the stakes. Democrats and Republicans in the state are in a fight, and the outcome could threaten the very existence of the entire Medicaid program there.
More than 700,000 Mississippians get Medicaid, with the federal government paying about three-quarters of the cost and the state picking up the rest of the tab. The federal Affordable Care Act calls for expanding Medicaid to roughly 300,000 additional low-income Mississippians. Initially, the federal government would pay the entire bill, and after a few years, the state would finance 10 percent.
When the U.S. Supreme Court made the expansion of Medicaid optional for states last year, Republicans in Mississippi, led by Gov. Phil Bryant, adamantly refused to go along.
"I do not believe that the federal government has the revenue to fully fund Medicaid across the United States of America," he said. "I am not going to fall into this trap and leave the taxpayers of Mississippi holding the bill."
Democrats pushed back and made Medicaid expansion a legislative priority.
"What it boils down to in the end is that we are going to make sure that all Mississippians, regardless of race, can get the health care they deserve and that the federal government now says can be afforded to them," said Sen. Kenny Wayne Jones, who chairs the Legislative Black Caucus, one of the most vocal pro-expansion groups.
Democrats are in the minority in Mississippi's House and Senate. To pressure the Republicans to at least debate expansion, Democrats refused to vote on renewing Medicaid. The regular legislative session ended in April, and without a reauthorization vote by the Legislature, Medicaid in Mississippi expires July 1.
Republican House Speaker Philip Gunn didn't allow a debate because he sees it as a waste of time. He and other Republicans are furious about the Democrats' tactics.
"I am dealing with reality," he said. "The reality is that an expansion bill is not going to pass the House of Representatives. I think they are playing politics, and we are dealing with reality."
But Democrats say the reality is that about 1 in 5 Mississippians is on Medicaid. Democratic state Rep. Steve Holland says that is a huge issue for patients and providers.
"If Medicaid went away in the state of Mississippi, the only people that would survive medically are the freaking plastic surgeons," he said. "Every other medical function would go to hell in a hand basket."
This is not the first time that Medicaid has been a political football in Mississippi. For all the heated debate, Republican Sen. Terry Burton says his colleagues on both sides of the aisle admit Medicaid will most likely be renewed. But sometimes it comes down to the 11th hour.
"I don't think there is any chance whatsoever that Medicaid in Mississippi will cease to exist," he said. "We will come back, and we will reauthorize Medicaid, and we will fund Medicaid, and we will have a bill and a budget bill before July 1, I believe."
It is widely expected that the governor will call lawmakers back next week for a special session. Democrats, despite their insistence that Medicaid expansion must happen in Mississippi, say all they really want is a debate and an up-or-down vote. It's something that hasn't happened yet, says Democratic Minority Leader Bobby Moak.
"[It's the] same thing that legislatures all over the United States are debating right now in their chambers," Moak said. "We have not had an opportunity to debate that. Yes, we need to come back, and we need to debate that issue."
Still, there is a chance that lawmakers won't be called back or that they won't agree.
In that case, the governor says he will run Medicaid by executive order without any legislative action. But it is unclear if that is legal.
This piece is part of a collaboration among NPR, Mississippi Public Broadcasting and Kaiser Health News.