Advocacy for Medicaid Expansion in Mississippi

Advocacy for MedicaidExpansion in MississippiA White Paper on Medicaid Expansion

Mark Slyter

HA 605 H

Introduc

O

The issue

Act (ACA

they rem

receiving

expand e

negotiate

in ACA.

coverage

Medicaid

offsetting

Policy Po

M

stimulate

generate

federal st

as schedu

response

economic

ealth Policy

ction

One of the mo

e of expansio

A) but struck

oved the pro

g federal Me

eligibility. T

ed funding fr

For hospita

e was offset b

d expansion,

g gain in exp

osition on M

Mississippi sh

e the Mississ

partisan opp

timulus alloc

uled in the A

will jeopard

c impact to M

M

ost debated p

on escalated

k down a po

ovision that r

dicaid fundi

The ruling by

rom Medicai

als across the

by $155 billi

are struggli

panded cover

Medicaid Ex

hould draw d

sippi econom

position then

cated for Mi

ACA putting

dize healthca

Mississippi.

P

edicaid Exp

political top

d after the 20

rtion of the l

required stat

ing. States n

y the Court je

id expansion

e nation, the

ion reductio

ing with sign

rage.

xpansion

down the ma

my. If the pr

n alternative

ississippi. P

state econom

are delivery,

Establishin

Page 1 of 27

pansion in M

ics today at

012 U.S. Sup

law related t

te’s to expan

now have the

eopardized t

n to offset sig

estimate wa

n in paymen

nificant paym

aximum fede

oposed ACA

plans should

ayment redu

mies withou

cause signif

ng a federal h

Assignmen

Student

Dat

Mississippi

the state lev

preme Court

to Medicaid.

nd Medicaid

e option of d

the economic

gnificant pay

as $171 billio

nts. States li

ment reducti

eral funding

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uctions for pr

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healthcare st

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vel is Medica

upheld the A

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eligibility to

deciding whe

cs for provid

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ike Mississip

ons for prov

g available fo

expansion c

tly identified

roviders are

uo option. A

ss and have

timulus optio

th Policy Advo

yter

er 6, 2013

aid expansio

Affordable C

urt’s decision

o continue

ether or not t

ders that

ctions schedu

ted to expan

ppi opposing

viders withou

or healthcare

ontinues to

d to receive t

moving forw

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Mississip

economic

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is fundin

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ealth Policy

ppi will impr

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y. Clearly op

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Mississippi is

d (Exhibit 1)

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Page 2 of 27

erate job cre

atus quo, the

) act and sig

nd the busine

the economic

es that is tak

and joins ma

e Medicaid e

isions in AC

sion argue th

ExhibiImplem

Source: T

budgets will b

ortionate Sha

Assignmen

Student

Dat

ation and ha

e two options

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ess communi

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any of these s

expansion is

CA to reduce

hat even thou

it 2: Uninsurmentation

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are Hospital

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ts: Mark Sly

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ave a signific

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nhance the M

ity should be

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er 6, 2013

cant positive

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payments

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impact of

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(Exhibit

Exhibit 3Expansio

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ealth Policy

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et hospitals c

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Page 3 of 27

ne example

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12). Anothe

l Medicaid m

buting factor

currently elig

nfluential AC

vidence of th

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ded in credib

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ce the intern

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the oppositi

payments fro

er speculative

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gible that are

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he “woodwo

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ble studies su

akers opposi

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national trend

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nt: #4 Healt

ts: Mark Sly

te: Decemb

on cites in M

om the state

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Appendix B

uch as admin

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conomic Co-opera13

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th Policy Advo

yter

er 6, 2013

Massachusett

after covera

ed by the

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nt and spendi

ed coming “o

he individual

ut its impact

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able concern

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le federal fun

otal Health n, 2001-2010

ation and Developm

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ealth Policy

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of the state e

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interest theo

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de those with

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d expansion

ssed in the p

t a greater bu

The most rele

public intere

ning these st

nomic self-in

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ng the econom

ge of their pr

ment spending

ymbolic gest

s to make a s

gesture but i

will focus app

conomy and

ers

cribes stakeh

ory or econom

ability is at th

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ablishes a mo

want to limi

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urden on tax

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est position c

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nterest (Feld

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mic opportu

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g on program

P

ture that they

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it has little im

propriately o

d Mississippi

holder policy

mic theory (

he heart of t

es affordable

ore efficient

it governmen

tion, entitlem

xpayers.

olders – poli

consistent w

motivations,

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vidual and p

unities in the

aditionally, b

ms such as M

Page 4 of 27

y want to low

esture that th

mpact in add

on the eviden

ians access t

y positions a

Feldstein, 20

he debate. S

e access to h

and effectiv

nt spending t

ment spendin

iticians, busi

with their pro

the public in

). Politician

party influen

market. He

business has

Medicaid exp

Assignmen

Student

Dat

wer federal s

hey want to e

dressing the i

nce that iden

to affordable

as driven by

006). The c

Supporters o

health insura

ve care deliv

to protect th

ng is creating

iness, provid

o or con stan

nterest positi

ns are driven

nce. Busines

ealthcare infl

s a negative v

pansion. As

nt: #4 Healt

ts: Mark Sly

te: Decemb

spending is l

end world hu

issue of the

ntifies what

e healthcare.

either publi

ompeting pu

of Medicaid

ance. Suppor

very model.

he public eco

g debt and b

ders, insurer

nce on Medic

ion is not as

by the desir

ss is driven b

lation has co

view of incr

a sub-set of

th Policy Advo

yter

er 6, 2013

like asking

unger. The s

US federal d

is in the bes

c or self-inte

ublic interest

expansion w

rters contend

Opponents t

onomic inter

budget issues

rs and the pu

caid expansio

influential a

re to remain

by profits an

onsumed a la

eased

f the busines

ocacy

state

debt.

t

erest

t of

want

d

to

est.

s that

ublic

on.

as

in

nd

arger

s

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commun

self-inter

the numb

Medicaid

(Cutler &

access to

of Medic

recipient

O

Republic

economic

public po

increase

supportin

– of Med

As menti

expansio

individua

majority

Republic

these ind

candidate

ealth Policy

ity, provider

rest in maint

ber of insure

d expansion

& Gruber, 19

o affordable h

caid expansio

or donor to

Of these stake

cans public in

c developme

osition, the R

in governme

ng the econo

dicaid expan

ioned, the ec

n. Oppositio

al acceptance

currently ha

cans are also

dividuals to v

es and weak

rs and insure

aining profit

d. Although

could expan

997). Finally

health insura

on in genera

the expande

eholders, law

nterest posit

ent – jobs, pe

Republicans

ent spending

omic advanta

sion in the st

conomic theo

on to any co

e and suppor

ave an anti-A

keenly awar

vote. These

en the Repub

P

ers also requ

tability supp

h insurers sh

nd or crowd-

y, the public

ance while m

al is different

ed coverage.

wmakers are

tion is to low

ersonal inco

view on Me

g. Their posi

ages – more j

tate (Holaha

ory better ex

omponent of

rt by the par

ACA position

re that more

newly motiv

blicans abili

Page 5 of 27

ire profits to

port Medicai

hare a similar

out opportun

is driven by

minimizing th

t based on w

e the stronge

wer governm

me and the p

edicaid expan

ition is chall

jobs, greater

an, Buettgen

xplains Repu

f the ACA he

rty. In recen

n which emb

e people rece

vated voters

ity to stay in

Assignmen

Student

Dat

o maintain th

d expansion

r focus on pr

nities for the

y their indivi

heir tax burd

whether the in

st and most

ment spending

private mark

nsion is bigg

lenged with

r income, an

s, Carroll, &

ublicans oppo

elps Republi

nt Mississipp

boldens Rep

eiving entitle

are likely to

n office. The

nt: #4 Healt

ts: Mark Sly

te: Decemb

heir missions

n to increase

rofits, the im

e private insu

idual self-int

den. The pu

ndividual is

relevant stak

g and debt w

ket. Consiste

ger governm

consistent ev

nd positive e

& Dorn, 2012

osition to M

icans strengt

pi polling, a s

publican opp

ements creat

o favor Dem

ese are powe

th Policy Advo

yter

er 6, 2013

s. Providers

payments an

mpact of

urance mark

terest to hav

ublic percept

a Medicaid

keholders.

while promot

ent with this

ment and the

vidence

conomic imp

2; Neal, 2012

Medicaid

then their

significant

osition.

te incentives

mocratic

erful self-inte

ocacy

s’

nd

ket

ve

tion

ting

s

pact

2).

for

erest

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motivato

support o

the Demo

Literatu

In

expansio

the Unin

Implicati

et al., 20

Governor

Affordab

Institutio

Impacts o

Kaiser R

“T

State-by-

the ACA

Medicaid

develope

data sour

1 All the

ealth Policy

rs for Repub

of Medicaid

ocrats politic

re Review

n Mississipp

n. The first

sured in coll

ions of the A

12). The sec

r, Phil Bryan

ble Care Act

ons of Higher

of Medicaid

eport

The Cost an

-State Analy

A Medicaid e

d costs, Med

ed using the U

rces for HIPS

references in

blicans to ad

expansion is

cal and econ

pi, there are t

is a national

laboration w

ACA Medica

cond is a sta

nt, to assess

on the Miss

r Learning (

Expansion i

d Coverage

ysis” or Kaise

xpansion at

dicaid enrollm

Urban Institu

SM are the C

n this section

P

dvance their o

s also driven

nomic interes

three primary

l study produ

with The Urb

aid Expansio

ate study com

the, “Financ

sissippi Med

IHL) produc

in Mississipp

Implications

er Report pr

the federal a

ment and the

ute’s Health

Current Popu

n are taken f

Page 6 of 27

own politica

n by self-inte

sts.

y studies cite

uced by the

an Institute t

on: National

mmissioned f

cial Impact R

icaid Budge

ced the third

pi, 2014-202

s of the ACA

rovides a cle

and state lev

e number of

h Insurance P

ulation Surv

from the Kai

Assignmen

Student

Dat

al and econo

erest. Medic

ed as eviden

Kaiser Com

titled, “The

and State-by

from Millim

Review of th

et” (Meersch

d study titled

25” (Neal, 2

A Medicaid E

ar and conci

vel (Holahan

uninsured.

Policy Simul

vey (CPS) an

iser Report u

nt: #4 Healt

ts: Mark Sly

te: Decemb

mic interest

caid expansio

nce for and a

mmission on

Cost and Co

y-State Anal

man, Inc. by M

he Patient Pr

haert, 2012).

d, “The Fisca

012).

Expansion: N

ise analysis o

et al., 2012)

The estimat

lation Mode

nd the Medic

unless otherw

th Policy Advo

yter

er 6, 2013

s. Democra

on strengthe

against Medi

Medicaid an

overage

lysis” (Holah

Mississippi

otection and

The Missis

al and Econo

National and

of the impac

)1. It include

es were

l (HIPSM).

cal Expenditu

wise cited.

ocacy

t

ens

icaid

nd

han

d

sippi

omic

d

ct of

es

The

ure

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Panel Su

populatio

projectio

T

$649 mil

over non

increase

expenditu

percent o

Medicaid

the feder

enrollme

represent

reduce th

uninsured

T

to the ben

$22 in fe

$649 mil

small inc

expansio

(Reeves &

ealth Policy

rvey (MEPS

on. In additi

ns.

The study est

llion over ten

-expansion.

of $1,048 m

ures for unco

of uncompen

d expansion

ral Mississipp

nt would gro

ting 22.4 to 3

he uninsured

d representin

The study con

nefits in fede

deral fundin

llion state co

crease of 3.8

n would add

& Gunn, 20

S). These da

ion, Congres

timated Miss

n years (an a

The $649 m

million minus

ompensated

nsated care c

would incre

pi Medicaid

ow by 288,0

32.1 percent

d population

ng 18.8 to 7.

ncluded the

eral funding

ng for every

ontribution o

percent abo

d a modest 0

13). More th

P

ata sources p

ssional Budg

sissippi’s inc

average annu

million net in

s the savings

care. Curre

osts for the u

ase by $14.5

d budget. In

000, an incre

t of the popu

by 327,000

.9 percent of

costs of imp

and expand

$1 Mississip

over ten year

ove the curre

.4 percent to

han half (58

Page 7 of 27

provide insur

get Office (C

cremental co

ual cost of $6

ncrease acco

s of $400 mil

ently, state an

uninsured. T

5 billion ove

addition to c

ase from the

ulation, respe

moving from

f the Mississ

plementing M

ded coverage

ppi contribut

s. The Miss

ent state Med

o the overall

%) of the cu

Assignmen

Student

Dat

rance covera

CBO) estima

ost of Medica

64.9 million

ounts for the

llion associa

nd local gov

The federal

er ten years –

cost, the stud

e current 669

ectively. Me

m a total of 5

sippi populat

Medicaid exp

e. Medicaid

tes – $14.5 b

sissippi cost

dicaid expen

2013 Missis

urrently unin

nt: #4 Healt

ts: Mark Sly

te: Decemb

age and spen

ates were use

aid expansio

n) – a 3.8 per

Medicaid ex

ated with red

vernments fin

subsidy to M

– a 29.8 perc

dy concluded

9,000 to 957

edicaid expa

562,000 to 2

tion, respect

pansion are m

expansion w

billion federa

of Medicaid

nditures. For

ssippi appro

nsured in Mi

th Policy Advo

yter

er 6, 2013

nding for the

ed to make

on would be

rcent increas

xpansion

duction in sta

nance about

Mississippi fo

cent increase

d Medicaid

,000 enrolle

ansion would

235,000

ively.

minor comp

would provid

al subsidy to

d expansion

r 2013, Med

opriations bu

ssissippi wo

ocacy

U.S.

se

ate

30

for

e in

ees

d

ared

de

o

is a

dicaid

udget

ould

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be insure

specific s

services t

would be

governm

T

data that

omission

within th

produced

The study

significan

Mississip

Milliman

“F

Mississip

Mississip

(Meersch

choice in

eligibility

2 All the r

ealth Policy

ed with Medi

savings on it

that are curr

e covered un

ment.

The author no

could offset

n in the analy

he state. How

d from $14.5

y does not in

ntly, if not c

ppi.

n Report

Financial Im

ppi Medicaid

ppi Governo

haert, 2010,

n implementa

y to 133 perc

references in

icaid expans

tems such as

rently covere

nder Medicai

otes a signifi

t the cost of

ysis of the ec

w many jobs

5 billion of fe

ncorporate th

ompletely, o

mpact Review

d Budget” or

r Haley Barb

2012)2. The

ation of ACA

cent of Fede

n this section

P

sion. The be

s mental heal

ed by the stat

id with expan

icant limitati

Medicaid ex

conomic imp

s, wages, spe

ederal funds

his economic

offset the $6

w of the Pati

r the Millima

bour and upd

e June 28, 20

A provisions

eral Poverty L

n are taken f

Page 8 of 27

enefits are co

lth, substanc

tes outside th

nsion – whic

ion in the stu

xpansion. Th

pact that resu

ending and o

infused in t

c impact fac

49 million c

ent Protectio

an Report w

dated in 201

012 U.S. Sup

s related to e

Level (FPL)

from the Mil

Assignmen

Student

Dat

onservative b

ce abuse, pub

he Medicaid

ch is primari

udy is that it

he most sign

ults from add

other econom

the Mississip

ctor. This fa

cost of Medic

on and Affor

was first comm

2 at the requ

preme Court

expanding th

). With this

lliman Repor

nt: #4 Healt

ts: Mark Sly

te: Decemb

based on mi

blic health a

d program. T

ily funded b

t is missing s

nificant miss

ditional fede

mic growth f

ppi economy

ctor alone co

caid expansi

rdable Care

missioned in

uest of Gove

t decision ga

he Medicaid

flexibility, M

rt unless oth

th Policy Advo

yter

er 6, 2013

ssing state-

and social

These servic

y the federal

state-specific

sing data is t

eral spending

factors would

y over ten ye

ould

ion for

Act on the

n 2010 by fo

ernor Phil Br

ave states a

program

Mississippi

herwise cited

ocacy

ces

l

c

the

g

d be

ears?

ormer

ryant

d.

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retained M

expansio

T

$336 to $

3.9 perce

the low, e

enrollme

included

participat

conclude

woodwor

63,000 en

inclusion

the 2014

represent

T

results. T

significan

estimate

Mississip

between

Medicaid

ealth Policy

Milliman, In

n segments

The study est

$454 million

ent increase o

estimating 6

nt. A full 10

at the reque

tion was not

ed Medicaid

rk effect wou

nrollees (see

n of the wood

projected of

ting 32.2 to 3

The study sum

The study co

nt impact to

the total fina

ppi Medicaid

$609 million

d expenditur

nc. to evalua

on the Missi

timated Miss

n over seven

over non-exp

60 percent en

00 percent e

est of the MS

t considered

enrollment w

uld account

e Appendix B

dwork effect

f 740,000 wo

34.7 percent

mmary the a

oncluded the

the Mississi

ancial impac

d budget dur

n and $1.032

res.” There a

P

ate the financ

issippi Medi

sissippi’s inc

years (an an

pansion. Th

nrollment of

nrollment sc

S Departmen

a reasonable

would grow

for 21.4 to 2

B, Advantag

t and other n

ould increas

t of the Miss

author includ

e costs of AC

ippi Medicai

ct of the full

ring the next

2 billion doll

are several m

Page 9 of 27

cial impact o

icaid program

cremental co

nnual averag

he cost range

Medicaid el

cenario was

nt of Medicai

e assumption

between 22

21.8% of the

ges and Limi

notable study

e to a total 9

sissippi popu

ded the misle

CA including

id budget. T

implementa

t seven years

lars, or betw

misleading p

Assignmen

Student

Dat

of three poten

m.

ost of Medica

ge cost of $4

e relates to th

ligible, to th

modeled but

id to underst

n. In additio

0,000 to 294

e enrollment

itations secti

y comparison

960,000 to 1

ulation, respe

eading upper

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nt: #4 Healt

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he level of p

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t the author

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4,000 enrolle

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ion to note th

ns). The tot

,034,000 enr

ectively.

r bound full

expansion w

n Report sta

ACA on the

l years 2014

nd 8.8% of b

summary. A

th Policy Advo

yter

er 6, 2013

Medicaid

on would be

llion) – a 2.9

participation

80 percent

noted this w

per bound. F

he study

ees. The

48,000 to

he Kaiser Re

tal enrollees

rollees

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ated, “We

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d. The autho

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nal ACA man

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ansion.

ignificant ex

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re incomplet

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aders have c

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ACA impac

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$336 to $454

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ancial impact

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for Mississip

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neous. This

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t rather than

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4 million ov

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relatively so

imited and ra

liman Repor

ill increase M

f the Millima

s in bold lett

t of the ACA

” The repor

ppi – it only

age 10 of 27

assumes all

e with privat

s was unlike

n the relevant

urden of the

timated Miss

ver seven yea

omic impact,

ing from fed

uld be covere

are Hospital

olid methodo

aises concer

rt as evidenc

Mississippi c

an Report to

ters, “The sc

A on the Mis

rt does not ad

y provides in

Assignmen

Student

Dat

newly eligib

te insurance

ely yet retain

t sub-set of M

state regardl

sissippi’s inc

ars – a 2.9 to

, federal sub

deral subsidy

ed in Medica

(DSH). Wit

ology incorp

rns in its mis

ce that Medic

costs by $1 b

justify an an

cope of our r

ssissippi Me

ddress “affor

nformation on

nt: #4 Healt

ts: Mark Sly

te: Decemb

ble will enro

will drop it t

ned it in their

Medicaid ex

less of the d

cremental co

o 3.9 percent

sidy impact,

y, reductions

aid expansio

th these excl

porated in th

suse by some

caid expansi

billion.” Thi

nti-Medicaid

report is limi

edicaid budge

rdability” of

n the impact

th Policy Advo

yter

er 6, 2013

oll, all curren

to enroll in

r summary.

xpansion.

ecision on

ost of Medic

t increase ov

, increases in

s in state

on, and

lusions the

e analysis.

e politicians

ion is

is is an

d expansion

ited to a

et (page 1,

f ACA or

t of ACA to

ocacy

ntly

The

caid

ver

n

.

the

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IHL Rep

2012 (Ne

of the fis

provides

expansio

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$497 to $

The cost

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expansio

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General F

impact re

impact. I

provided

Report in

3 All the r

ealth Policy

ort

The Fiscal a

ort was prod

eal, 2012)3.

cal impacts

an overall e

n to the Mis

l Economic M

c impact of j

g in Mississip

The study est

$556 million

range relate

moderate (85

n would hav

dditions to th

Fund revenu

elated to job

It is easily c

d in the impa

ncluding the

references in

and Economi

duced by The

As stated in

of Medicaid

economic im

ssissippi Med

Model, Inc.

jobs, labor in

ppi.

timated Miss

n over twelve

es to the thre

5%) is $551

ve an offsetti

he Mississipp

ue were inclu

s and incom

alculated fro

ct of the add

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n this section

P

ic Impacts of

e Mississipp

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dicaid budge

(REMI) Tax

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sissippi’s inc

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e levels of th

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ing economi

pi General F

uded in the e

e that is in th

om the detail

ditional perso

Mississippi e

n are taken f

age 11 of 27

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pi Institution

the purpose

in Mississipp

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state General

cremental co

annual averag

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und revenue

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l report by a

onal income

economic im

from the IHL

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Expansion in

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was to “prov

pi.” This stu

sion in addit

nomic impac

The REMI m

l Fund reven

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ge cost of $4

gible partici

) is $556 mi

lated to jobs,

e). The addi

ove. Howev

the report is

adding the cu

e in the state

mpact data).

L Report unl

nt: #4 Healt

ts: Mark Sly

te: Decemb

n Mississipp

Learning (IH

vide an unbi

udy is uniqu

tion to the im

ct was estima

model estim

nue of new f

aid expansio

41 to $46 mi

ipation low (

illion. The M

, income and

itions to the M

ver, the addit

not applied

umulative ec

(see Append

The study e

less otherwis

th Policy Advo

yter

er 6, 2013

pi, 2014-2025

HL) in Octob

iased assessm

ue because it

mpact of

ated using th

mates the

federal Medi

on would be

illion annual

(75%) is $49

Medicaid

d additional

Mississippi

tional econo

to the summ

conomic imp

dix A for IH

stimated

se cited.

ocacy

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ber

ment

he

icaid

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state

omic

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pact

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Medicaid

from $6.6

$619 mil

positive i

(an annua

result of

Mississip

annual av

subsidy a

expansio

final estim

310,039

would be

represent

this woul

of the po

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years 201

the Missi

the twelv

care coul

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ealth Policy

d expansion

6 to $7.4 bil

llion). Adjus

incremental

al average ec

Medicaid ex

ppi for Medi

verage increm

and economi

n would hav

mate reporte

(high partici

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ting 24.8 to 3

ld be an estim

pulation.

The study con

17 to 2025.

issippi Gene

ve year perio

ld enhance th

eyond the sco

would have

lion over tw

sting for the

impact to th

conomic boo

xpansion ran

icaid expansi

mental feder

ic impact, th

ve a $6 billio

ed was Medi

ipation) in th

ed increase f

30.5 percent

mated increa

ncluded Med

The state co

eral Fund rev

od – 2012 to

he health of

ope of the st

P

an offsetting

welve years (a

economic im

he Mississipp

ost of $512 t

nged from 7,9

ion would in

ral funding o

he $10 billion

on plus econo

icaid enrollm

his twelve ye

from the curr

t of the popu

ase to a proje

dicaid expan

osts of Medic

venue were p

2025. The a

Mississippia

tudy. The au

age 12 of 27

g economic

an annual av

mpact, Medi

pi economy o

to $572 milli

950 to 8,860

ncrease $10.

of $0.9 to $1

n plus in fed

omic stimulu

ment would g

ear period. F

rent 740,000

ulation, respe

ected 1,050,

nsion will ge

caid expansi

projected to r

author went

ans that migh

uthor’s concl

Assignmen

Student

Dat

impact from

verage econo

icaid expans

of $6.1 to $6

ion). Additi

0 by 2025. T

8 to $12.1 b

1.0 billion).

deral subsidy

us to the stat

grow 244,76

For the low p

0 to a project

ectively. Fo

039 enrollee

enerate addit

ion including

range from $

on to sugge

ght have a lon

luding comm

nt: #4 Healt

ts: Mark Sly

te: Decemb

m jobs and in

omic stimulu

sion would h

6.9 billion ov

ional jobs in

The federal s

illion over tw

In summariz

y to Mississip

te over twelv

68 (low parti

participation

ted 984,768

or high partic

es representi

tional state M

g the offsetti

$497 to $556

st increased

ng-term econ

ment was, “P

th Policy Advo

yter

er 6, 2013

ncome rangin

us of $554 to

have a net

ver twelve y

n Mississippi

subsidy to

welve years

zing the fede

ppi for Medi

ve years. Th

icipation) to

n scenario, th

enrollees

cipation scen

ing 32.5 perc

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ing additions

6 million ov

access to he

nomic benef

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o

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Gruber, 1

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describin

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not read

inference

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but the ov

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appropria

the full e

reason fo

state agen

ealth Policy

id expansion

research to s

mple, Medica

d mortality b

dicaid expan

ment interven

1996).

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ng the unden

d an explanat

ppi economy

or comprehe

es could mis

that is not en

verall econo

nificant misr

ately and eff

conomic ben

or excluding

ncy and ther

n) in the year

support of a

aid expansio

by 5.1 percen

nsion is com

tions, Medic

tique of the s

niable econom

tion of the ec

y. This was

end beyond t

lead the read

nough to offs

omic public a

epresentatio

fectively in s

nefit in repo

this informa

refore relucta

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rs ahead mig

long-term ec

n for childre

nt (Currie &

mpared with s

caid expansi

study is in th

mic benefit o

conomic imp

a significant

the informat

der to conclu

fset expansio

and private e

n of the data

support of M

rting summa

ation could b

ant to signifi

age 13 of 27

ght be a chall

conomic ben

en was found

Gruber, 199

studies relate

on provides

he conclusion

of Medicaid

pact related

t oversight b

tion in the ex

ude the only

on costs. At

economic be

a leads to mi

Medicaid exp

ary results is

be that the au

ficantly unde

Assignmen

Student

Dat

lenge (Page

nefit but it w

d to lower in

94). If this ty

ed to cost pe

greater savi

ns by the au

expansion f

to jobs and i

because most

xecutive sum

economic im

the state gov

enefit to Mis

issed opportu

pansion. The

s unknown.

uthor is a sta

ermine the G

nt: #4 Healt

ts: Mark Sly

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21, General

was not cited

nfant mortali

ype of outco

er life saved

ings (Cutler

uthor that fell

from the data

income to th

t users of the

mmary. The

mpact is in t

vernment lev

ssissippi far e

unities in us

e reason the

Although sp

ate employee

Governors po

th Policy Advo

yter

er 6, 2013

l Conclusion

d in the study

ity by 8.5 pe

ome resulting

of alternativ

& Gruber, 1

l short of

a. The autho

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ese studies d

author’s

the additiona

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exceeds the

sing the study

author left o

peculative, a

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ocacy

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y.

ercent

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ve

1997;

or

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ue,

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out

a

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levels of deta

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rbaugh et al.

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n study com

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ed Mississipp

onclusion of

Milliman and

ail (see Appe

1 to $65 mil

the study su

in the impac

act into cons

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study found m

th Medicaid

ated to expan

n their numbe

participation

pport a posit

ual model for

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his model wi

mparison grid

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f the Kaiser,

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llion annual

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in Mississip

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expansion.

nsion from 2

er of scenari

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edicaid Dolla

ill be used w

d (see Appen

act – increase

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age 14 of 27

Milliman an

rts all have s

, for a compa

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he benefits of

ociated fede

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d $500 milli

alf (58%) of

The studies

231,000 to ju

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economic a

r of Medicaid

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ars Through

with an evide

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es in jobs, in

e generated –

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nd IHL Repo

some very sim

arison grid o

sissippi for M

f Medicaid e

eral subsidy.

sighted over

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f the currentl

consistently

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most likely

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etails) with a

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orts

milar conclu

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Medicaid exp

expansion fa

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r $1 billion a

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ly uninsured

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n.

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nomy (Carb

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a focus on th

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usions with

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pansion.

ar exceed the

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evidence from

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Medicaid

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are providers

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support from

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s are viewed

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iness commu

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as biased an

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age 15 of 27

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for Medicaid

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nd promoting

ance of busin

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Dat

gnificant infl

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community.

utside of the

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g their own s

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fluence on po

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when

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making Missi

ppi Hospitals

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driver for M

hed some ver

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ess leaders in

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issippians he

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ry specific g

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alternative to

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issippi Econo

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n promoting

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e MEC Blue

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age 16 of 27

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o draw down

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omic Counc

Music, Thak

the position

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nomic impac

ovative, com

the workforc

eprint recom

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around health

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Student

Dat

s the messag

hamber of co

istorically ad

cent MEC st

ng healthcar

The summar

n the federal

dations in th

cil (MEC) Bl

akur, & Mail

n to advance

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cts, but also

mpetitive sys

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mmendations:

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ts: Mark Sly

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ge and messe

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dvocated tha

trategic plan

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lo, 2012), M

healthcare a

as the potenti

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:

th Policy Advo

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enger. The m

nown as the

at healthcare

n, MEC Blue

nomic driver

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l be tailored

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ississippi

as an econom

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ver 50,000+

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ississippi Ec

healthcare to

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+ full-time jo

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conomy. Dr

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Healthcare

dvances the

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d be able to

le Mississipp

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have a $9.5 b

obs and a pay

ollaborative

ith health sys

age 17 of 27

ysicians in th

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rawing down

the Mississip

e. Establishi

previous ME

ssissippi bus

ncreased heal

all business e

ion, etc.

e to Advanc

obtain care.

pians access

tter of compa

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billion total

yroll of over

to Improve

stems to imp

Assignmen

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he state.”

als througho

osition in sup

al pro-busine

n the maxim

ppi economy

ing a pro-bus

EC recomm

sinesses, com

lth care prof

exchanges, s

ce Business.

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to healthcar

assion for ot

hich in turn

annual impa

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e Competitiv

prove the he

nt: #4 Healt

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te: Decemb

out the state.”

pport of the

ess endorsem

mum federal

y.

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endations –

mprehensive

fessionals. S

state based e

. People wh

ysicians, the

re services a

ther unfunde

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act to the stat

n per year (M

veness. Mis

alth and pro

th Policy Advo

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er 6, 2013

”

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ments in the M

funding

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health care

Some pro-

exchanges,

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erapists, hosp

as a matter of

ed care. Safe

he economy.

te economy

MHA, 2007).

ssissippi

ductivity of

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print

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of

h care

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.

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workforce. B

artners that a

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ct of over $5

ional cost to

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Businesses th

address dise

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0 jobs in Mis

500 million t

o the state bu

lth insurance

00 (7.9%). M

tals all benef

P

hat participat

ase managem

o draw down

ssissippi and

to the state –

udget. In add

e. The unins

Mississippi

fit in taking

age 18 of 27

te in this col

ment, wellne

n the maxim

d have an inc

– an econom

dition, thous

sured in Mis

citizens, bus

action to ma

Assignmen

Student

Dat

llaborative w

ess and other

mum federal f

cremental po

mic impact af

sands of Mis

ssissippi will

sinesses, pat

aximize fede

nt: #4 Healt

ts: Mark Sly

te: Decemb

would have h

r factors to r

funding for h

ositive annua

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ssissippians w

l be reduced

tients, taxpay

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th Policy Advo

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health system

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healthcare w

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will have ac

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Currie, JM

Cutler, DA

FeldsteinE

Gruber, JP

HaislmaiE

Hess, R.,C

Holahan,thF

MeerschaCM

MeerschaC

MHA. (2M

Neal, B. 2In

Reeves, TFht

ealth Policy

h, A., MarksLook at the R., & Gruber,

Medicaid eligD. M., & GruAnd Implicatn, P. J. (2006Edition. ChicJ. (1996). Heast Decade: ier, E. F., &

Expansion Pr, Hampton, P

Care: An Eco, J., Buettgenhe ACA Medamily Foundaert, J. D. (2

Care Act As AMedicaid Budaert, J. D. (2

Care Act On 2007). BeyonMississippi H

(2012). The 025 An Econnstitutions ofT., & Gunn, ISCAL YEAttp://www.d

s, C., & RudoResearch. Ka

J. (1994). Sgibility for puber, J. (1997ions. Health

6). The Politiago, IL: Heaealth InsuranNational BuGonshorows

rojections. ThP., Music, Donomic Drivens, M., Carrodicaid expandation.

2010). FinancAmended bydget.

2012). Financthe Mississipnd Health Ca

Hospital AssoFiscal and E

nomic Brief f Higher LeaP. (2013). S

AR 2013. frodfa.state.ms.u

P

R

owitz, R. (20aiser CommisSaving babieregnant wom7). Peer Rev

h Affairs, 16(ics of Healthalth Adminisnce for Poor ureau of Ecoski, D. (2012

The Heritage ., Thakur, Rer (pp. 30): Moll, C., & Donsion: Nation

cial Impact Ry H.R. 4782,

cial Impact Rppi Medicaiare: Mississiociation (MHEconomic ImFrom the Unarning. STATE OF Mom us/Offices/O

age 19 of 27

References

004). The Rossion on Mes: the efficac

men: Nationaview: Medica(1), 194-200h Legislationstration PresWomen and

onomic Rese2). State LawFoundation

R., & Mailo, NMississippi Eorn, S. (2012nal and state

Review of th, The Recon

Review of thd Budget. ippi HospitaHA). mpacts of Me

University Res

MISSISSIPP

OBFM/Forms

Assignmen

Student

Dat

ole of Medicedicaid and tcy and cost oal Bureau ofaid And Priv

0. n: An Econoss Perspectivd Children inarch.

wmaker’s Gun: Issue BriefN. (2012). BEconomic C2). The cost e-by-state an

he Patient Prciliation Act

he Patient Pr

als as Vital E

edicaid Expasearch Cent

PI GENERA

s/FY2013Bu

nt: #4 Healt

ts: Mark Sly

te: Decemb

caid in Statethe Uninsureof recent expf Economic Rvate Insuranc

mic Perspecves. n the US: Le

uide to Evalf(3720), 3.

Blueprint MiCouncil.

and coveragnalysis: Henr

rotection andt of 2010 On

rotection and

Economic En

ansion in Mter (pp. 31):

AL FUND BU

udget.pdf

th Policy Advo

yter

er 6, 2013

e Economiesed (April 200pansions of Research. ce: Evidence

ctive, 3rd

essons from t

uating Medi

ississippi He

ge implicatiory J. Kaiser

d Affordablen the Mississ

d Affordable

ngines (pp. 3

ississippi, 20Mississippi

UDGET FO

ocacy

: A 04).

e

the

icaid

ealth

ons of

e sippi

e

3):

014-

OR

HA 605 H

Ap

SUMMAR

Table 1. H

Year En

2014 2

2015 2

2016 3

2017 3

2018 3

2019 3

2020 3

2021 3

2022 3

2023 3

2024 3

2025 3

Table 2. M

Year En

2014 2

2015 22016 2

2017 2

2018 2

2019 2

2020 2

2021 2

2022 2

2023 2

2024 2

2025 2

Table 3. L

Year En2014 2

2015 2

2016 2

2017 2

2018 2

2019 2

2020 2

2021 2

2022 2

2023 2

2024 2

2025 2

ealth Policy

pendix A: IH

RY OF RESULT

High Participatio

nrollment

SMe

C

280,782 $

296,972 $

313,125 $

312,781 $

312,437 $

312,093 $

311,750 1$

311,407 1$

311,064 1$

310,722 1$

310,380 1$

310,039 1$

Moderate Partici

nrollment

SMe

C

247,749 $

263,975 $ 280,165 $

279,857 $

279,549 $

279,241 $

278,934 1$

278,627 1$

278,321 1$

278,015 1$

277,709 1$

277,403 1$

Low Participatio

nrollment

SMe

C214,716 $

230,978 $

247,204 $

246,932 $

246,661 $

246,389 $

246,118 1$

245,848 1$

245,577 1$

245,307 1$

245,037 1$

244,768 1$

HL Report in

TS (Addendum c

on Scenario (95%

State edicaid Costs

AdditState GFund R

8.5 $

17.5 $

18.9 $

45.9 $

78.5 $

92.1 $

117.8 $

138.9 $

143.7 $

148.7 $

153.8 $

159.1 $

ipation Scenario

State edicaid Costs

AdditState GFund R

8.0 $

16.6 $ 18.0 $

43.8 $

75.0 $

87.9 $

112.5 $

132.6 $

137.2 $

141.9 $

146.8 $

151.9 $

n Scenario (75%

State edicaid Costs

AdditState GFund R

7.3 $

15.3 $

16.8 $

41.1 $

70.3 $

82.4 $

105.5 $

124.4 $

128.7 $

133.1 $

137.7 $

142.5 $

Mississippi Go

Mississippi Go

Mississippi Go

P

ncluding the

calculations to I

% participation

tions to General Revenue

Net FisBur

8.5 $

26.7 ($

39.1 (2$

43.9 $

47.8 3$

50.6 4$

53.2 6$

55.7 8$

57.8 8$

59.6 8$

61.4 9$

63.3 9$

o (85% participa


Net FisBur

8.0 $

25.2 ($ 37.1 (1$

41.9 $

45.6 2$

48.4 3$

50.8 6$

53.2 7$

55.3 8$

56.9 8$

58.7 8$

60.5 9$

% participation b


Net FisBur

7.4 $

23.4 ($

34.6 (1$

39.2 $

42.8 2$

45.5 3$

47.8 5$

50.0 7$

51.9 7$

53.5 7$

55.1 8$

56.8 8$

overnment Impac

overnment Impac

overnment Impac

age 20 of 27

e Additional

IHL Report on M

by 2016), 2014

State cal

rden

CumulaState Fi

Burde

- -$

(9.2) (9$

20.2) (29$

2.0 (27$

30.8 3$

41.4 44$

64.6 109$

83.3 192$

85.9 278$

89.1 367$

92.4 460$

95.8 555$

ation by 2016),

State cal

rden

CumulaState Fi

Burde

- -$

(8.6) (8$ 19.1) (27$

1.9 (25$

29.4 3$

39.5 43$

61.6 104$

79.4 184$

81.9 266$

85.0 351$

88.1 439$

91.4 530$

by 2016), 2014

State cal

rden

CumulaState Fi

Burde- -$

(8.1) (8$

17.8) (25$

1.8 (24$

27.5 3$

36.9 40$

57.7 98$

74.4 172$

76.8 249$

79.6 328$

82.6 411$

85.7 497$

ct

ct

ct

Assignmen

Student

Dat

Mississippi

Medicaid Expan

4-2025

ative iscal en Employ

4,1

9.2) 8,4

9.4) 8,7

7.4) 9,0

3.4 9,12

4.8 9,0

9.4 9,1

2.7 9,2

8.6 9,0

7.7 8,9

0.1 8,92

5.9 8,8

2014-2025


3,94

8.6) 7,97.7) 8,3

5.8) 8,6

3.6 8,7

3.1 8,6

4.7 8,7

4.1 8,7

6.0 8,6

.0 8,5

9.1 8,52

0.5 8,4

4-2025


3,64

8.1) 7,3

5.9) 7,82

4.1) 8,1

3.4 8,1

0.3 8,14

8.0 8,22

2.4 8,2

9.2 8,1

8.8 8,0

.4 8,0

7.1 7,9

Addit

Addit

Addit

nt: #4 Healt

ts: Mark Sly

te: Decemb

Economic I

nsion, October, 2

yment PersonIncom

78 190$

01 417$

76 484$

59 545$

20 594$

65 633$

54 673$

00 712$

92 744$

99 775$

24 808$

60 841$

yment PersonIncom

41 180$

55 394$ 65 461$

59 520$

19 567$

66 604$

50 643$

94 681$

89 711$

99 741$

27 771$

66 803$

yment PersonIncom

41 166$

84 366$

28 431$

35 489$

93 532$

43 567$

20 604$

63 639$

62 667$

77 696$

08 724$

50 754$

tional Mississip

tional Mississip

tional Mississip

th Policy Advo

yter

er 6, 2013

mpact Data

2012)

nal me

CumulEcomo

Impa

.8 19$

.0 60$

.8 1,09$

.4 1,63$

.0 2,23$

.0 2,86$

.8 3,53$

.8 4,25$

.6 4,99$

.8 5,77$

.2 6,58$

.2 7,42$

nal me

CumulEcomo

Impa

.0 18$

.8 57$

.4 1,03$

.8 1,55$

.0 2,12$

.8 2,72$

.8 3,37$

.0 4,05$

.0 4,76$

.0 5,50$

.6 6,27$

.4 7,08$

nal me

CumulEcomo

Impa.8 16$

.6 53$

.4 96$

.0 1,45$

.8 1,98$

.6 2,55$

.8 3,15$

.6 3,79$

.8 4,46$

.0 5,16$

.8 5,88$

.2 6,64$

ppi Economic Im

ppi Economic Im

ppi Economic Im

ocacy

ative omic act

90.8

07.8

92.6

38.0

32.0

65.0

38.8

51.6

96.2

72.0

80.2

21.4

ative omic act

80.0

74.8 36.2

57.0

24.0

28.8

72.6

53.6

64.6

05.6

77.2

80.6

ative omic act 66.8

33.4

64.8

53.8

86.6

54.2

59.0

98.6

66.4

62.4

87.2

41.4

mpact

mpact

mpact

HA 605 H

ealth Policy

Appendix BB (1 of 7): M

P

Mississippi M

age 21 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

HA 605 H

ealth Policy


P

Mississippi M

age 22 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

HA 605 H

ealth Policy


P

Mississippi M

age 23 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

HA 605 H

ealth Policy


P

Mississippi M

age 24 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

HA 605 H

ealth Policy


P

Mississippi M

age 25 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

HA 605 H

ealth Policy


P

Mississippi M

age 26 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

HA 605 H

ealth Policy


P

Mississippi M

age 27 of 27

Medicaid Exp

Assignmen

Student

Dat

pansion Stud

nt: #4 Healt

ts: Mark Sly

te: Decemb

dy Comparis

th Policy Advo

yter

er 6, 2013

son Grid

ocacy

Advocacy for Medicaid Expansion in Mississippi

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