Mississippi will lose out on billions of dollars if Congress continues to advance legislation that would make deep cuts to Medicaid and other agencies to pay for a tax cut championed by President Donald Trump.

Tens of thousands of Mississippians could lose their health insurance as a result of what could be the largest cut in the history of Medicare and Medicaid. 

While the budget resolution passed by Congress this week doesn’t specifically call for cuts to Medicaid, experts have said there is no way to achieve the proposed magnitude of cuts to a group of federal agencies – $880 billion – without slashing Medicaid. 

Mississippi could see a potential reduction of up to $5.4 billion in federal funding for Medicaid under one proposal over the 10-year period, and $16 billion under another, according to a brief by the Center for Mississippi Health Policy based on a report conducted by the Hilltop Institute at the University of Maryland, Baltimore County. 

Neither Gov. Tate Reeves, a Republican and outspoken supporter of Trump, nor the Mississippi Division of Medicaid responded to requests for comment by the time this story published. 

All of Mississippi’s Republican Congress members – Reps. Mike Ezell, Trent Kelly and Michael Guest, along with Sens. Roger Wicker and Cindy-Hyde Smith – voted for the budget resolution. Rep. Bennie Thompson, a Democrat, voted no.

Mississippi, one of the poorest states in the nation with a large Medicaid population, would be significantly impacted by such a blow to the program. In particular, low-income people in vulnerable groups such as pregnant women, disabled adults, children and the elderly would face losing coverage, and hospitals and providers that rely on the program to reimburse for services could face massive losses. 

One state lawmaker in recent weeks said it would bring Mississippi, one of the most federally dependent states in the nation, “to its knees” – particularly on the heels of the state Legislature passing an income tax cut that will result in an estimated loss of about $2.2 billion of the state’s $7 billion in operating revenue.   

Medicaid is a federal-state program that provides health coverage to millions of people in the U.S. States administer the program, which is funded by both states and the federal government.

One option being discussed in Congress to downsize Medicaid is to lower the limit of or to eliminate what’s called the provider tax. Despite being a tax, it allows the state to draw down more federal dollars to use for the Medicaid program and to reimburse hospitals at a higher rate. Mississippi is currently nearly maxed out on the tax it’s allowed to impose on hospitals.

Health care leaders are sounding the alarm bells on the potential cuts, which they say will leave hospitals high and dry. The state, which has not expanded Medicaid, has had to rely in recent years on federal COVID-19 relief money and tweaks to its supplemental payments to keep hospitals afloat.  

Richard Roberson, the CEO of the Mississippi Hospital Association, says that the provider tax is “a lifeline to Mississippi hospitals big and small.”

Now, it may be in jeopardy.

“If Congress reduces the 6% ceiling to 5%, 4%, 3% – whatever it may be – there are hundreds of millions of dollars at stake that would be lost that are right now keeping many Mississippi hospitals open,” Roberson said at a House Democratic Caucus meeting at the State Capitol last week. “So that’s a significant concern that we have.”

Other proposals being floated include capping the amount of money states can get per Medicaid enrollee, as well as reducing the federal match rate for states that have expanded Medicaid. As a state that hasn’t expanded Medicaid, Mississippi already does not receive an enhanced federal match rate, so it would not be affected by the latter option.

But any proposal that pushes people off Medicaid has direct consequences for hospitals, argued E.J. Kuiper, CEO of the Louisiana-based Franciscan Missionaries of Our Lady Health System, which owns St. Dominic Health in Jackson. 

Without insurance, patients let their health conditions deteriorate. That, in conjunction with the fact that the emergency room is the only place health care providers can’t turn patients away for not having money, means the emergency room becomes the only source of primary care for uninsured patients. 

“Driving people off Medicaid rolls and making them uninsured – the societal cost is not going to go away,” Kuiper said. “People are still going to get sick whether they’re insured or not. What we’re concerned about is if people don’t have access to the Medicaid program, and are afraid to go see a doctor, what could be a $400 problem in April turns into a $10,000 problem in November.”

The emergency room is the most expensive place to receive care. When patients can’t pay, hospitals pick up the slack covering their care, and the practice – called uncompensated care – costs Mississippi hospitals millions each year. 

Mississippi already has one of the highest rates of uninsured people in the nation. 

Tens of thousands of Mississippians losing health insurance would have a domino effect on employment and the economy, according to a recent report from the Commonwealth Fund. 

Mississippi – whose state leaders have called for work requirements for Medicaid enrollees and stress the importance of a strong labor force participation rate – faces nearly 10,000 people losing their jobs as the result of  potential cuts to Medicaid.

The resolution narrowly passed Congress amid infighting between Republicans allied with Trump and hard-line conservatives who think the legislation doesn’t cut federal spending enough.

But now that the House and Senate have both passed identical versions of the budget resolution, lawmakers can begin working on specifics of what gets cut and how in a complicated process called “reconciliation.” Because reconciliation has been unlocked, Republicans can avoid a filibuster from Democrats and pass the final bill with a simple majority. 

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