The budget reconciliation bill approved over the weekend by Democrats in the U.S. Senate and now pending a vote in the House does not provide help for poor Mississippians trying to obtain health insurance.

While generally praising the bill, Sharon Parrott, president of the Washington D.C.-based Center for Budget and Policy Priorities, said, “However, the current bill does nothing to make affordable coverage available to the more than 2 million people with incomes below the poverty line who are uninsured because their states have refused to adopt the Medicaid expansion. Most of the people in the Medicaid coverage gap live in the South and three in five are people of color.”

An earlier version of the bill, considered last fall, provided a mechanism for people living under the federal poverty level (about $13,550 annually) to obtain health insurance. The proposal was designed specifically to provide a health care option for the poor in the 12 states, including Mississippi, that have not expanded Medicaid. But at the time Senate Democratic leadership could not muster the 50 votes needed to pass what is known as the reconciliation bill. Democratic senators Joe Manchin of West Virginia and Kyrsten Sinema of Arizona rejected the far-reaching $3.5 trillion bill for various reasons, not necessarily related to the health care provision.

Over the weekend, Sinema and Manchin got on board to help pass a scaled-down, $669 billion version of the reconciliation bill – called the Inflation Reduction Act – that provided numerous items, including:

• Various tax credits and other incentives for electric vehicles and other green energy technology.
• A 15% minimum tax on large corporations.
• Caps on insulin for Medicare recipients.
• A provision that allows Medicare to negotiate the costs of drugs.
• Continuing subsides to help people purchase private insurance on the health care marketplace exchange.

The health care provision that was in the earlier version of the bill but removed from last week’s proposal would allow those falling under the federal poverty level to obtain private health care coverage paid for by the federal government on the health care exchange.

Under current law, people who earn below the federal poverty level do not qualify for marketplace policies.

Two million Americans could access health care coverage through the plan, with the bulk of those being in Texas, Florida, Georgia and North Carolina, according to an analysis by Judith Solomon, a health policy analyst with the Center for Budget and Policy Priorities. Primarily Republican politicians in Southern states have been opposed to Medicaid expansion.

In Mississippi, studies have estimated that between 200,000 and 300,000 primarily working Mississippians could qualify for coverage if the state would expand Medicaid.

If Mississippi were to expand Medicaid under current law, the federal government would pay 90% of the health care costs with the state paying the remainder. Gov. Tate Reeves, House Speaker Philip Gunn and others have argued Mississippi cannot afford the costs of expanding Medicaid, though multiple studies have found that the expansion, including the infusion of billions of dollars in federal funds, would actually increase state revenue collections.

Of course, still dangling in front of the non-Medicaid expansion states is a sizable incentive to expand Medicaid. The federal American Rescue Plan, passed in early 2021 as a response to the COVID-19 pandemic, provides additional incentive for states to expand Medicaid. The incentive in Mississippi to expand Medicaid is more than $600 million over a two-year period.

The Inflation Reduction Act will likely pass the House in the coming days and be sent to President Joe Biden, who is expected to sign it into law.

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