November 7, 2024 – Mississippi is grappling with whether or not to expand Medicaid, the federal-state insurance program for low-income Americans. An Oct. 31 JAMA Forum piece co-authored by Harvard T.H. Chan School of Public Health’s Ben Sommers explores the cost and benefits of expansion.
Sommers, Huntley Quelch Professor of Health Care Economics, and his co-authors—Lauren Gullett and Shira Hornstein, both PhD students in health policy at Harvard—noted that Medicaid expansion could be enormously beneficial in Mississippi, a state that has high uninsured rates, hospitals in danger of closing, and poor health outcomes. Prior research has found that, in states that expanded Medicaid, there have been substantial reductions in mortality and improvements in self-reported health, particularly among Black and Latino individuals. The co-authors acknowledged that some in Mississippi are concerned about the costs associated with expanding Medicaid, but they said research suggests that the benefits of expansion would outweigh the costs.
As part of expanding Medicaid in Mississippi, some policymakers are pushing for work requirements for enrollees. The co-authors cited a number of studies suggesting that work requirements could “severely hinder the potential benefits of Medicaid expansion.” For example, when Georgia expanded Medicaid but instituted a work requirement for enrollees, administrative costs ran into the millions and only about 4,500 people enrolled during the first year—far below initial projections that 100,000 people would enroll.
“Ongoing efforts to impose work requirements as an expansion compromise [in Mississippi] would likely block almost all the potential benefits of expanding in the first place,” the co-authors wrote.
Sommers was also recently quoted in a Nov. 1 article in Public Health Watch on what might happen to the Medicaid program if conservatives gain power in the 2024 election. Conservative plans for Medicaid involve funding cuts and changes—such as work requirements—that could lead to more people being uninsured, and to financial strain for hospitals and health providers that care for the uninsured and for Medicaid patients.
Medicaid funding cuts could force states to consider either raising taxes or reducing Medicaid services and eligibility, Sommers said. He noted that the recent Medicaid “unwinding”—in which states began removing enrollees after pandemic-era restrictions on doing so ended—can shed light on what might happen if there are federal cuts to the program.
“I imagine, in some states, it would be a race to the bottom,” he said. “Those who are eager to have small Medicaid programs will move fast.” If this happens, worse health outcomes would likely follow, he said.
Read the JAMA Forum article: Medicaid’s Edge Case—Potential Expansion and Work Requirements in Mississippi
Read the Public Health Watch article: What the Election Could Mean for Health-Care Coverage for the Poor
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