Monday, March 4, 2013

Anatomy of a legislative murder, or how Gov. Bryant and Speaker Gunn are killing Medicaid

This is a somewhat technical post, and I apologize for that, but it's important to understand this bit of legislative procedure so that you can be informed on the state of play in Mississippi regarding Medicaid expansion.


First, under Rule 35 of the House Rules, amendments that concern code sections not in the legislation as introduced are improper.  For example, if a bill is before the House that seeks to change language in Section 97-3-7 of the Mississippi Code, a House member could not offer an amendment to the bill that would change language in Section 97-3-5.  The Senate has no such rule.

Second, many of our state-level governmental departments are creatures of statute, and most state statutes that create governmental departments have "repealers" in them.  Repealers are sentences that set a date upon which the governmental entity in question loses its statutory authority to exist.  The statutes creating the Department of Medicaid have repealers in them, and they dictate that the Department of Medicaid will cease to exist on July 1, 2013.  That means the Legislature must pass, and Gov. Phil Bryant must sign, a bill that would change the language of the repealer before July 1.  (The idea that the governor can run Medicaid through executive order is one that has already been decided in the negative, thanks to Gov. Barbour attempting to do that back in 2006.)

Finally, a bit on the legislative process as a whole.  A bill begins its process in the Legislature when it is drafted by legislative staff at the request of a legislator.  Once the bill has been drafted, it is introduced and assigned to a committee by the leader of the chamber (either Lt. Gov. or Speaker).  The bill then has to be passed out of the committee to which it has been assigned in order to be considered on the floor of the originating chamber.  If passed by the originating chamber, it is then transmitted to the other chamber, where it is assigned to a committee (again by the leader of that chamber).  The bill then has to pass that committee before being considered on the floor of the other chamber.

So that's the background, now here's how all of that affects Medicaid expansion in Mississippi.

Where we are now

Gov. Bryant has said over and over that we won't be expanding Medicaid in Mississippi.  If you ask him, he'll either say it's too expensive, or that people already have healthcare, or that those working poor people are just lazy and will go to the doctor because they don't have anything else to do.  The problem for Gov. Bryant is that Mississippi isn't a dictatorship (even though our government might sometimes resemble that of a banana republic).   The Legislature is where the Medicaid expansion fight will play out.

HB 560 was the House version of legislation designed to extend the repealers on the Department of Medicaid. Speaker Gunn referred it to the House Medicaid Committee upon introduction.  HB 560 did not contain the code sections dealing with eligibility for Medicaid, which meant that an amendment could not be offered to expand Medicaid and accept the federal government's funds to do so.  As a revenue bill, it needed a three-fifth's majority vote to pass.  House Democrats, knowing of the existence of SB 2207 (more on that below), voted against HB 560, which caused it to fail.

The Mississippi Senate passed SB 2207, its bill to extend the repealers on the Department of Medicaid, back on February 6th. It was transmitted to the House for consideration the following day.  SB 2207, authored by Sen. Dean Kirby (R - Pearl), has the necessary code sections that would allow a House member to offer an amendment to expand Medicaid coverage in Mississippi. (That's how Rule 35 comes into play.) In an effort to shut down the conversation on Medicaid expansion, Speaker Gunn referred SB 2207 not to the House Medicaid Committee (as he had done with HB 560), but to the House Rules Committee, one week later.  The chairman of the House Rules Committee, archconservative Rep. Mark Formby (R - Picayune) has not brought the bill up for a vote, and will not.  That means that SB 2207 is effectively dead.

(It also means that Speaker Gunn apparently doesn't trust his Medicaid Committee chairman, Rep. Bobby Howell (R - Kilmichael), not to cave to pressure from doctors and hospitals.)

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