The idea is cleverly conceived. It doesn’t look like an expansion. And it applies to moms – and who doesn’t like moms?
One of the most significant decisions facing the Mississippi Legislature in 2023 is whether to expand Medicaid to cover women who have ended a pregnancy within the last 12 months. This would constitute a massive expansion of Medicaid, moving us closer to the end game of socialized medicine, or “Medicaid for All.”
Over the past several years, the phrase “Medicaid expansion” has applied to an option under the Affordable Care Act (ACA) to provide coverage to low-income, able-bodied adults without children. Eleven states, including Mississippi, have declined to expand Medicaid to this new eligibility category because it is unnecessary, expensive, and provides yet another welfare incentive not to work.
This Medicaid expansion is also essentially different from past accretions (for instance, pregnant women and kids) because it applies to able-bodied adults. In doing so, it abandons the limiting principle that Medicaid is supposed to be for those who, in theory, are unable to work. (Initially, Medicaid was established to help low-income children without parental support, the elderly, blind, and disabled.)
With Medicaid enrollment and subsidized ACA insurance enrollment skyrocketing during the COVID-19 pandemic, the Biden administration hit upon another way to easily boost the rolls of able-bodied adults on Medicaid: extend Medicaid’s 60-day postpartum coverage to 12 months. The idea is cleverly conceived. It doesn’t look like an expansion. And it applies to moms – and who doesn’t like moms?
Many states have taken the bait. Here in Mississippi, House Republicans, along with Governor Tate Reeves, remain skeptical. Their skepticism is merited because the whole concept is based on two lies. The first lie is that the postpartum period lasts 12 months. The second lie is that this expansion is basically harmless and shouldn’t matter to conservatives.
The first lie is easily disproven. Healthcare professionals the world over typically define the postpartum period as 42 days. Mississippi Medicaid already provides postpartum coverage that lasts a generous 60 days. The Medicaid expansion under consideration is thus not postpartum coverage. It lasts much, much longer than the postpartum period.
Therein lies the reason increasing “postpartum” Medicaid coverage to 12 months is not an “extension.” It is an expansion of Medicaid to a new eligibility category: women past the postpartum timeframe. (The expansion also applies to women who did not carry a child to term.)
Most of these women are moms – but they are not postpartum moms. They are not pregnant, not recently pregnant, not elderly, not disabled. In terms of eligibility considerations, they are much closer to the Obamacare able-bodied adult population than they are to traditional Medicaid enrollees.
In addition, Mississippi Medicaid relies on self-attestation to verify pregnancy. This means that a woman need only possibly believe that she was pregnant – and miscarried – in order to receive “postpartum” Medicaid coverage. We would like to hope that a would-be mother would never, ever engage in such deception, but given that Medicaid is already rife with fraud, we have to acknowledge that someone, somewhere is not being truthful about eligibility.
Under the never-ending COVID-19 public health emergency, states are effectively barred from verifying Medicaid eligibility. This means that anyone who has enrolled in Medicaid since early 2020 has been allowed to stay on the program, with the result that overall enrollment has increased by 27 percent nationwide – and by 22 percent in Mississippi. This includes “postpartum” mothers. It includes “postpartum” fathers. It includes virtually anyone who has signed up for Medicaid at any point since 2020.
By authorizing “postpartum” Medicaid coverage, the Mississippi Legislature would go a long way toward locking in this shadow expansion of Medicaid. Moreover, thanks to a proposed rule on “streamlining” Medicaid eligibility verification, the Medicaid rolls are set to explode even more. The Biden rule is unlawful and harmful, but it will add millions more to Medicaid before it gets struck down by the courts, if it ever does.
All this raises the question of why it should matter if we add yet another eligibility category to Medicaid: post-postpartum women. The answer goes back to whether Medicaid should be a program limited to those who are most vulnerable and unable to work. If it is, any expansion of Medicaid to able-bodied adults is not really an expansion of Medicaid, but a transformation of Medicaid into “Medicaid for All” – a program that by including virtually everyone will end up providing high-quality care to no one.
