BY: B. Keith Plunkett @Keithplunkett

With one single decision President Barack Obama pulled the rug out from under any moves by Mississippi Democrats to expand Medicaid in Mississippi. In fact, he pulled the rug out from under the supporters of expansion in all the states who have yet to decide to expand the program. He also began the slippery slide into the undoing of his own signature achievement as President, ObamaCare, something that was inevitable.

On Wednesday the Obama Administration blinked in the face of the huge number of states who have outright rejected any form of Medicaid expansion by delaying cuts to  DSH payments to states. 23 refused participation at last count.

DSH, or “dish”, payments are given to hospitals by the federal government to states through Medicaid for caring for the uninsured.

What the administration has done is basically admit that these payments to hospitals will never end, something that would have been eventually learned through a court order had the cuts actually been attempted. Back in June of 2012, the Supreme Court of the United States ruled that states had the legal authority to reject expansion and the federal government could do nothing to penalize states for it. The exact language in the ruling says:

“What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”

As Governor Phil Bryant has been saying all along, DSH payments are part of that existing funding. To remove the payments would be a violation of the ruling.

The Obama Administration and the Department of Health and Human Services has been working on a piecemeal approach with states for the past several months to convince them to participate, because without states buying-in to Medicaid expansion the whole house of cards that is ObamaCare comes tumbling down. Seeing the handwriting on the wall, President Obama decided to give himself a time-out on Wednesday to reassess.

That reassessment will not likely lead to an admission of a mistake by the President, nor is it likely to bring two sides to the table for a “do-over” on health care. It’s more likely that both sides will continue to point fingers at the other while ObamaCare slowly turns into yet another ineffective behemoth federal program that mostly serves the bureaucrats who implement it.

The simple truth is that this was always a game of chicken about full-out government takeover of the health care industry, and states who rejected the expansion have won this round. DSH payments were never going to be cut. One only need to look at the SGR and the annual “Doc Fix” under Medicare to see a perfect example of why.

The SGR is the acronym for the Medicare Sustainable Growth Rate. Enacted by the Balanced Budget Act of 1997, SGR is the method by which the Center for Medicare and Medicaid Services attempts to control spending by Medicare on physician services.

Every year Congress gets a report on the needed SGR cuts to physician payments for the following year to match the target. Virtually every year, cries of cuts to medical services erupt and Congress suspends, adjusts or delays the cuts.

Congressmen won’t make those cuts for the very reason they won’t make DSH cuts, they would be targeted in their home districts for voting against providing health care to the most needy. It’s political suicide.

ObamaCare’s entire premise is that it will produce deficit savings as more people share in the risk of health coverage for all. The prediction was that as more uninsured enter into the Medicaid system via expansion, the cost of care would go down. New CBO and IRS projections clearly show that to be a utopian fantasy. Instead of decreasing, premiums have steadily risen, and participation has not increased.

With only two and half years left for President Obama, it will be necessary to pull out all the stops to get to the next logical “big government” step, one that was always in the cards. They’ll say that since the quasi-government system isn’t working, we need single-payer, a full government takeover of the health care system.

Mississippi Democrats want you to think that DSH cuts are coming. The latest attempts have been to assert that since the cuts are delayed, they will be more severe when they happen. Therefore, we should expand Medicaid now. That is just a last gasp for House Democrats to pretend this entire charade has meaning. It doesn’t. It never did.

House Democratic leadership should get to the table immediately with hat in hand and agree to reauthorization of Mississippi’s Medicaid program so that services to the most needy Mississippians aren’t interrupted.

Whether Democrat Legislators are willing to admit to what’s on the scoreboard or not, this games over.

About Keith: Keith Plunkett has worked on communications issues with a range of public officials from aldermen to Congressmen, and a variety of businesses, governmental agencies and non-profits. He serves or has served as a board member of several non-profit, civic and political organizations. Contact him by going to or follow him on Twitter @Keithplunkett


10 thoughts on “Plunkett: DSH payments will never be cut. Dems should vote to reauthorize Medicaid now.

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