Neshoba County General Hospital could be forced to layoff 25 full-time employees if the Mississippi Legislature does not expand Medicaid under the Affordable Care Act, to cover an estimated 300,000 Mississip-pians, mostly low-wage workers with no private health coverage.
Hospital administrators are pressuring lawmakers to expand Medicaid, an option under President Obama's health care law that state Republicans have so far resisted pursuing.
Some CEOs say they might be forced to lay off employees if, as expected, their facilities lose millions of federal dollars they've been receiving to treat uninsured patients.
Lonnie Graeber, CEO of Neshoba General, said numbers indicate that if Medicaid is not expanded, the hospital could lose about $300,000 a year.
That would be in addition to about $600,000 in cuts under the new health care law.
"About $900,000 to $1 million a year will have a huge impact on Neshoba General," Graeber said. "There is no question it could result in layoffs. It could cost about 25 full time positions here."
Despite the cuts, Graeber said the hospital would not cut services.
"There are some hospitals that aren't doing well already and this will have a significant impact," he said. "They could face cutting services or going out of business. We are doing well enough that we have to react but we are healthy financially. It will not put us out of business but it will definitely have an effect on our workforce."
Hospital officials have not determined what areas would be affected by the layoffs.
"It's not something that we could absorb," he said. "We would have to react but we haven't started any planning because we are just getting the figures together."
Out of $74 million in total charges last year, Neshoba General provided $9 million in uncompensated care.
The Medicaid Upper Payment Limit Program helps offset that loss, Graeber said, noting that the hospital receives on average about $1 million a year from the program.
The Mississippi Hospital Association announced Monday that it's working with Gov. Phil Bryant's office to address budget constraints resulting from the Affordable Care Act amid Bryant's ongoing opposition to the federal health care overhaul.
Claude Harbarger, leader of the MHA Board of Governors, said he is grateful that Bryant is willing to work toward a solution.
He said the state's hospitals are already losing millions of dollars as they begin to implement the Affordable Care Act.
Chris Anderson, C.E.O. of Singing River Health System in Gautier, who supports expansion, said it was time to stop talking about expansion and start exploring alternatives.
"It has not been productive saying you're either for it or against it," Anderson said. "That's really not gotten us anywhere thus far in the session. So the interest now is saying, 'is there anything between these two positions that we can all agree on?'"
No specific proposals were offered by the hospital association, which held a news conference Monday in Madison.
The announcement by what was the most important group to have pushed expansion came on the same day as a House hearing that showed little consensus on whether Medicaid expansion would represent a net loss or gain for Mississippi.
"Medicaid and the Affordable Care Act is likely the biggest issue this legislature or any other legislature has faced in decades," House Medicaid Committee Chairman Bobby Howell, R-Kilmichael, said at the start of a three-hour hearing.
Lucien Smith, deputy chief of staff and policy director for Gov. Bryant, gave the first of six presentations. He argued before the packed hearing room that the expansion would cost hundreds of millions. But Smith said that even those who support the expansion should wait before making up their minds.
"Making an error on Medicaid expansion will be incredibly costly, and secondly, it's premature to make a decision on it," Smith said.
Part of that argument comes from an unclear picture of how Disproportionate Share Hospital funding would change over the next few years. Those funds are used to help pay back hospitals that serve a large share of uninsured citizens. The funding stream is scheduled to be reduced, but presenters at the hearing said they're not yet sure by how much.
Theresa Hannah, Executive Director of the Center for Mississippi Health Policy, told the committee that many of the uninsured don't receive preventative care. She offered statistics showing what she said was the devastating impact on Mississippians. The state has the highest rate of diabetes-related leg amputations, according to Hannah, and while it has one of the lowest rates of breast cancer, it has one of the highest rates of death from breast cancer.
About 640,000 of the state's roughly 3 million residents already are covered by the federal-state health insurance program for the poor and disabled.
Bryant says Mississippi can't afford it, though the federal law specifies that from 2014 to 2017 the federal government would pay 100 percent of medical costs for people qualifying under new standards. During the three years after that, the federal share progressively drops to 90 percent. The remaining cost must be covered by participating states.
The law originally made Medicaid expansion mandatory. When a divided U.S. Supreme Court upheld most of the law last summer, it said states would have an option - not a mandate - to extend Medicaid to people earning up to 138 percent of the federal poverty level. That's an annual income of about $15,000. Mississippi's current income cutoff for Medicaid is about $5,500.
Many Democratic lawmakers are pushing for expansion.
Many fiscally conservative lawmakers, particularly Republicans, could find themselves in a bind. They don't want to increase entitlement rolls, and many don't want to buck Bryant. But, they also don't want the blame if health care providers cut jobs. Republicans control both chambers of the legislature.