Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project. Read more about the project by clicking here.

Despite stacks of studies over years showing otherwise, most of Mississippi’s Republican leadership has been steadfast in its main argument that “the state can’t afford” Medicaid expansion to cover the working poor in the poorest, sickest state in the country.

In late 2018, struggling Mississippi hospitals hoping to cover hundreds of millions a year in uncompensated care for the indigent decided to call the bluff: They offered “Mississippi Cares,” a plan for hospitals and the working poor themselves to cover the state’s cost to pull down billions in federal dollars.

But legislative leaders, including then-Lt. Gov. Tate Reeves and House Speaker Philip Gunn, who remain opposed to Medicaid expansion, rejected the plan. It never even went to a vote.

Now, continually hammered by uncompensated care costs for the uninsured, the COVID-19 pandemic and other financial headwinds, Mississippi hospitals couldn’t afford to cover the state’s share on Medicaid expansion, said Mississippi Hospital Association President/CEO Tim Moore. Many are on the brink of financial ruin — something they had hoped Medicaid expansion could rectify.

READ MORE: ‘What’s your plan, watch Rome burn?’: Politicians continue to reject solution to growing hospital crisis

“I don’t know how (hospitals) would fund the match now because of the condition they’ve gotten in with all these losses. It would be left up to the state now,” Moore said. “When you have major hospital systems in this state that have lost a quarter billion dollars last year, hospitals that have never had losses having them now and others budgeting for major losses for next year – the number of hospitals close to the brink is the most it’s ever been.”

State Health Officer Dr. Daniel Edney recently gave a similar warning to the state Board of Health. He said six hospitals in the Delta are “in significant, dire circumstances,” and at least four others across the state are struggling.

“There are 10 or 12 that in a year or two from now may not be here,” Edney said. “… To lose six hospitals in the Delta would be catastrophic … No one’s coming to the rescue.”

Among other problems, Moore said, hospitals are having to pay back federal loans they took during the pandemic as labor costs, pharmaceutical and other supply costs skyrocket and revenue remains flat.

“It’s a perfect storm for a financial disaster for hospitals,” Moore said, one that has been ameliorated by federal health dollars in states that have expanded Medicaid per the Affordable Care Act.

READ MORE: Mississippi leaving more than $1 billion per year on table by rejecting Medicaid expansion

To try to overcome political opposition, MHA had proposed creating a public-private partnership, expanding Medicaid eligibility to adults earning up to 138% of the poverty level but imposing a $20 a month premium on enrollees and a $100 copay for non-emergency use of hospital emergency rooms. Hospitals would cover remaining state costs.

A study projected the plan would create an average additional 36,000 jobs a year in Mississippi for the first 11 years and provide an increase in state tax revenue, a decrease in private insurance premiums and a reduction in uncompensated care costs of $252 million a year. The plan also included a requirement that unemployed beneficiaries enroll in job training or education programs.

Q&A: What is Medicaid expansion, really?

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