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

The inner workings of Medicaid, a federal program intended to provide health coverage to low-income Americans, are wonky and incredibly difficult to understand.

You’ve probably heard the term “Medicaid expansion,” words that have become weaponized by opportunistic politicians, used as a smoke screen to avoid talking earnestly about an extension of the existing federal program that provides even more people with basic health care coverage. 

As Mississippi’s health care crisis continues, we’ve compiled answers to some frequently asked questions to show the direct effects of the policy, how it could change lives across the state, and what the state could stand to gain by passing it.

Click on questions below to jump to answers, or scroll down to see it all.

Click to jump to a specific question

What is Medicaid? 

Medicaid is a federal program that provides health coverage to millions of people in the U.S., including low-income adults, children, pregnant women, elderly adults and people with disabilities. States administer the program, which is funded by both states and the federal government. Mississippi currently participates in the traditional Medicaid program.

What is Medicaid expansion? 

Medicaid expansion is a special provision created under President Barack Obama’s 2010 Affordable Care Act that aims to allow more low-income Americans to be covered by the program and decrease the number of uninsured people. Mississippi is one of 12 states that has not opted into the expansion program. In states that have chosen to expand, Medicaid eligibility is extended to adults up to age 64 who have incomes up to 138% of the federal poverty level – or about $25,000 for a family of two. 

Currently in Mississippi, non-disabled adults without children generally never qualify for the program, and the income requirements are very stringent for those who are parents ($4,608 in annual earnings for a family of three). 

How many additional people would be insured if Mississippi expanded Medicaid?

Studies have estimated Medicaid expansion in Mississippi would cover over 200,000 additional people. Other states that have expanded have seen a decline in uninsured people – a desired outcome in Mississippi, which ranks 6th in the nation for the percentage of uninsured people. 

What would the economic impact of Medicaid expansion be?

Estimates show Medicaid expansion would bring in more than $1 billion in new revenue each year. Multiple studies have shown Medicaid expansion would save the state money by reducing uncompensated care costs for hospitals, reducing chronic illness through preventive care, and that it would help the economy by creating thousands of jobs and the “multiplier effect” of the federal dollars. Studies by state economists have shown it would, over time, increase the state’s GDP and population. 

What are the mechanisms that could be used in Mississippi to expand Medicaid? 

Expansion of Medicaid in Mississippi would require action by the state Legislature, and approval by the governor.

Who is in favor of Medicaid expansion and why?

Many leaders and physicians in the medical community favor Medicaid expansion because of the financial benefits their institutions would reap. Health care organizations like the Mississippi State Medical Association, Mississippi Hospital Association, American Cancer Society, American Heart Association, and countless others support expansion. And top business leaders and organizations like the Delta Council have publicly supported Medicaid expansion because of the broader economic benefits it would create. 

Democrats in the Legislature, who wield little power and influence over major policymaking decisions, and scores of other Democratic elected officials have publicly supported Medicaid expansion for years. Republican Lt. Gov. Delbert Hosemann, the leader of the state Senate, has repeatedly highlighted the need for health care for working people, though he stops short of advocating for Medicaid expansion. Several other legislative Republicans and even Republican statewide candidates in recent elections have publicly supported expansion, but none have succeeded in starting earnest debate in the Legislature.

Who opposes Medicaid expansion and why? 

Top Republican leaders in the state, led by Gov. Tate Reeves and Speaker of the House Philip Gunn, have long rejected Medicaid expansion. Many of the arguments against expansion have been overtly political and partisan — opposition against expanding “Obamacare,” which many Republicans opposed from the start. Others are more philosophical arguments against increasing any large government program or that health care should be done through the private sector. But two of the main arguments from Mississippi elected leaders against it have been that the state budget cannot afford it and that the federal government will one day stop paying the largest share and leave state taxpayers holding the bag.

What has happened in other states that have expanded Medicaid?

Other states that have expanded Medicaid have seen a large drop in uncompensated care costs – the costs that hospitals must cover themselves to care for uninsured patients. Louisiana, our neighbor that expanded Medicaid in 2016, saw a 55% decrease in uncompensated care costs for rural hospitals after expanding — and a substantial drop in mortality rates.

Why do states have the choice of whether to participate in Medicaid expansion? 

The U.S. Supreme Court in 2012 issued a decision in a case that challenged the constitutionality of the Affordable Care Act, the sweeping health care reform law enacted in 2010 that aimed to make health insurance more affordable. One major tenet of the law was to expand Medicaid to cover more people. The high court upheld the law in general, but said that the federal government could not mandate that states expand Medicaid. Based on that portion of the ruling, 12 states, including Mississippi, have not expanded Medicaid. In Mississippi, the few times the issue of Medicaid expansion has been before either full chamber of the Legislature is when Democratic members have offered amendments to other Medicaid-related bills. The Republican majorities have regularly voted down those amendments.

How much do Mississippi hospitals pay to care for people who don’t have insurance or Medicaid? 

The cost of uninsured care for calendar year 2021 is estimated to be $482 million. The cost of total uncompensated care (uninsured plus others who don’t pay the full balance) is $594 million. Hospitals must cover these costs themselves, often leading to budget woes that can close a hospital for good or require drastic cuts in health services offered. The effects of this uncompensated care have only worsened as the COVID-19 pandemic and the accompanying high labor costs have financially strained hospitals. Medicaid expansion would flow millions per year directly to hospitals to help them cover these costs.

Is our current Medicaid program free? Who qualifies for it? 

Medicaid is free for beneficiaries and funded by the federal and state governments. Currently in Mississippi, several categories of people qualify for Medicaid:

• Infants and children who live in low-income families
• Uninsured children whose family income does not exceed 209% of the federal poverty level will qualify for Children’s Health Insurance Program
• Parents and caretakers of minor children who live in the home. The parents must be without the support of one or both parents due to disability, death, or continued absence or who are unemployed or have very low income. To qualify, the parent or caretaker must cooperate with child support enforcement requirements for each child whose parent is absent from the home.
• Pregnant women with income under 194% of the federal poverty level. These women will receive benefits for two months postpartum and are then put on the family planning waiver.
• Pregnant women under 19 years old automatically qualify for pregnancy Medicaid.
• Disabled children who require a level of care typically provided in a hospital or long term care facility but are living at home. 
• Working disabled: Adults whose income is below a certain level and who work at least 40 hours per month. 
• Aged, blind or disabled people who received Supplemental Security Income (SSI), those who formerly received SSI, and those residing in a nursing facility or participating in a Home and Community Based Services Waiver Program.

How much does it cost the state and taxpayers to provide our current Medicaid program? 

Medicaid expenditures are based on usage. The more Medicaid beneficiaries see health care providers for treatments, the greater the cost. For the current fiscal year, the Legislature has appropriated $902 million in state funds for the Division of Medicaid and expects to receive $5.79 billion in federal funds. Mississippi, as the nation’s poorest state, receives the best matching rate with the federal government currently paying 84.5% of the health care costs. The state pays the rest. If not for the COVID-19 emergency that is slated to remain into effect until early in 2023, the federal government would be providing Mississippi a 77.86% matching rate. But currently, the federal government pays 90% of the health care costs for those covered through Medicaid expansion. In addition, the federal government would provide non-expansion states a two-year incentive to opt into Medicaid expansion. For Mississippi that would result in more than $600 million in federal funds over two years.

What services are covered under the current Medicaid program? 

Full Medicaid benefits cover office visits, family planning services, inpatient and outpatient hospital care, prescription drugs, eyeglasses, long term care services and inpatient psychiatric services. Medicaid will also provide transportation to eligible beneficiaries if they do not have other means of getting to medical appointments. 

What are the differences between traditional Medicaid and expanded Medicaid?

The difference is more people are eligible under expanded Medicaid. Expansion would mean people earning up to 138% of the federal poverty level — or $25,000 for a family of two — would qualify for benefits. This would mostly include low-income, able-bodied parents; low-income adults without children; and many low-income individuals with chronic mental illness or disabilities who struggle to maintain well-paying jobs but do not currently meet disability requirements for Medicaid.

What is postpartum Medicaid and what is the debate about extending it?

Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days postpartum, but many women, particularly in Mississippi and other non-expansion states, lose coverage at that point aside from basic family planning services and birth control. Health professionals and advocates have argued Mississippi needs to extend that coverage to a year postpartum like 34 other states have done. They say this will provide much-needed improvements in health outcome for mothers and babies in the state, where 60% of births are covered by Medicaid.  

Despite bipartisan support for extending coverage for the tens of thousands of moms covered by Medicaid in Mississippi in the Senate, Speaker of the House Philip Gunn killed the bill in the 2022 legislative session and remains opposed. He cites his opposition to Medicaid expansion, but the legislation would not have expanded Medicaid eligibility – it would’ve extended coverage for people who already qualify.

Mississippi and Wyoming are now the only two states with neither extended postpartum coverage nor Medicaid expansion.

What is CHIP and how is it different from Medicaid?

CHIP stands for the Children’s Health Insurance Program and provides health coverage for uninsured children up to 19 years old and whose family income does not exceed 209% of the federal poverty level.   

The coverage, unlike Medicaid for adults, includes dental care as well as medical services. 

The state recently added mental health coverage as a mandatory benefit – including services necessary to prevent, diagnose and treat a broad range of mental health symptoms and disorders.

What is the history of Medicaid?

The U.S. Congress, at the behest of President Lyndon Johnson, approved Medicaid in 1965 to offer a safety net health coverage for poor Americans. Under the landmark legislation, the federal government and the states would share in paying the costs of the program. Mississippi was one of the last states to opt into the traditional Medicaid program during a 1969 special session. Mississippi Gov. John Bell Williams, who called the special session, voted against the Medicaid program as a member of Congress. As governor, Williams said it would benefit Mississippi to opt into the Medicaid program.

How many people in Mississippi are on Medicaid now?

As of July 2021, about 797,000 Mississippians were enrolled in either full-benefit Medicaid coverage or the Children’s Health Insurance Program.

The post Q&A: What is Medicaid expansion, really? appeared first on Mississippi Today.

Speaker Philip Gunn announced on Wednesday that he will not seek reelection to the House next year, ending the third-longest speakership in state history.

“It has been one of the greatest honors of my life to serve as speaker of the Mississippi
House,” Gunn said in a statement. “I am extremely grateful to the people of District 56 who have given me the opportunity to serve them for the last 20 years and to the members of the House who have entrusted the role of speaker to me for 12 years. I believe we have moved Mississippi in a positive direction, and I am proud of what we have accomplished together and look forward to another productive session in 2023.
“Having said that, I have decided not to seek re-election for House District 56. My service as Speaker coming to an end does not mean I will not be open to future opportunities to serve,” Gunn said. “I love our state and will always work to make her better. I believe there will be an opportunity for me to serve our state soon and when that time comes, I will be ready.”

Gunn made the announcement first to his GOP House caucus members at a meeting at the Capitol on Wednesday.

Lt. Gov. Delbert Hosemann, who presides over the Senate, praised his House counterpart.

“My friend, Philip Gunn, has decided to pause his public service to the state,” Hosemann said. “His fingerprints exist on most of Mississippi legislative history for his 12 years as speaker. From child trafficking to tax reform (legislation), he provided consistent conservative, faith-based leadership to his colleagues.” 

House Education Chairman Richard Bennett, R-Long Beach, one of Gunn’s top lieutenants, said: “I wasn’t surprised, but for selfish reasons I am disappointed because I think Philip has done a wonderful job. He is the best speaker I have known in my time. His ethics, his morals and his wanting to do the right thing — that’s in his DNA. He doesn’t just talk, he walks the walk. You’ll see that in anything he decides to do in the future … He said he doesn’t have any plans right now. He’ll rejoin the private sector at some point. It’s just going to be a huge loss not only for the House of Representatives but for the state of Mississippi. That’s why I hope he will get back into the public arena.”

Gunn’s announcement ends more than a year of speculation on Gunn’s future — particularly whether he might make a gubernatorial run in 2023. He made some such overtures last year, including fundraising and statewide travel, but had appeared to cool on the idea of challenging incumbent Republican Gov. Tate Reeves. He had also been discussed more recently as a possible candidate to run the state community college system.

A Clinton resident, Gunn was elected to the House in 2003 and soon rose to prominence as a key voice in the Republican caucus. When the Republicans garnered the majority in the House as a result of the 2011 elections, Gunn was elected speaker by the 122-member House, the first Republican to hold that office since Reconstruction.

Gunn helped increase Republican numbers in the House, with the 2015 elections resulting in a GOP supermajority. He successfully championed numerous tax cuts during his time in office, but has so far been unsuccessful with what he said has been his No. 1 policy priority, elimination of the state personal income tax.

READ MORE: Gunn whips final House votes to change state flag – Mississippi Today

A social conservative and devout Baptist, Gunn also supported elimination of abortion. This was accomplished with a U.S. Supreme Court decision in a case involving a Mississippi House bill Gunn supported.

“For those fortunate enough to truly know Speaker Philip Gunn, we are certain that the state of Mississippi and her people are much better off as a result of his leadership as speaker,” said House Ways and Means Chair Trey Lamar, R-Senatobia. “Most importantly, he is a God-fearing family man and it has been a tremendous honor to serve with him and call him my friend.”

State Rep. Nick Bain of Corinth, a former Democrat who changed to the Republican Party before the 2019 election, said, “He has been good to me. He has been good to my constituents in Alcorn County … I have nothing but good things to say about him.”

Gunn was one of the first Republicans on the statewide level to advocate for removing the Confederate battle emblem from the state flag. Gunn did so after a white supremist killed nine people at an African American church in Charleston, S.C. The killer had featured a Confederate flag in his social media posts.

READ MORE: Will Gunn run? Speaker signaling 2023 challenge of Gov. Tate Reeves

For years, Gunn’s Republican caucus did not express interest in following his lead on the state flag. But in 2020 legislation came out of the House championed by Gunn and ultimately approved by the full Legislature retiring the state flag and establishing a panel to recommend a new flag to place on the ballot. Mississippi voters overwhelmingly approved the new flag sans the Confederate symbol.

House Speaker Protem Jason White, R-West, is considered by many as the heir apparent to the speakership, although Gunn reportedly did not endorse a successor to the caucus on Wednesday.

“He told everyone that it is not for him to turn his seat over to anyone, but would be up to the House of Representatives,” Bennett said. “… But I think Jason (White) is the lead person and I’d be surprised if Jason was not the next speaker of the House.”

READ MORE: Speaker Philip Gunn scales back his income tax elimination proposal

White, one of Gunn’s closest allies, confirmed that he had formed a political action committee and “has been fairly successful” in raising funds to help his Republican colleagues in the House seeking reelection.

He said he would focus on his own reelection to the House, and to work on the reelection efforts of House colleagues and “then figure it out from there.”

Bain said of a possible White candidacy for speaker, “If Jason runs, he will have my full support.”

The post Speaker Philip Gunn will not seek reelection appeared first on Mississippi Today.

Call it “goat fuel” as Lane Kiffin does, or call it “poking the bear” as Kiffin also does. But whatever you do call it, proclamations that Nick Saban’s Alabama college football dynasty is over do seem a tad premature.

Alabama has lost two games to two Top 10 teams, both on the road, both before 100,000 fans, both on the last play of the game. Alabama out-gained Tennessee in a 52-49 loss. The difference? Bama missed a field goal late; Tennessee made one. Bama also out-gained LSU Saturday in an overtime loss at LSU. Alabama is still a splendid football team. The Crimson Tide, which plays at Ole Miss on Saturday, remains one of the four or five best teams in the country.

That said, there are chinks in the Tide’s armor. They are not clearly the best team in the land or even the SEC, as they have been for most of the last decade. It’s not so much that they have weaknesses as it is they are not as dominant as they have been. It’s not just the close losses to Tennessee and LSU that show this. It’s also the narrow wins over Texas and Texas A&M. 

Biggest difference? When Alabama lines up on third down and a yard or two to go on offense, they can’t just run it and know they will make it. It’s not automatic. Alabama simply does not run the football as effectively as they have in the past. They don’t get the push up front.

Conversely, Alabama does not stop the run as they have in past. Against really good teams – and both Tennessee and LSU are that – Bama isn’t dominant up front on both sides of the ball. LSU out-gained Bama on the ground 185-137. Tennessee out-rushed the Tide 182-114. 

There are other chinks, perhaps most notably Saban’s current team doesn’t have the super natural ability at wide receiver it has had in recent seasons. There’s no DeVonta Smith, no Jaylen Waddle. Bama’s wide receivers are merely very good, they are not other worldly.

There’s also this factor: Other teams have caught up to Bama, most notably Georgia, which former Saban lieutenant Kirby Smart has patterned after Bama, using a replica of Saban’s system. Georgia, as Alabama has had, possesses four- and five-star talent stacked at every position. When Georgia takes the field, the Bulldogs look like an NFL team.

So what to make of Saturday’s matchup of 7-2 Alabama against 8-1 Ole Miss? Before we get into it, know that the last time an Alabama football team lost as many as three games in a single season was 2010. Ole Miss’s superb freshman running back Quinshon Judkins had just turned 7.

Oddsmakers have made Alabama a 12-point favorite, which seems, at least to this observer, more than a little out of kilter. Honestly, before I saw the betting line, I thought it would be between four and six points. Ole Miss has had an extra week to prepare. Bama is coming off a physically taxing, overtime struggle. Ole Miss is at home. There’s not a much better recipe for success than that.

Clearly, oddsmakers figure bettors will fixate more on the recent history of the rivalry. Alabama has averaged nearly 57 points a game in winning the last six meetings by an average of 32 points per game. Ole Miss has scored at a 25.5 per game clip over those six games. But the Rebels haven’t even slowed Alabama, much less stopped the Tide.

This Alabama team is averaging 42 points a game. This Ole Miss team averages 37. All that considered, seems the best bet of all might to bet on both teams to score plenty. The over-under is 63, which is a high number but not for these two offenses.

There’s another factor to consider: When was the last time Alabama played a game when the Crimson Tide had no chance at the national championship? This Crimson Tide team clearly does not. How will Alabama react? Will they lose their edge?

My guess is that Saban won’t let that happen. Alabama will fire back. Alabama will play well. Ole Miss will get Bama’s best shot. My point is, Alabama’s best shot, as good as it is, is not what it has been.

The post Goat fuel? Call it what you want, but Alabama’s armor has chinks appeared first on Mississippi Today.

The Alabama-Ole Miss betting line opened with 7-2 Bama, a 14-point pick over 8-1 Ole Miss at Oxford. The betting line moved to 12 points, meaning most bettors were putting their money on the Rebels. The lopsided point spread caught the Clevelands off guard. This week’s podcast includes that discussion, plus much, much more football talk on the college, professional and high school levels.

Stream all episodes here.

The post Podcast: Double digit favorites? Alabama? Really? appeared first on Mississippi Today.

Longtime prosecutor Doug Evans, known for trying Curtis Flowers six times for murder with convictions that were later overturned, is headed for a Nov. 29 runoff for a circuit court judge seat.

Evans earned the second-most votes Tuesday in five-person election and will face top vote-getter Winona Municipal Court Judge Alan “Devo” Lancaster because neither candidate garnered 50% of the vote.

The 5th Circuit Court district includes Attala, Carroll, Choctaw, Montgomery, Grenada, Webster and Winston counties. The winner will succeed Judge George Mitchell, who died in April.

As a circuit court judge, Evans could hear criminal cases in the same district where the U.S. Supreme Court said he prevented Black people from serving as jurors, including in Flowers’ case. 

Evans, who has been the district attorney of the district for over 30 years, first tried Flowers in 1997 for the killings of four people at the Tardy Furniture store in Winona. 

Evans secured four death penalty convictions for Flowers, but those were overturned by state and federal courts. In two trials, a jury didn’t reach a unanimous verdict. 

READ MORE: Curtis Flowers files federal lawsuit against Mississippi DA Doug Evans for misconduct in wrongful prosecution

The U.S Supreme Court overturned Flowers’ conviction in 2019, ruling Evans barred Black jurors in the case. 

Evans recused himself after the Mississippi Center for Justice, which represented Flowers, asked for him to be removed from the case. Attorney General Lynn Fitch was appointed as the lead prosecutor.

In September 2020, Fitch’s office dropped charges against Flowers after he spent 23 years in prison, most of it on death row at the Mississippi State Penitentiary at Parchman. 

In 2021, Flowers sued Evans in federal court for misconduct, which Evans has denied. U.S. District Court Judge Neal Biggers Jr. ordered the case stayed until May 1, 2023.

Other candidates in the 5th District Circuit Court race were Ackerman attorney Kasey Burney Young, Kosciusko attorney Doug Crosby and Louisville attorney Zachary Madison. 

Lancaster is a partner at the Lancaster Taylor Law Firm in Winona. He has been a municipal judge in Winona since 2010 and attorney for Montgomery County Economic Development since 1986. 

The post Embattled DA in Curtis Flowers case headed to runoff in circuit judge race appeared first on Mississippi Today.

Three Mississippi U.S. House incumbents won handily, and a new U.S. House member was elected on Tuesday, according to preliminary election results gathered by the Associated Press.

Incumbent U.S. Reps. Trent Kelly in the 1st Congressional District, Bennie Thompson in the 2nd Congressional District and Michael Guest in the 3rd Congressional District easily won their races on Tuesday. In the 4th Congressional District, Mike Ezell won his first term in the U.S. House.

Thompson, the longest serving delegate representing Mississippi in Washington, remains the state’s sole Democratic representative. Kelly, Guest and Ezell are Republicans.

While the national spotlight was on key battleground states and congressional districts to determine which party would control the U.S. House and Senate, there was never much doubt who would win Mississippi’s four contested elections. Various reports indicate that turnout was light across the state on Tuesday.

Neither of Mississippi’s two U.S. senators, Roger Wicker or Cindy Hyde-Smith, were up for reelection this year. The seat Wicker holds is up for grabs in 2024, and the seat Hyde-Smith holds is up in 2026.

In the House races:

• District 1 incumbent Kelly, a former district attorney in northeast Mississippi, defeated Dianne Dodson Black, an Olive Branch small business owner. Kelly was first elected to Congress in a 2015 special election to replace Alan Nunnelee, who died in office. Black was attempting to become the first African American woman from Mississippi elected to a federal office.
• District 2 incumbent Thompson upended Brian Flowers of Clinton, a Navy veteran who works in mechanical planning at the Grand Gulf Nuclear Power Plant near Port Gibson. Thompson, chair of the Homeland Security Committee and the special committee formed to investigate the Jan. 6, 2021, attack on the U.S. Capitol, is the second Black Mississippians to serve in Congress in the modern era.
• District 3 incumbent Guest, a former district attorney in Madison and Rankin counties, beat Neshoba County native Democrat Shuwaski Young. Young was running for office for the first time, but has experience working in the Mississippi Secretary of State’s office and in Homeland Security on the national level. Guest was first elected in 2018.
• In District 4, Ezell, who defeated incumbent U.S. Rep. Steven Palazzo in the Republican primary earlier this year, defeated Democrat Johnny DuPree and Libertarian Alden Patrick Johnson. DuPree, former mayor of Hattiesburg, also has run unsuccessfully for governor and secretary of state. In 2011, DuPree became the first African American major party nominee for governor.

Other contests across Mississippi, such as for judicial posts and school board seats, also were on the ballot.

Click here to see full results from Tuesday’s midterm elections.

The post Mississippi election results: Three Republicans, one Democrat again win U.S. House seats appeared first on Mississippi Today.

As Jacksonians prepare for the winter, and the ominous possibility of another water system failure, they’re also coping with the looming uncertainty of how their drinking water will be managed in the years to come. 

“I really don’t know what to expect,” said Kathy Sykes, a lifelong Jackson resident and former state lawmaker, about the future of the water system. “Problems with our water system are going to be magnified once the cold weather sets in.”

On Monday, Mayor Chokwe Antar Lumumba said the system remains vulnerable to the winter weather, which last year froze equipment at the city’s main treatment plant and shut off drinking water for thousands of residents for over a month. The cold weather led to a citywide boil water notice in 2018 because of bursting pipes, and caused similar issues in 2014 and 2010 as well. 

For now, the federal government is leading discussions over the long-term plan for the water system, with the Department of Justice negotiating a settlement with Jackson’s lawyers over the city’s drinking water violations. Yet the status of those talks and what potential outcomes they might yield are hidden from the public because of a confidentiality agreement between the two parties. 

Similarly, Jackson has a “very-detailed” spending plan the city has shared with the Environmental Protection Agency, but which it can’t share with the public because of a different confidentiality agreement, city officials said. 

In the meantime, Sykes and others continue to see abrupt interruptions to their water connections. Since Sept. 15, when the state lifted the last citywide boil water notice, Jackson has issued 30 boil water notices, more than one every other day, to over 2,200 customers because of breaks in the aging distribution system, ranging from a day to nearly a week in duration.  

Jackson recently announced it’s seeking a contractor to manage its water facilities for the next year, which the mayor said he expects to begin Nov. 17, pending city council approval. The governor’s state of emergency is set to end just after on Nov. 22, which would mark the state’s takeover of Jackson’s water operations at nearly three months.

But other than that, there is little foresight for the city’s residents over the future control of their water system. Adding to the uncertainty, Gov. Tate Reeves has expressed growing distrust in Jackson’s ability to manage the system on its own.

Reeves argued recently that the August crisis was a result of Mayor Chokwe Antar Lumumba’s “absolute and total incompetence,” and said that it’s “not that difficult” to run a drinking water system. 

In a September press conference, the governor said that “there is a need” for state lawmakers to “take action” on a long-term solution, and later cast doubt over whether Jackson would operate its own water system “anytime soon, if ever again.” To date, however, Reeves has not pushed for a specific outcome. 

The city’s failures appear in virtually every corner of the drinking water system: operators are underpaid, leaving staffing shortages; miles of undersized water lines need replacing; and equipment at the two treatment plants haven’t been maintained or are so old they can’t be fixed. 

The city has for years planned to decommission one of the plants, the century-old J.H. Fewell, but now can’t because of shortcomings at the 30-year-old O.B. Curtis, which also may need replacing, according to the mayor.

Meanwhile, Jackson city council members have met with Reeves and Lt. Gov. Delbert Hosemann to discuss possible solutions, council president Ashby Foote said. Foote told Mississippi Today that Hosemann proposed creating a “utility district” for Jackson that would be governed by a board, similar to what rural water authorities use. 

Hosemann’s office confirmed he has met with stakeholders, but declined an interview for further details. 

Publicly, Lumumba has yet to entertain any long-term solution aside from sending the city more money. For years, the state government has built barriers to Jackson’s ability to raise money, as the NAACP argues in a Civil Rights Act complaint that the EPA has agreed to investigate. Reeves disputed some of those allegations in a letter to Congress. 

Jackson’s water issues also parallel a decline in the federal government’s share of local water spending, which plummeted from 31% in 1977 to 7% in 2017, according to congressional budget data. 

In that time, the city’s ability to replace federal spending only grew worse, as its population decreased 26% since 1980, and a failed water meter contract with Siemens led to a 31% decrease in water and sewer revenue from 2014 to 2020, city budget records show. 

But the path to rehabilitation requires more than just money, water system experts and local officials agree.

“Pouring more money into a failing institution does not fix that institution,” said Manuel Teodoro, a public policy scholar at the University of Wisconsin-Madison. Teodoro has helped consult water utilities since the 1990s, and served on expert advisory panels for local and state governments, UNICEF and the World Health Organization. 

Jackson, Teodoro explained, is unique only in the degree of its infrastructure failure, but the circumstances the city is facing are “depressingly ordinary” around the United States. 

Part of the issue, he said, is there are “way too many” water and sewer utilities around the country. Teodoro – as well as other water policy experts – is a proponent of regionalization, citing the theory that creating “economies of scale,” or pooling resources together, saves every city and suburb money in the long run. 

Regionalizing can take different forms, whether it’s combining physical infrastructure or combining operations staff. 

“Anyway you slice it, bigger is better,” Teodoro said. “There's no question, in my mind, that Jackson, just like anywhere else in the country, would be better off with a larger organization running the utilities for the region.”

Cleveland, Ohio, for instance, is a 48% Black city of 368,000, and is part of a regional authority that serves drinking water to 1.3 million people including the city’s suburbs. Cleveland, like Jackson, has seen financial issues amid population loss over the years, but has had relatively few issues with its drinking water, Teodoro said. 

Opponents of regionalizing look at Detroit as a cautionary tale: as part of the city’s bankruptcy deal in 2014, a court forced the city into a regional water authority, GLWA. While the authority pays the city to lease its water facilities, researchers from University of California Berkeley found that GLWA actually underpays Detroit, and in recent years it aggressively shut off water connections for residents in debt. 

Without a push from the state or federal government, Jackson and its neighbors appear unwilling to join forces, Mississippi Today reported in September. 

Regionalization, another expert said, can surface trust issues between communities, especially where there’s a history of racism or marginalization. 

“Whether communities want to cooperate or want to cede decision-making power over their drinking water to a community that they see as not having their best interest in mind, that can be tough,” said Sara Hughes, an associate professor at the University of Michigan who studies water management. “Even if it technically makes a lot of sense or is what looks best on the spreadsheet, I think that can be a big ask for communities sometimes.” 

Jackson losing control is part of why Lumumba is wary of a regional authority, and it’s also why he’s repeatedly shut down the idea of privatization, a model that serves drinking water to 15% of Americans. 

Opponents to privatization usually point to increased costs, which is an accurate assessment, Teodoro said, but one that only paints part of the picture. 

“It turns out you get what you pay for,” he said. “And what you have in the case of investor-owned (or private) systems is higher prices, but consistently higher quality.”

If a private company bought Jackson’s water system, the PSC would regulate any rate increases the company proposes, Northern District Public Service Commissioner Brandon Presley confirmed. 

The costs and benefits of a privatized system comes down to incentives, Teodoro explained. Because they’re investing in the infrastructure – and because they can profit from making upgrades, as a 2017 Washington Post story explored – private companies are quicker to raise rates to fund needed improvements.

The Washington Post story also found, though, that cities dissatisfied with a private company’s service have difficulty trying to buy back their systems because of the high price tag. 

But regardless of who owns it, a city’s water system is expensive, and whoever runs it will have to be willing to raise rates on residents’ water bills, Teodoro said.  

“People are going to pay for (water systems) with their taxes, or they’re going to pay for them with their health,” he said.

While Jackson raised water and sewer rates by 20% last December, it was the first rate hike since 2013, WLBT reported, and also a lower increase than what the city’s consultants recommended.  

City officials, who have to spend money and run for elections on issues other than just water, have historically lacked incentive to raise people’s water rates until a catastrophe hits, Teodoro explained.

“That’s not because Jackson’s past leaders were stupid or evil, they were making rational decisions,” he said. “That has nothing to do with the politics of Jackson. That has everything to do with the politics of every local government in the United States.”

While Lumumba has shut down alternatives to the city continuing to operate its water system the way it has for years, some of Jackson’s city council are hoping for a change. 

Councilman Kenneth Stokes called for the state to take over Jackson’s water system, and said if the state doesn’t do it, then the federal government should take control instead. Stokes added that he would also support privatizing the system. 

“We got to make sure that we put citizens first,” he said. “All this, ‘This is my territory, this is mine,’ that’s nonsense when you got children drinking contaminated water.”

Councilman Vernon Hartley, whose ward in west Jackson regularly feels the brunt of water pressure issues, said that while he wants the city to retain primary control, he would support regionalization. A regional authority, he reasoned, would mean more money and more political influence.

“It's apparent to me that the way we've been doing things is not right,” Hartley said. “We’re going to pressure the federal government into giving (Jackson) more money, and which it needs to (do). But without proper management of that money, we’re going to end up in the same place.” 

Recognizing the obstacles to regionalization, Teodoro mentioned certain measures – such as Jackson paying more to join because of its financial baggage, or the federal government subsidizing suburbs such as Byram and Clinton – to create incentives for regionalization. But one incentive, he said, should already exist: pride.     

“It should be shameful to the people of Mississippi to have that degree of infrastructure failure in your state capital,” Teodoro said. “So, if for no other reason, then I would think state pride would make folks want to participate in regional solutions, sustainable solutions for Jackson's water.” 

The post The mystery of what’s next for Jackson’s water system appeared first on Mississippi Today.

Mississippi’s health care crisis has reached a grim, catastrophic, inevitable point. 

Hospitals are closing, and many more are on the verge. Already sporadic health services are being slashed. Hundreds of thousands of Mississippians cannot afford the care they need. Too many people are dying.

Worst of all, our state’s leaders do not appear to be in any hurry to help.

In such bleak moments, it’s difficult not to ponder some “what-ifs.” Today could have been a day celebrated as a victory for Mississippi’s future — one that truly changed the trajectory of the state. An overwhelming majority of Republicans and Democrats alike would be headed to the polls, deciding to do for themselves what their elected officials have refused to do for more than a decade: expand Medicaid.

Expanding Medicaid, as 38 other states have done and two more are poised to do, would immediately address some of the most urgent aspects of the crisis. It would provide health care for hundreds of thousands of poor, working Mississippians who can’t afford trips to the doctor for basic care or emergencies. It would give an immediate shot in the arm to the dozens of hospitals that are struggling to balance budgets and keep their doors open. It would bring our poorest-in-the-nation state more than $1 billion in new revenue every year. It would create tens of thousands of new jobs, and it would save countless lives and livelihoods.

But there will be no such celebration today.

Last year, the Mississippi Supreme Court handed down an unprecedented ruling that killed Mississippi’s ballot initiative process, which gave voters the direct power to change laws. That broadly unpopular court decision halted a bipartisan campaign to collect signatures to put Medicaid expansion on the ballot this November. And state legislative leaders — many of the same ones who have rejected Medicaid expansion for more than 10 years — broke their promises to restore that power to voters.

Since we launched in 2016, Mississippi Today has proudly held elected officials accountable and provided Mississippians with the information they need to do the same. For months, our health care and political reporters have closely covered the growing crisis and its effects. But no issue warrants more focused, intensive scrutiny than our leaders’ inaction during this time.

So this week, we are launching a long-term project that focuses on the imminent crisis and potential solutions to it — including Medicaid expansion.

More than a dozen Mississippi Today staffers have been working on this project for several weeks. We will be thorough and independent, tough and fair. But above all else, we will be dogged in our pursuit of truth.

Our project will, first and foremost, thoroughly define the extent of the Mississippi health care crisis. It will show how hundreds of thousands of working Mississippians cannot afford the basic preventative care that keeps the more costly hospital visits and debilitating personal debt at bay. It will show how Mississippi has more rural hospitals at immediate risk of closing than any state in the nation and what that means for so many communities across the state. It will show how the state’s abysmally low investment in public health negatively affects every Mississippian, even those who have private health insurance and can get the care they need.

We will also define what, exactly, Medicaid is. The federal policy is wonky and incredibly difficult to understand. The term “Medicaid expansion” itself has become weaponized by opportunistic politicians, used as a smoke screen to avoid talking earnestly about its merits. We aim to cut through the jargon and political noise to show the direct effects of the policy, how it could change lives across the state, and what the state could stand to gain by passing it.

And perhaps most importantly, we will squarely confront the politics of the crisis. Even as cries for state intervention have grown on both sides of the political aisle, a handful of elected officials have seemingly decided it is not worthy of focus. They regularly invoke the name of former President Barack Obama, who championed the federal health care program in question, as the chief reason not to expand Medicaid. They disregard nonpartisan economic studies that show the enormous benefits to the state. Too often, they have even seemingly ignored the health care crisis itself.

Many of these elected officials have consistently said they don’t believe the state can afford to expand Medicaid. We will always listen to and share their explanations for that, and we will seek to better understand them. But we cannot ignore appropriate context from state and national experts who have datasets that show otherwise. And we will talk with elected officials in other states — including leaders in dozens of red states that have expanded Medicaid — about how their decision is working out for them.

We hope our journalism will force our state’s leaders to at least acknowledge and reckon with the health care challenges we all face. Beyond that, we will respectfully press them with questions about possible solutions.

Some will question the timing of this project. Lawmakers typically ignore addressing major issues in legislative sessions during major statewide election years, like in 2023. From our perspective, there is no better time to pose these questions than during an election year. 

Others will accuse us of partisanship or advocacy. An important reality we will consider daily as we serve the public: A vast majority of Mississippians, regardless of political leaning, support expanding health care access to poor, working people. A vast majority of Mississippians support accepting federal funding to help keep hospitals open. And no one can question that every Mississippian wants a better future for their children and for themselves.

One year from now, when all 174 legislative seats and eight statewide offices are on the ballot, every voter will have the ability to intimately understand where their leaders stand on the health care crisis and what they have done — or not done — to address it. We’ll make sure of it.

If you have questions, suggestions, or comments about this project, contact editor-in-chief Adam Ganucheau at adam@mississippitoday.org.

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