A new national report on child well-being ranks Mississippi 32nd in the nation for education, the only measure in which the state’s rank has meaningfully improved in the last decade.
The 2023 KIDS COUNT Data Book, published annually by the Annie E. Casey Foundation, ranked Mississippi as 48th for overall child well-being, 47th in economic well-being, 50th in health, and 50th in family and community.
Credit: The Annie E. Casey Foundation
Economic well-being is composed of metrics including housing cost burden, secure employment, and child poverty. Education is based on pre-K participation, graduation rates, and reading and math proficiency. Health is calculated using low-birth weight, access to health insurance, and obesity. Family and community is based on single-parent homes, teen birth rates, and children living in high-poverty areas.
The education ranking has seen steady improvement over the last decade, moving from 48th in 2014. A press release from the Children’s Foundation of Mississippi, a partner in the report, attributed the most recent improvement to the increased high school graduation rate. This year’s report is based on graduation rates for students who graduated in May 2020, when the Mississippi Department of Education waived several graduation requirements in light of the pandemic and the graduation rate rose. More recent data from the education department shows the graduation rate has remained higher than pre-pandemic levels, even when the requirements have been reinstated.
“The overall rank for education is quite a bright spot,” said Linda Southward, executive director of the Children’s Foundation of Mississippi.
Commenting on the results generally, Southward also said the four areas of the report are very interconnected because of the essential role of the family in a child’s life. She tied the overall scores to the high child poverty rate of 28% in Mississippi.
The report also highlights problems with the nation’s child care system, which stem from rising costs and fewer workers in the field. Data cited in the report showed the national average cost of child care in 2021 was $10,600 annually for one child. The average cost in Mississippi, at $4,382, was the lowest in the nation. Child care workers in Mississippi are also the lowest paid in the nation, with an hourly median wage of $9.83.
Southward said there are about 1,500 licensed child care centers in the state, which are only able to offer slots for about two-thirds of kids under age 5, which points to a need for additional investment in family-based child care.
“(Research shows) that when parents can confidently go to work, know their child is being taken care of in a quality setting, the whole comprehensive approach to child care pays for itself,” Southward said.
One of the policy recommendations is to strengthen the Child Care and Development Block Grant, a federal program that gives states money to assist low-income families with the cost of child care.
Carol Burnett, director of the Mississippi Low Income Child Care Initiative, said the program is an excellent support to parents in Mississippi who receive it but only about 30% of the state’s eligible kids are being served because the program doesn’t have enough money to cover all of the eligible children. She said this problem is widespread nationally.
She also added that procedural barriers, or “red tape,” also limit parents from successfully applying. Burnett said she has observed the Mississippi Department of Human Services work to improve the process, including recently lifting a requirement to sue noncustodial parents for child support before being eligible for the grant.
Donna Echols had just returned to her north Jackson home from her eldest son’s fairytale wedding in the Bahamas and expected to greet the groom’s father who had stayed behind to watch the house and her pets.
What she didn’t expect was the start of an emotional rollercoaster.
That night, April 27, Echols found her ex-husband, “Diamond Jim” Mabus, on the living room floor unresponsive. Furniture was strewn around. She called 911 to ask for an ambulance.
What followed were five calls and an excruciating 90- minute wait before the county’s ambulance provider, American Medical Response, arrived and took Mabus to St. Dominic Hospital.
Mabus was in the intensive care unit for a week until his death on May 4 at the age of 76. An MRI scan revealed he had suffered a series of small strokes and a large stroke. He left behind two sons from his marriage to Echols, two other sons, and friends and family.
“It angers me so much,” Echols said about AMR’s drawn-out response time. “It’s so much a death sentence for someone.”
AMR spokesperson Nicole Michel said the night Echols called, the central Mississippi service area was at a level zero, meaning there were no available ambulances. Eight ambulances and two sprint medics were already responding to other calls, and during the nine o’clock hour, AMR received six service requests, including one for a heart attack.
Triage protocols are applied to service calls to determine if people are suffering or are likely to suffer a life-threatening illness or injury, the spokesperson said.
Medical providers say that seconds count when someone suffers a stroke because brain cells immediately start to die. Response time can determine whether someone fully recovers, faces complications such as paralysis or dies.
Echols made the first 911 call at 9:15 p.m., according to cellphone records shared with Mississippi Today. Within 10 minutes, four Jackson firefighters arrived and started tending to Mabus, but they were not able to render further medical attention because they are not trained EMTs or paramedics, she said.
When the ambulance still hadn’t arrived, firefighters at the scene called the ambulance provider themselves and were told Echols’ address was in the queue but nobody had been dispatched yet, Echols said.
At one point, Echols called someone she knows who works at Pafford Ambulance, another private company contracted with Madison and Rankin counties, to see if they could send an ambulance. There was an ambulance bus five minutes away, but she was told she needed toget AMR to give permission to Pafford to respond and cross over into Hinds County – AMR’s territory.
Echols called 911 again, and asked the AMR dispatcher what needed to be done to have Pafford respond instead. They told her there wasn’t anything they could do about that.
Finally, at 10:25 p.m. the AMR ambulance arrived. Echols saved the home security image of first responders wheeling Mabus out the front door around 10:30 p.m.
Jam Mabus was taken by ambulance from Donna Echols’ home in Jackson to St. Dominic Hospital on April 27 after nearly 90 minutes after she called 911. Credit: Courtesy of Donna Echols
In its contract with Hinds County, AMR is required to meet 85% of its Jackson and Clinton emergency calls in eight minutes or less and outer-Hinds County calls in 18 minutes or less, Mississippi Today reported in 2018 after analyzing the company’s contract.
That year, there were over 32,000 emergency calls countywide. A review of calls by Mississippi Today and WLBT found the average trip time is an hour and a half. Time starts from when an ambulance is dispatched to when a hospital admits the patient.
Hinds EMS Coordinator Joey Jamison did not immediately respond to a request to receive a copy of or review the most recent AMR contract.
Echols’ experience waiting for an ambulance came as providers across the state – including AMR – have shared fears that an ambulance system collapse is near.
A combination of staff shortages, low wages and an incomplete reimbursement system have been exacerbated by the ongoing COVID-19 pandemic, which has greatly affected Missisisppi’s ambulence system, Mississippi Today reported.
In 2018, Mississippi Today reported that “wall time” – the time ambulances wait at a hospital for a bed to become available – often contributes to long response times. AMR agreed that hospital wait times are a challenge its first responders face.
“Every minute a crew is waiting for a bed is a minute the crew cannot respond to assist a patient outside of the hospital,” the company said in a statement.
Weeks since Mabus’ death, Echols has more answers about that night, but she wonders whether AMR will make changes to ensure other families don’t have to go through what hers did.
She understands that staff shortages have plagued multiple fields, including police and fire departments and hospitals, but she wants to know what the company is doing to fix that.
While efforts are taken to build up staff, Echols sees a mutual agreement or “helping hands” clause in AMR’s contract as a potential solution to help when they are overwhelmed by a high volume of calls.
For example, such an agreement could have allowed a Pafford Ambulance to come to her home to tend to Mabus sooner, Echols said.
An AMR spokesperson said mutual aid agreements among ambulance providers in Mississippi tend to be in place for natural disasters or mass casualty events, but not for daily service requests.
Mutual aid can be requested, but the ambulance provider who receives it isn’t required to respond because their service area takes precedence, the spokesperson said. Providers strongly prefer not to send crews outside the primary service area and often they don’t have the resources to do so.
The spokesperson did not respond to questions asked about whether it is possible for another ambulance company to respond to a call in Hinds County and whether there is a process for someone to grant permission for an out-of-county ambulance to come to them.
“What I don’t understand is why AMR has not pushed for mutual aid for a helping hands situation if they can’t do the job,” Echols said. “It makes you ask the question: Are they more concerned about territory and profit than saving lives?”
A new Mississippi Today/Siena College poll shows one-of-every-five likely Republican primary voters would vote for Democrat Brandon Presley over incumbent Republican Gov. Tate Reeves in the November general election.
Many of those voters, however, still don’t know enough about Presley to have a definite opinion.
The poll of Mississippians likely to vote in the 2023 GOP primary showed 21% were likely to vote for Presley if the gubernatorial election were held today, while 70% would support Reeves’ bid for reelection.
The results showed that 8% of participants were undecided, while only 1% said they would not vote in the election.
Editor’s note: Poll methodology and crosstabs can be found at the bottom of this story. Click here to read more about our partnership with Siena College Research Institute.
To successfully become the first Democrat elected to the Governor’s Mansion since 1999, Presley must encourage a substantial base of Democratic voters to turn out on Election Day. But he’ll also have to convince some traditionally Republican voters to back him instead of Reeves.
Presley has embraced a supporter-led movement to appeal directly to Republican voters, which includes social media accounts and distributing “Republicans for Brandon Presley” bumper stickers.
The poll surveyed favorable and unfavorable sentiments for both candidates. Reeves was 60% favorable to 29% unfavorable, with 10% saying they didn’t know enough about Reeves to say.
Presley, an 15-year elected utility regulator from north Mississippi, was 23% favorable to 27% unfavorable. Notably, a sizable 47% of the poll’s respondents said they didn’t know enough information about Presley to form an opinion.
The poll also showed some differences in regional voter attitudes.
In the northeast congressional district where Presley lives, Reeves overwhelmingly carries Republican primary voters at 68%, while only 15% support Presley.
In the Delta region, Mississippi’s 2nd congressional district, 38% back Presley, with 52% supporting Reeves — the area with the most significant percentage of likely Republican voters saying they will support the Democratic candidate.
In the central part of the state, where Reeves lives, 73% support the governor’s reelection campaign, with 23% indicating they back Presley. In the southern district, the governor’s most extensive firewall of support, only 13% back Presley, while 79% said they would vote for Reeves.
Mississippi does not require voters to register with a political party, meaning voters do not have to participate in the same party primary as they have in previous elections.
The responses suggest a segment of the state’s Republican voters may defect to Presley in November’s general election, but it also predicts Reeves will be a shoe-in to capture the GOP’s nomination to vie for a second term in office.
The poll showed 59% of respondents would vote for Reeves if the GOP primary for governor were held today, while 33% said they did not know who they would support, and 8% said they would vote for someone else.
Of the 8% who indicated they would support someone else in the GOP primary for governor, the respondents were then asked to name specific candidates who would have their support. Several respondents said they would vote for Reeves’ two primary opponents in 2019 who are not running this year: former state Rep. Robert Foster and former Mississippi Supreme Court Chief Justice Bill Waller Jr.
None of the respondents named Reeves’ two 2023 primary challengers, John Witcher and David Hardigree.
The Mississippi Today/Siena College Research Institute poll of 646 registered voters was conducted June 4-7, 2023, and has an overall margin of error of +/- 4.8 percentage points. Siena has an ‘A’ rating in FiveThirtyEight’s analysis of pollsters.
Mississippi State University will lead an archaeological excavation of Prospect Hill, a former 5,000-acre plantation in Jefferson County, June 18-28 from 9 a.m.-3 p.m. in collaboration with the Archaeological Conservancy and descendent communities.
At Prospect Hill, near the present-day town of Lorman, approximately 300 formerly enslaved African Americans were sent to a Liberian colony in Western Africa known as “Mississippi-in-Africa” during the 1800s. The plantation owner, Isaac Ross and other major planters had co-founded the Mississippi chapter of the American Colonization Society with that in mind. When he died, his will stipulated his slaves would be freed and that the sale of his plantation would fund their move to Liberia.
The excavation of this site will be led by Shawn Lambert, an assistant professor in the department of anthropology & middle eastern cultures at Mississippi State University. Andrew Whitaker, a cultural anthropologist, will be assisting with the project as well. The organization is requesting that people arrive on June 19 to allow time for preparations.
“I think this is going to be fun and informative,” Lambert said to Mississippi Today. “I think we all will learn a lot together.
“We would like to find any notable features, cultural material, or artifacts that they have left behind so that we can get a better understanding of the history there.”
“We hope at the end of this, to take the materials we find and combine material culture with the documentary that the archaeological conservancy developed of Prospect Hill, with the voices of the descendant communities in Liberia. And, eventually put up an interactive, collaborative exhibition at a museum or at one of the museums at Mississippi State University.”
Mother Nature and Tennessee rained on the Southern Miss baseball parade that had seemed headed for Omaha and the College World Series. But anyone who was in Hattiesburg Monday night will not soon forget the sendoff 6,000 fans and Tennessee’s players and coaches gave retiring Golden Eagle coach Scott Berry.
Julie Whitehead of Brandon is a longtime patient of St. Dominic’s behavioral health services. After being admitted to the hospital following a suicide attempt in 2006, Whitehead was diagnosed with bipolar disorder.
She was admitted again six times over the next 15 years.
“Each one of those times, if I had not been admitted to St. D, I would be dead,” Whitehead said.
She has always considered herself lucky – she works part time and has Medicare and private insurance through her husband.
“I have resources. I’m not in the fix that a lot of people are in who suffer from mental illness. I’m not dependent on Medicaid and trying to find doctors who will take Medicaid, so I’m never worried about getting care,” she said.
But when St. Dominic’s announced the closure, her perspective changed.
“I’ve just kind of been in shock because if the beds aren’t there, it doesn’t matter whether I can pay for it or not …” she said.
The unit had been providing inpatient mental health and geriatric psychiatric treatment. But the nonprofit hospital, citing “significant financial challenges” and losses of several million dollars, announced it was discontinuing the services and laying off 5.5% of its total workforce earlier this month.
The hospital’s most recent available tax filing for the fiscal year ending June 2021 showed a loss of $21.7 million for the prior year. That year’s tax filing showed a gain but coincided with hospitals receiving an influx of federal COVID-19 aid.
Hinds County Sheriff Tyree Jones listens to opinions on possible crime deterrents during a Violent Crime Prevention Summit held at the Two Mississippi Museums, Thursday, Jan. 5, 2023 in Jackson. Credit: Vickie D. King/Mississippi Today
Advocates and law enforcement worry that as a result of the closure, more people in the Jackson area who need treatment will end up in jails or without the help they need.
“Jails across our state and America are populated with ‘patients’ suffering from mental illnesses. Sheriffs and wardens assume the responsibility of these individuals when in reality, SOME of them should not be in jail but rather a treatment institution,” he wrote. “The risks will increase.”
A spokesperson for St. Dominic said the hospital recognizes mental health is “a significant need.”
“While continuing to meet these needs directly is no longer viable for St. Dominic’s, we are working with partners to help patients access the care they need,” Meredith Bailess said in an emailed statement. “Our health system will continue to advocate for additional state and federal resources to stabilize healthcare providers in Mississippi.”
Although the Mississippi State Hospital opened 20 adult psychiatric beds earlier this year that had been closed due to staffing issues, the average wait time for a bed there is around two days. Bed availability at the University of Mississippi Medical Center in Jackson is limited, with only 21 adult beds and 12 beds for children.
Hinds Behavioral Health Services is one of 14 regional community mental health centers in Mississippi. The goal of the centers is to provide services to citizens with mental health issues and, when possible, keep people out of institutions.
The center runs a 24/7 mobile crisis unit that responds to people in crisis and attempts to stabilize them.
However, of the 1,196 people the unit came in contact with over the last year, 643 of those required a higher level of care, or admission to an inpatient facility, according to Jamie Evans, the supervisor for the mobile crisis unit at Hinds Behavioral Health Services.
When that happens, there are two options in the metro area for those people to go and immediately receive care: St. Dominic and Merit Health Central. The other options, which are referred to as a “single point-of-entry,” is the 16-bed crisis stabilization unit in Jackson. Another is the unit in Brookhaven, about an hour drive from Jackson.
Crisis stabilization units are short-term residential treatment facilities run by community health centers where people having a mental health crisis can be stabilized.
Single point-of-entry locations have memorandums of understanding with the community health center, and patients are able to bypass emergency rooms and be immediately admitted for care.
“It’s almost as if even if they are full, they secure beds on the side for us, because we’re meeting an individual in crisis, in one of the most vulnerable points in their mental health,” said Evans, explaining the relationship between Hinds Behavioral Health Services and single points of entry. “It’s very fast paced, and we really don’t have time to sit in the ER and wait for a doctor to see them.”
Now, however, the only single point-of-entry option besides the crisis stabilization unit in Jackson is Merit Health Central, which houses around 70 psychiatric beds, according to Evans.
St. Dominic Hospital Behavioral Health Services in Jackson, Miss., Friday, June 9, 2023. Credit: Eric Shelton/Mississippi Today
The services’ closure, which Hinds Behavioral Health Services learned about at the same time the hospital made its public announcement, will leave a substantial gap, Evans and other mental health advocates agreed.
“There will be a huge impact to the systems, especially the elderly and those that find themselves in a crisis situation,” said Angela Ladner, executive director of the Mississippi Psychiatric Association.
She also said the speed at which the closure is happening is “disconcerting.”
In worse-case scenarios, mentally ill people with nowhere to go can end up in jail – unregulated facilities that are detrimental to people going through a mental health crisis.
In an attempt to minimize that practice, the Legislature this year passed House Bill 1222, which required mental health training for law enforcement agencies.
The hospital, which was purchased by the Baton Rouge-based Franciscan Missionaries of Our Lady Health System in 2019, announced the unit was closing on June 5 and would stop accepting patients at 7 a.m. the next day.
In the meantime, Evans and other advocates say they will work together to find a way to bridge the gap. Hinds Behavioral Health Services received funding to open a second, 16-bed crisis stabilization unit in Hinds County, but that won’t happen immediately.
Whitehead says her next steps are to collect a “portable” version of her more-than-a-decade worth of medical records to take with her wherever she lands next.
She guesses the only other thing she can do is “do my best to stay stable.”
Correction 6/14/23: This story has been updated to reflect that there is also a crisis stabilization unit in Jackson.
Correction 6/14/23: This story has been updated to make clear the difference in wait times for Forensic Services beds at Mississippi State Hospital compared to wait times for acute psychiatric care beds there.
Editor’s note: Julie Whitehead freelanced for the Mississippi Center for Investigative Reporting, which is now part of Mississippi Today.
Even the former president’s attorney general Bill Barr thinks this is really bad for Donald Trump. Sadly, if he had returned the top secret documents, it wouldn’t have come to this. This isn’t a left-wing witch hunt. This is Trump’s fault. If you haven’t read the indictment, please take the time to do so.
Mississippi politicians have long viewed being anti-abortion as a key to winning elections, working diligently for years to stretch the limits of the law and pass some of the nation’s most restrictive bans.
But based on a new Mississippi Today/Siena College poll, being anti-abortion may not be the key electoral issue that politicians – especially Republican politicians – have believed it to be.
A poll of Mississippians who say they will vote in the Aug. 8 Republican primary found that 45% support repealing the state’s “trigger law” that bans most abortions in the state. Another 44% of likely Republican voters oppose repealing the ban, and 11% said they were not sure.
Editor’s note: Poll methodology and crosstabs can be found at the bottom of this story. Click here to read more about our partnership with Siena College Research Institute.
Mississippi’s trigger law went into effect in 2022, when the U.S. Supreme Court overturned Roe vs. Wade. That decision effectively meant that abortion was no longer a national right and that the issue could be decided by each state.
It was a Mississippi case that led to the overturning of Roe. After the Supreme Court decision, the Republican leadership of the state proudly proclaimed Mississippi to be solidly pro-life, with some saying it was the nation’s “safest state for the unborn.”
The poll results are especially notable since the respondents are those who say they intend to vote in Republican primary in August. Generally speaking, it is believed that Republican primary voters tend to be staunchly anti-abortion while Democratic voters support abortion rights.
But based on the new poll, abortion might not be any longer the hot-button social issue that Republicans use to attack Mississippi Democrats and link them to national Democrats.
That issue, according to the results of the poll, could become rights of transgender Americans. According to the poll, likely Republican primary voters by an overwhelming 70%-to-19% margin oppose “repealing the current ban on gender affirming healthcare for any trans person under 18 years of age.” The remaining 11% of the poll respondents were undecided.
Earlier this year during the 2023 legislative session, Republican leaders pushed through a bill banning gender affirming care for minors. The bill prohibits medical providers in Mississippi from providing the care and also appears to ban parents from seeking out-of-state care for their children, though it is unclear how that provision would be enforced.
In the 2023 session, Republican legislative leadership also attempted to take steps to ensure that laws in the state banning most abortions are not weakened.
The Legislature made an unsuccessful effort to revise the state’s ballot initiative process that was struck down in 2021 on a technicality by the state Supreme Court. The initiative process allows voters to gather signatures to bypass the Legislature and place issues on the ballot. The House leadership, led by Speaker Philip Gunn, wanted the new initiative process to ban efforts of placing abortion issues on the ballot. The Legislature ultimately was unable to pass a law restoring the initiative.
Of course, the one time that Mississippians voted on the issue of abortion under the old and now invalid initiative, they rejected the so-called “personhood amendment” by a 58% to 42% margin. The personhood proposal on the ballot in 2011 defined a person “to include every human being from the moment of fertilization, cloning or the equivalent thereof.” Then-Lt. Gov. Phil Bryant said at the time a vote against personhood would be “a victory for Satan.”
Since the U.S. Supreme Court overturned the national right to an abortion in 2022, six states have voted on abortion. In all of those states, the electorate voted — usually by large margins — to expand abortion rights. Some of those states, such as Kansas, Kentucky and Montana, are seen as conservative as Mississippi.
On other issues, likely Republican Party primary voters, according to the poll:
Support eliminating the grocery tax 76% to 15%, with 9% undecided or not answering.
Support eliminating the state personal income tax 71% to 18%, with 11% not sure.
Support full funding of public education through the Mississippi Adequate Education Program 57% to 16%, with 26% having no opinion or not knowing.
Support expanding Medicaid 52% to 35%, with 13% not sure.
The Mississippi Today/Siena College Research Institute poll of 646 registered voters was conducted June 4-7, 2023, and has an overall margin of error of +/- 4.8 percentage points. Siena has an ‘A’ rating in FiveThirtyEight’s analysis of pollsters.
Blue Cross and Blue Shield of Mississippi and the University of Mississippi Medical Center went head to head for months last year over reimbursement rates.
Turns out, it wasn’t for nothing.
An analysis by Mississippi Today and The Hilltop Institute at the University of Maryland, Baltimore County shows that in March 2022, during the throes of the dispute, Blue Cross’ negotiated rates were largely lower than other major private insurance companies — Aetna, Cigna, Humana and United — for several common procedures. This was especially true for more expensive procedures and emergency room visits.
A negotiated rate is how much an insurer has agreed to pay an in-network provider through a plan for covered services.
Hospitals perform and are reimbursed for thousands of procedures each year, but what they charge and what insurers pay has largely been kept a secret — that is, until 2021, when the federal government ordered hospitals to start publishing the data.
Mississippi Today worked with The Hilltop Institute to identify 21 common adult and pediatric procedures, then analyzed what Blue Cross reimbursed the hospital for each of those in March 2022, before the entities entered the contract dispute, and in March 2023, after the two entities renegotiated their contract.
Both Blue Cross and UMMC declined to answer any of Mississippi Today’s questions for this story.
The data show that for the selected services, Blue Cross almost never paid close to what UMMC charged, unless it was for cheaper procedures. The only exam that Blue Cross paid exactly what UMMC charged in 2022 was for a fetal non-stress test, which costs $231. (In 2023, when the cost was raised to $400, Blue Cross’ payment increased to $380.)
Hospital prices as of September 2022 show that in general, commercial negotiated rates are on average around 58% of the hospital charge for a given service, according to Morgan Henderson, principal data scientist at Hilltop.
In 2022, Blue Cross largely paid less than other private insurers for more expensive procedures, though the data shows that these insurance companies generally pay less than what UMMC charges.
According to data over the past three fiscal years from the Center for Healthcare Quality and Payment Reform, UMMC charged four times more for services provided to patients than it cost to deliver those services, which Henderson said was in line with what other hospitals charge.
Hospital charges are arbitrary — they can differ substantially from hospital to hospital. It’s rare that any payer gives hospitals the full amount they charge for any service, according to Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform.
Some key findings from 2022 data show:
Other insurers paid UMMC $250 for blood tests called total metabolic panels, $151 for comprehensive metabolic panels and $127 for therapeutic exercises. Blue Cross paid $12, $15 and $35, respectively.
With the exception of X-rays, Blue Cross paid significantly less than other private insurers did for common radiologic procedures.
Preventative care for kids and other services, such as chest radiologic exams and hospital observations, were more equitable compared to what other insurers paid — but they were all services that cost around or less than $150.
Blue Cross paid more for vaginal deliveries, C-sections and fetal tests than other companies.
Henderson pointed specifically to Blue Cross’ low reimbursement rates for emergency room visits, one of the more common reasons people visit a hospital.
For the base cost of emergency room visits (not including any other services often charged during ER visits), Blue Cross reimbursed UMMC in March 2022 at far lower rates than other major insurers and what UMMC charges — by thousands.
“In light of this, the fact that BCBS Mississippi pays only $537.38 for a level 5 ED facility fee – for which the charge is almost $4,800 – is especially striking,” Henderson said.
Emergency room visits are categorized, and charged, based on severity. For a mild injury, a patient is charged a base level 1 fee, excluding any tests that might be performed during that visit. The most severe injury constitutes a level 5 emergency room visit.
And as the severity of the emergency room visit goes up, so does the charge. Depending on the level of injury, UMMC can charge anywhere from $468 to $4,796 for an emergency room visit. But for the most severe ER trip, Blue Cross reimbursed UMMC $537, while other insurance companies paid thousands more.
“This is a very good deal for BCBS Mississippi, especially when compared to the negotiated rates that other large commercial insurers pay for this same service,” he said.
As state lawmakers continue not to expand Medicaid, health care administrators across the state report that people who are uninsured and can’t afford preventative care are using the ER more often for general health care needs.
A year later, data from March 2023 shows that payments from Blue Cross for common procedures generally remain lower than other private insurance companies. In some cases, Blue Cross still pays thousands less.
The terms of UMMC’s agreement with Blue Cross, which was decided when the dispute ended in December, have not been disclosed.
Medicare rates are typically used as a gold standard to judge whether insurer payments are too high or too low. While Blue Cross rates are reasonable compared to Medicare payments, they’re still lower than other private insurers.
“I found the (Blue Cross) vs. non-(Blue Cross) price gaps for emergency and some other procedures very large, but in general what you found is expected,” said Ge Bai, a professor of health policy and management at Johns Hopkins Carey Business School, in an email to Mississippi Today.
“Large insurers can flex their muscle on the negotiating table and make threats toward hospitals, such as what (Blue Cross) did last year. Small insurers’ threats won’t be as concerning to hospitals because their beneficiaries do not account for a large portion of the hospital’s patient volume. Therefore, small insurers’ negotiated prices can be relatively higher.”
At a market share of 55%, Blue Cross insures the majority of Mississippians with private insurance, and UMMC is the state’s largest public hospital.
But according to consumer advocates, insurers with lower negotiated rates are supposed to pass those savings on to consumers in the form of low premiums, and if a for-profit company has a big surplus, larger premiums shouldn’t be necessary.
However, that doesn’t seem to be the case for Blue Cross — at least for the past three years.
Alleging they had to pay more in claims than expected, Blue Cross raised premiums in January 2020 for small business plans and individual plans. Since then, the insurance company has raised rates for individual plans at an average of 18% and small group plans at an average of 15.6%, according to data from 2023.
After UMMC asked Blue Cross for substantially increased reimbursement rates last year and Blue Cross refused, the hospital system terminated its contract with the insurance company and subsequently went out of network in April. The move forced tens of thousands of Mississippians to pay significantly more or go elsewhere for health care, including for some services that are only available at one place in Mississippi: UMMC.
UMMC houses the state’s only Level 1 trauma center, Level IV neonatal intensive care unit and children’s hospital. It is also home to the state’s only organ transplant center, where transplant candidates with Blue Cross insurance were marked as “inactive” on the wait lists when the hospital was out of network with the insurer.
During the dispute, UMMC maintained that it was asking for below-market rates for academic medical centers, while Blue Cross officials said to increase reimbursement rates, Mississippians’ premiums would have to go up.
A Mississippi Today investigation found that Blue Cross was sitting on a huge reserve of money, to the tune of $750 million.
While insurers generally try to hold at least three times as much capital as the minimum requirement — a ratio of 300% — to ensure the company can pay out claims, Blue Cross’ ratio has been around 1,600% for years, financial records revealed. It’s significantly larger than Blue Cross peers in neighboring states, and perhaps the largest such surplus by percentage in the country.
State Insurance Commissioner Mike Chaney said it was UMMC’s goal during the dispute to get closer to a 160 to 170% reimbursement rate from Blue Cross compared to Medicare.
Chaney, who advocated on behalf of consumers during the dispute between Blue Cross and UMMC, has long complained about the difficulties in regulating insurance reimbursement rates. He has previously said that Blue Cross won’t make that data available to his office.
New health care price transparency rules, which went into effect in 2021, requires hospitals and insurers to publish their rates, but that doesn’t mean those numbers are easy to access. They’re published on an individual basis, hospital by hospital, and the files, which don’t always look the same, are huge and sometimes hard to decipher.
Gov. Tate Reeves axed a bill earlier this year that would have allowed Chaney’s office the authority to study and address inequalities in reimbursement rates among insurance companies. The bill, which Reeves called a “bad idea,” would have allowed the commissioner to fine companies thousands per violation if they can’t justify unequal reimbursement rates for different hospitals for the same procedures.
“Transparency should provide policy-makers an understanding of what is contributing to the critical financial issues hospitals, clinics, and health providers are facing,” said Mitchell Adcock, executive director of the Center for Mississippi Health Policy. “If payments are not equitable, there are no other financial sources that provide enough revenue to cover health providers' costs.”
And as state leaders continue to oppose expanding Medicaid to the working poor, providers rely on private insurance company payments to offset uncompensated care for people who are uninsured.
Uncompensated care and higher health care costs have worsened the state’s hospital crisis. A third of rural hospitals in Mississippi are at risk of closure.
“The current hospital revenue model, good or bad, is private insurance payments to help cover the limited payments from Medicare and Medicaid and help offset some of the uncompensated care cost,” Adcock said. “Therefore, private insurance payment rates have a significant impact on hospitals’ ability to operate.”
Correction 6/13/2023: The 2022 chart has been updated to correctly reflect what UMMC charged for CT scan and MRIs.
