In Belhaven on Sunday night, members of Mississippi’s LGBTQ community solemnly placed roses on a blue, pink and white flag as they read aloud the names of 70 trans people killed in the last year in the U.S. – a figure that’s almost certainly an undercount.
Gatherers flipped through a booklet with pictures of those who had been killed, including including four Black trans and gender non-conforming people in Mississippi: Mel Robert Groves, 25, from Jackson; Kesha Webster, 24, from Jackson; Shawmaynè Giselle Marie McClam, 27, from Gulfport; and Jimmie “Jay” Lee, 22, from Oxford.
“That weighed heavy on me,” Jensen Luke Matar, a trans community organizer, said after the final name was read aloud. “You look at those names, you look at those ages, you catch those cities – the ones you have connection to, the ones you were born in. Some right here in Jackson, in our backyard.”
“This is real y’all, this is real lives,” he continued. “You recognize how many trans and non-binary people are in this space right now? That could’ve been any of us.”
The emotional ceremony was organized by several Mississippi-based LGBTQ organizations and nonprofits as part of Transgender Day of Remembrance, an annual, international vigil to highlight violence experienced by the community. For more than two hours, gatherers laughed, cried, shared resources and sought not just to mourn but to celebrate their trans community members who are still living.
Across the country and in Mississippi, trans people face an epidemic of violence, the brunt of which is borne by Black trans women. This violence is rooted in a web of anti-trans forces, experts say, including an increasingly hostile political environment, widespread misconceptions about trans people and prescriptive cultural and religious beliefs – all of which are present in Mississippi.
At the vigil, four faith leaders spoke, including Reverend Lance Presley from Broadmeadow United Methodist Church.
“I want you to understand this: If there’s no way to understand scripture or tradition or anything else as affirming and celebratory of trans identity, of trans lives, of trans people, then the scripture is wrong, then the tradition is wrong,” he said.
Last week, Tate Reeves’ unveiled priorities for next year’s legislative session include a “Parental Bill of Rights,” which he described enabling parents to determine what pronouns their children should be called in public school.
A report by the National Center for Transgender Equality notes that just over 25% of trans people killed this year lived in Texas and Florida, two states that have passed prominent anti-trans legislation.
Following the service, there was a reception with cupcakes made by Tayla Carey, a trans woman whose brother, a well-known Black, LGBTQ student at Ole Miss named Jay Lee, was murdered earlier this year. Several of Lee’s friends drove down from Oxford for the vigil.
Carey shared a poem she had written for Lee, tearing up because it was the first time she’d read it aloud.
“Your spirit will be with me always,” she said. “When I see a bird chirping on a nearby branch … I will know it’s you singing to me. When a butterfly brushes so gently by me and so carefreely, I will know that it is you assuring me that you are free from pain. When a gentle fragrance of a flower catches my attention, I will know that it is you reminding me to appreciate the simple things in life.”
Some of the resources that were shared at the memorial included: Sarah Schnaithman, a trans lawyer in Amory, Miss.; the TRANS Program, which advocates against anti-trans legislation, assists with gender marker change applications and provides peer support; Grace House Services, a transitional home for individuals with HIV/AIDS; the ACLU of Mississippi; Capital City Pride; and Awakening Love, a trans-led nonprofit that provides short-term financial assistance.
Transgender Day of Remembrance was started in 1999 to honor Rita Hester, a Black trans woman whose murder still has not been solved. In a 2020 article about Hester’s life, NBC News noted that “for many in the trans community, the day is the only annual gathering they have.”
On Friday, Sept. 9 – the 11th day of the water crisis in Jackson, Miss., and weeks into a citywide boil water notice – I went to brush my teeth.
I was at my apartment in Belhaven, one of the oldest and wealthiest neighborhoods in the majority-Black capital city. With the day off work, I had planned to drive to a suburb of Jackson to wash my clothes, thinking the laundromats in town were still affected by the crisis. Getting ready to leave, I turned on my bathroom sink faucet; for a second, the stream of water ran normally before it sputtered, lost pressure and turned a shockingly dark, coffee-colored brown.
My reaction was to turn off the faucet.
Earlier that week, I had seen a picture on Twitter of a bathtub, supposedly in Jackson, that was full of opaque, black water. Without more context, I had dismissed it as fake, but I wasn’t doubting anymore. I turned on my shower – it also sputtered before the water turned the same dark brown. I tried my sink again. Still brown. Then I flushed my toilet; it lurched away from the wall. I opened the lid to see chocolate-colored water slowly filling the bowl.
I took a video and posted it on Twitter with the caption, “My water just now in Jackson, MS.”
Within minutes, I was getting hundreds of retweets. That turned into dozens of direct messages, emails and phone calls from reporters around the world requesting to play the video on TV that night, and literally thousands of replies all asking the same question: What was in my water, and why was it that brown?
I had the same questions. Like all of my coworkers at Mississippi Today, I had been covering the crisis since it began on Aug. 29, but I wasn’t reporting on the condition of the water system or treatment plants.
Still, I thought I’d be well-suited to get the answers as a journalist. But more than two months later, I still don’t know what, exactly, was in my water, or why it turned brown. I’ve talked with experts in water quality and city officials – they gave different answers. The experts say that discolored water is a natural phenomenon in aging water systems, though the pipes in my building could’ve contributed. City officials are adamant my brown water was “an isolated incident,” but we obtained records showing people across the city had experienced similar brown water during the height of the crisis.
The city also said they were going to test my water, but after weeks of back and forth with me, they admitted they never did.
But the first call I made that day was to my landlord’s front office. I wanted to know if other properties in Belhaven were affected or if my unit, a 1940s quadruplex, was the only one.Though the pipes in Belhaven are decades old, much of the neighborhood is downhill and nearby J.H. Fewell, the city’s secondary water plant – as a result, the homes here are often better able to weather water-related crises than those in other parts of the city.
The office manager answered the phone. Multiple properties were affected, she said. The water in Nejam Properties’ office in Belhaven Heights, a sister neighborhood on the hill across Fortification Street, was the color of “weak coffee.”
“That’s all to do with the city of Jackson and the boil water notice and stuff like that,” she said in a way that seemed intended to be reassuring.
Even before Gov. Tate Reeves declared the water emergency in a late-night press conference on Aug. 29, there was widespread confusion in Jackson about whether the water was safe to drink. Despite months of on-again, off-again boil water notices, many people, including myself, had been using the water normally. The mayor, Chokwe Antar Lumumba, had repeatedly questioned if the most recent boil water notice, which had been imposed by the state in July, was necessary.
This lack of clarity from both the city and the state continued throughout the crisis, making it hard for many Jacksonians to know what to trust. Reeves’ initialpress conference did not include Lumumba or anyone from the city – and the very next day, Lumumba disputed several of Reeves’ comments, including an alarming statement that raw flood water had entered the O.B. Curtis treatment plant and was flowing into people’s homes.
In my apartment, the first clue as to what happened came a few hours after I posted the video. That afternoon, I learned my neighbor directly beneath me on the north side of the buildinghad been getting brown water in his kitchen sink for a week if he used hot water. But on the south side, my neighbors still had clear water, albeit with low-pressure. An expert later told me this could indicate an issue with the pipes inside my section of the building – something my landlord, not the city, would be responsible for.
My water cleared up the day after I posted the video on Twitter, but it continued to gain views. By Monday, it had been watched more than 10 million times. That afternoon, I looked through my Twitter DMs.
One message stood out. It was a request from the City of Jackson’s account. They asked for my address so they could come test the water.
I could send it, I replied, but I wanted to know why they were asking.
“… If the water is that brown… we want to get the address to Public works and the health department to find the reason why,” they responded.
“Gotcha!” I wrote back before sending my address. Since I work from home, I said the city could come by any time.
“Ok…,” they wrote. “I’m going to give that address to our public works person… and hopefully they’ll be able to determine what the heck is going on.”
After some back and forth, the city’s Twitter account asked if my water was still brown.
“Can we get a sample of it? (I’m asking per our public works director)”
The next morning, I ran into three city contractors on the sidewalk outside my apartment. They weren’t there to test my water but to install new meters.
I showed them the video. Gesturing down at the water meter, one of the contractors remarked that their work wouldn’t prevent the discolored water from happening again.
Jackson, he said, needs to re-pipe the whole city.
The exchange prompted me to check in with the city’s Twitter account.
“When do you think y’all will send someone over?” I asked at 9:42 a.m.
Six hours later, the city replied, “Hey Hey!!!! I think they went out there this morning…”
That was my last exchange with the city’s Twitter account, but I would learn – when I reached out to the city a month later – that Public Works never tested my water.
Meanwhile, at Mississippi Today, we were trying to do our own test of my water – an effort that proved fruitless.
Our health editor, Kate Royals, had been researching how to test water and found a private lab in Ridgeland, a suburb of Jackson, called Waypoint Analytical. We ultimately submitted three tests to Waypoint over the course of a month, for a total of $137.
The first sample, which I took the same day I posted the video, had puzzling results. That Friday afternoon, I talked to the lab manager who told me I needed to collect 100 milliliters of water and could put it in Tupperware, the only clean container I had at home. We had decided to test my water for E. coli and “total coliform,” a type of bacteria used to indicate the presence of pathogens.
The water was still dark and turbid when I turned it into the lab, but the results they sent us a few days later showed the water was too dark to test.
“The sample could not be read for Total Coliform due to the dark coloration of the sample interfering with the Reading,” the results said.
So six days later, the day the boil water notice was lifted, we tried again.
The second test came back with high levels of total coliform but no E. coli. But I had committed two possible user errors. One, my Tupperware container might’ve introduced bacteria into the sample. Two, I didn’t flush out the line by running the bathroom sink faucet before taking the sample, the water-testing protocol generally recommended by the Environmental Protection Agency.
Nearly another month passed before we could get a third and final test. This time, I got more guidelines from the lab and followed them to a tee, cleaning my faucet with bleach (which yielded more brown sediment) and running the water for one minute before collecting it in a sterile container and placing it in a bag of ice.
It came back with no bacteria detected. But that’s not the full story.
One expert I later consulted, Francis de los Reyes – a professor of environmental engineering and microbiology at North Carolina State University – suggested that because the lab’s test required re-growing bacteria, the bleach I had used on the faucet could’ve lingered in the water, killing any organisms that might’ve been present. He said I should’ve run the tap for longer than one minute to clear the bleach.
So what was in my brown water, and why did it happen? Other experts I talked to could only speculate. De los Reyes’colleague, Detlef Knappe, who specializes in water quality and treatment, told me that because there was likely no E. coli in my water, the brown color was probably the “natural” result of a drop in pressure in the old pipes.
In a functioning water system, Knappe explained, generators push water from the plant to homes, where it stays suspended in the pipes until a faucet is turned on. But in old water systems like Jackson’s, lined with cast iron pipes, a drop in pressure can cause accumulated sediment to collapse into the disrupted water stream and turn it brown. The water isn’t leaving the plant a dark brown color, Knappe said, but becomes discolored somewhere along its journey to the faucet.
Christine Kirschoff, a professor of civil and environmental engineering at Penn State University, had another perspective. Though she agreed that the brown water was likely caused by a drop of pressure in the pipes, she said it could’ve been exacerbated by the routing of the pipes in my building. That scenario would explain why my downstairs neighbor also had discolored water but my neighbors to the south never did.
The last week of September, I went on vacation and promptly got food poisoning. I would later learn that as I was laid up on my couch – subsisting on chicken nuggets and Uncrustables and using up the last of the bottled water I’d bought the first week of the crisis – the mayor had commented on my water at a town hall the same week.
A recording of the town hall at the New Jerusalem South Church on Sept. 27 shows Lumumba, microphone in hand, standing in front of poster boards of graphs, pictures of O.B. Curtis and a spreadsheet labeled “IMMEDIATE NEEDS.” He starts talking about my water around the 12-minute mark in a tangent about re-watching an interview he gave on national TV.
By now, my tweet had helped shape the national perception of Jackson’s water crisis.
“I was upset, because I did an interview,” Lumumba said. “And y’all know when I do these interviews, I can’t see the packages they’re running, I can’t see the images that they’re running in the background – all I see is a blank screen. And they keep showing this black water coming out of a faucet, right?”
My water, Lumumba went on to say, represented an “extremely rare situation” issue at “one isolated building.”
“That is not what is coming out of your water treatment facility, right?” he said. “You’re not having black water going to every resident. Y’all – y’all live in Jackson. Y’all – how many times have you seen a black water come out of your faucet? Right? I have residents tell me time and time again that they don’t know where that was, right?”
For me, this raised several new questions. Did the city actually send anyone to test my water? How were they able to determine the brown water was isolated to my building? What other discussions did they have about my water? Why didn’t the city reach out to me with their conclusion?
On Oct. 13, I sent an email asking if the city had tested my water to Melissa Faith Payne, the city’s public information officer.
“I believe the discolored water at your building was an isolated incident … and not indicative of the water that actually comes from the plant,” she responded the next day. “I think it had more to do with the lines/pipes at your building. I’ll Loop our public works team in to get more information for you.”
I followed up. What was the mayor’s basis for his comments at the town hall? If it was easier, I suggested, I would be happy to talk with the Public Works employee that tested my water.
“I briefed the Mayor just before the town hall,” Payne replied, adding that she was still waiting on an answer from Public Works.
About a week later, I got a statement from Jordan Hillman, the interim director of Public Works. The department could not make any employees available for an interview, she said, due to the workload of maintaining the water system, but Hillman did explain why the city thought my water was an isolated incident.
“This incident was indicative of a local pipe issue for a variety of reasons including knowledge of water condition leaving plants, water color at nearby fire hydrants, and experience with similar issues,” Hillman said. “There were extremely limited reports of similar water discoloration through our report tool.”
The tool that Hillman is referring to is an online survey the city created for residents to report the color of their water. My coworker Alex Rozier, who has been covering the crisis closely, recommended I fill it out the same day I posted the video.
I asked the experts what they thought of Hillman’s reply.
Knappe, the NC State professor, told me that the water from a fire hydrant isn’t necessarily representative of the color of water inside a home, because the pressure and speed at which water comes out of a hydrant is much greater than a faucet. Kirschoff said that it depends on where the fire hydrant that the city examined was located relative to my apartment.
Unsatisfied, I put in several public records requests. I asked for copies of any communications about my water, which the city has only partially fulfilled.
After a few more days of inquiries, Hillman finally told me that “no samples were taken from your specific home or area at that time.”
I also asked for responses to the report tool. Despite the fact that the mayor said my experience was an “extremely rare situation,” the submissions from other Jacksonian detailing discolored water seem to say otherwise. Out of 565 responses, including mine, to the form since Aug. 29, 423 – or 74% – reported discolored water. The submissions came from across the city but about a third were concentrated in northeast Jackson. (We did not filter duplicates from this count.)
Responses from more than 20 people, a little more than 4%, contained descriptions of brown, gritty water that matched what I had seen in my home. Though far more people used the word “brown” to describe their water, I couldn’t tell if their report matched my experience because the city was supposed to send me pictures that had been uploaded in response to the form but hasn’t.
“Reddish brown water in both toilets strong enough to leave a brown ring,” one person wrote.
“When I boil my water it turn my pot brown inside my bath water have dirt in it,” another person said.
“My water is brown and leaves deposits of dirt..” a third submitted.
I asked Hillman and Payne why the city thought these responses were “extremely limited” on Nov. 4 but I haven’t heard back.
More than two months after my water turned brown, I haven’t had an issue. I’ve gone back to using my water to cook, wash my dishes, and brush my teeth, but every morning, I see reminders and warnings – representations of what could happen again. The grainy water left permanent, hair dye-like splotches on my toilet bowl, bathtub, and sink basin. Now, I always run my water for one minute before I use it.
The city and state seem to have returned to the contentious relationship that preceded the crisis, with both sides accusing the other of providing incorrect information, which only further weakens public confidence in the system.
There’s no sign this will change. As winter sets in, raising the possibility that another freeze could shut down the system, the state is considering if it will lift the emergency declaration. Multiple lawsuits have been filed. And though it’ll become public soon, just last week, the city inked an agreement with the federal government to fix the water system – in secret.
Hundreds of thousands of Mississippians fall within what’s called the “coverage gap” — they work lower-paying jobs that do not offer health insurance, but they also do not qualify for traditional Medicaid coverage.
Although the Children’s Health Insurance Program (CHIP) covers uninsured children up to age 19 whose family income does not exceed 200% of the federal poverty level, some children in Mississippi remain uninsured. There are 41,203 Mississippi children enrolled in CHIP as of October, according to the Division of Medicaid.
Numerous studies have shown that expanding Medicaid — lawmakers choosing to opt into an expanded version of the federal-state health coverage program — would guarantee health care for at least 200,000 primarily working Mississippians who don’t currently have it. It would also cover these currently uninsured children.
But a handful of state political leaders have rejected expansion for more than a decade, ignoring the nonpartisan, reputable experts who have thoroughly studied the effects of expansion.
Below is an interactive, county-by-county map showing the Mississippi children who would qualify for Medicaid if state leaders chose to expand.
Advocates are urging the Mississippi Department of Education to include the disability rights movement in the state’s social studies standards.
Late last year, MDE officials were accused of removing civil rights content from the standards, which then became a focal point for numerous frustrations with social studies education.
The revised social studies standards were first presented to the State Board of Education in December 2021. The proposed changes removed many specific names, events and details in lieu of more broad descriptions. During the first public hearing in January 2022, education department officials walked back this change to the satisfaction of several groups present. Still, other people expressed concern that officials were adding critical race theory to the standards. MDE officials have repeatedly stated the theory is not taught in K-12 classrooms.
At the hearing Friday, seven of the eight speakers advocated for the inclusion of the disability rights movement in U.S. History and minority studies courses, as well as broader education about disabled individuals in earlier grades.
Davonda Ferrell, whose seven-year-old daughter has Down syndrome, felt that the exclusion of the disability rights movement sends the message to her daughter that she is not important.
“It’s only right that when students first start school, they learn about all of the diverse groups that are within our school and community,” Ferrell said. “It is vitally important to start early and often to promote inclusion of all students.”
Scott Crawford, of the Mississippi Coalition for Citizens with Disabilities, said that one in three Mississippians have a disability, but few know how the struggle to be included benefits them today. Crawford mentioned sit-ins led by Judy Heumann, transportation boycotts in Denver, and the “Capitol Crawl” as important examples of activism that led to the passage of the Americans with Disabilities Act.
“This didn’t just happen,” Crawford said. “People put their bodies on the line.”
Other activists said that the representation of the disability rights movement shows disabled children that it is possible for them to lead productive lives.
“All civil rights movements matter, and all should be included in the curriculum,” said Christy Dunaway, a disability rights activist.
Jean Cook, spokesperson for MDE, said they plan to bring the final version of the standards before the State Board of Education at its Dec. 15 meeting, where any changes in response to these comments will be noted.
During her 14 years working as an OB-GYN in Greenville, Dr. Lakeisha Richardson has seen five patients diagnosed with breast cancer during their pregnancies.
Most of them did not have health insurance prior to pregnancy, so going to the doctor for annual checkups was neither affordable nor routine. They missed out on clinical screenings and the chance to learn whether they were at higher risk of breast cancer.
Pregnancy does not cause breast cancer, but it can make it grow and spread more quickly, and breast cancer associated with pregnancy has a lower survival rate. For Richardson’s patients without health insurance, pregnancy brought Medicaid coverage that allowed them to go to the doctor for prenatal visits, and that was when their cancer was diagnosed.
One of Richardson’s patients died from breast cancer a few weeks after giving birth.
“Legislators think, women are healthy, they’re going to have a baby, and they can come off Medicaid,” Richardson said. “They don’t think that other illnesses and disease processes can exist in pregnant women.”
Mississippi doctors like Richardson see thousands of patients every year who have no health insurance, and thus limited access to affordable health care, until they become pregnant and qualify for Medicaid. If the patient has a chronic condition like diabetes or hypertension, getting treatment during pregnancy is critical – but not necessarily sufficient to prevent problems like preterm delivery, low birth weight, birth defects, and even stillbirth.
Access to routine care prior to conception increases the chance a person can have a healthy pregnancy and delivery. But in Mississippi, where one in six women of reproductive age is uninsured, preconception health care is far from universal. Under current Medicaid eligibility policy, adult women can get coverage only when they are pregnant or have kids at home and very low household income.
“If they have a preexisting disease like diabetes or hypertension, if they’re uninsured they’ve probably been off their meds for a while, so they’ll come in with elevated blood pressure, elevated glucose that have been uncontrolled for months or years,” Richardson said. “If it takes them a while to get their Medicaid and they’re already late to prenatal care, they have growth restrictions for the baby.”
But perhaps nowhere are the consequences of sickness – sickness that is largely preventable – more evident than in the unnecessary suffering of Mississippi’s mothers and babies.
Nationally, the leading cause of infant mortality is birth defects. But in Mississippi, the causes are more preventable: premature birth and pregnancy or delivery complications as well as sudden infant death syndrome (SIDS).
Within each of these statistics, Black women and babies suffer much more than their white counterparts.
Expanding Medicaid would not on its own solve Mississippi’s maternal and infant health crisis, which State Health Officer Dr. Daniel P. Edney has identified as a top priority. Health insurance is not the same as access to health care, and access to health care alone is not enough to ensure all Mississippians have healthy food, opportunities to exercise, and safe neighborhoods.
But OB-GYNs interviewed across the state said that lack of access to health care prior to conception is a problem they see every day. They may see a patient get her diabetes or hypertension under control when she has Medicaid coverage during her pregnancy, only to lose coverage and return to self-managing her conditions. They won’t see her again unless she gets pregnant again, and then the process of treating her chronic condition must start all over again.
“We work really hard and optimize their diabetes during pregnancy, and then they’ll be a gap in care between and patients come back for the next pregnancy and it’s like we’re starting from square one again,” said Dr. Sarah Novotny, a maternal-fetal medicine specialist at the University of Mississippi Medical Center.
An analysis by the consulting firm Manatt found that expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line would likely cut enrollment in pregnancy Medicaid by about half – meaning that it would provide more consistent coverage and access to care for about 10,000 women each year who can currently have health insurance only during and right after their pregnancies.
Dr. Jaleen Sims has worked as an OB-GYN at Jackson-Hinds Comprehensive Health Center since 2019. The federally qualified health center offers services on a sliding scale, so it’s affordable for people without insurance.
“I serve the underserved population that experiences the most suboptimal outcomes, the highest comorbidity rates, the highest mortality rates – those are my patients,” she said.
She estimates that more than half of her patients who are pregnant with their first child have not had health insurance as adults before getting pregnant.
Medicaid offers full coverage for pregnant women with incomes 194% of the federal poverty level, or $4,603 monthly for a family of four. That ensures that low-income and working-class women can get health care during their pregnancies. About 60% of births in Mississippi are covered by Medicaid, the second-highest percentage in the country, after only Louisiana.
Hinds County has both the state’s largest number of Medicaid-covered births, at an average of 2,300 annually from 2016 to 2020, and one of the state’s highest per capita rates of pregnancies covered by Medicaid. Some people with pregnancy Medicaid have another form of insurance, too, but generally the rate of Medicaid coverage during pregnancy gives an indication of how many people lacked insurance before they conceived.
Sims sees patients with hypertension, diabetes, obesity, lupus – “those chronic medical conditions that you really want to have under very, very good control before you get pregnant.”
Diabetes is a good example of a condition that can cause problems during pregnancy – but doesn’t have to.
Sometimes Sims sees patients who got treatment for diabetes during a previous pregnancy, but stopped seeing going to the doctor when that coverage ended. Instead, they’ve tried to manage it on their own.
“Then before you know it, they’re out of the medication, they’re just kind of living,” she said. “They’re like, ‘Well, I don’t check my finger sticks, I don’t have my insulin, I don’t have my medicine. Now I don’t really know where I am at this point.’”
During pregnancy, doctors try to keep blood sugar tightly controlled. That becomes harder to accomplish when the patient’s condition isn’t well managed when they arrive for their first prenatal visit.
If blood sugar is elevated during the first 10 weeks when the fetus’s organs are developing, the risk of birth defects is higher, Novotny said, even if blood sugar is controlled later in the pregnancy.
“A lot of times women haven’t been in care, they find out they’re pregnant, sign up for Medicaid, and by the time they come to us, it’s often the end of the first trimester, when damage may already be done,” she said.
Spina bifida and heart problems are the most common birth defects associated with diabetes. People with diabetes are also at risk for preterm delivery.
Dr. Emily Johnson, an OB-GYN in the Jackson area, said it’s important for people to know that chronic conditions and risk factors during pregnancy can be managed with very good outcomes. Early communication between provider and patient is critical.
“I think them knowing that information helps them have a little autonomy that they can be responsible for their blood pressure and they know what they’re supposed to call me for,” she said. “Communicating about the risk can help them take a little ownership of it and in some way provide some reassurance.”
For many uninsured women in Mississippi, getting signed up for Medicaid is one of the first rituals of pregnancy. But getting approved is a hurdle that for some people can delay their prenatal care by days or weeks.
Providers said they largely see patients get approved within a month or so. A mistake on the paperwork, however, can delay approval.
Matt Westerfield, spokesperson at the Division of Medicaid, told Mississippi Today that according to a recent analysis by the Office of Eligibility, the average approval time for pregnancy Medicaid from Aug. 2021 to Aug. 2022 was about 24 days. That’s slightly higher than the average approval time in 2021 for all eligibility categories of 20 days, according to documents Mississippi Today obtained through a records request.
Even a delay of a few weeks can make a difference, given the importance of early prenatal care. Dr. Kushna Damallie, an OB-GYN at The Woman’s Clinic in Clarksdale, said he would like to see a patient as soon as she misses a period. But that often doesn’t happen.
“One of the biggest hurdles we have in our practice is late prenatal care, no prenatal care, or insufficient prenatal care,” Dumallie said.
Westerfield told Mississippi Today that the Division of Medicaid doesn’t track when women go to their first prenatal visit or what percentage take place during the first trimester of pregnancy.
Richardson said early prenatal care is particularly important for women with a condition called an incompetent cervix, in which weak cervical tissue can cause very early delivery. Black women are more at risk for this condition. One treatment to help ensure a successful delivery is a cervical cerclage, in which providers stitch the cervix closed, usually around 12 to 14 weeks of pregnancy. If that doesn’t happen in time, the risk of miscarriage is higher.
In August of this year, Richardson had a patient who was in the hospital because her water had broken well before viability. The patient had known she needed to get treatment for her incompetent cervix but had not been able to get an appointment early enough.
“She moved from another state, so she didn’t have her Mississippi Medicaid and so she couldn’t get in anywhere to be seen,” Richardson said.
OB/GYN Dr. Nina Ragunanthan poses for a portrait inside of Delta Health Center in Mound Bayou, Miss., Thursday, July 14, 2022. Credit: Eric Shelton/Mississippi Today
While Medicaid expansion is a taboo topic among Republicans in the Legislature, extending Medicaid coverage for postpartum women has bipartisan support. A measure to extend coverage from 60 days to 12 months postpartum passed the Senate resoundingly in the last session, before House Speaker Philip Gunn killed it.
Today, Mississippi is one of just two states that has neither expanded Medicaid eligibility nor extended postpartum coverage.
Senate Republicans including Sen. Kevin Blackwell, R-Southaven, who sponsored the measure, have vowed to reintroduce the measure in the next session, though Gunn still opposes it.
Gunn recently said he believed postpartum Medicaid extension would help only a few thousand women in Mississippi, referring to his calculation that only 60% of the 5,000 new births expected annually after the state’s abortion ban would be covered by the program and dismissing the 21,000 people already covered by pregnancy Medicaid each year.
When discussing crisis pregnancy centers, which already get a $3.5 million tax credit from the state and which Gunn wants to expand to $10 million, he offered no information about the number of people they serve and how, probably because that data is not being collected by the state.
Providers largely say they’d welcome any opportunity to lengthen the amount of time their patients have health insurance. Novotny, the maternal-fetal medicine specialist, said 12 months of coverage postpartum would give her patients a chance to control their diabetes for a longer period before becoming pregnant again.
“They’ve been able to continue the management of their chronic diseases so that when they’re ready to get pregnant again, they are in a good place,” Sims said.
But postpartum Medicaid does nothing to improve access to health care before conception.
Some advocates are concerned that the conversation about postpartum Medicaid could distract from the need to address Mississippi’s health care crisis more broadly.
Nakeitra Burse, a public health consultant and advocate focused on maternal health, said some of the discussion of postpartum Medicaid seems to reflect a belief that pregnancy can be separated from the rest of a life.
“A person’s already experiencing obesity, diabetes, high blood pressure, and then you add pregnancy on top of that, then pregnancy also becomes a condition,” Burse said. “So you’re trying to treat all these things at one time, when people don’t even just have the opportunity to make the healthy decisions for themselves because they don’t have access to care.”
When patients do get access to care during pregnancy, making it to a doctor’s appointment isn’t as easy as it sounds.
“A lot of that decision making means: Do I miss work to go to the doctor? Do I go to the doctor over my child? It’s a lot of push and pull and give and take for the decision making that shouldn’t have to happen, if we had opportunity or access to quality health care.”
Dr. Nina Ragunanthan, an OB/GYN in Mound Bayou, pointed out that the focus on pregnancy and postpartum coverage, rather than expanding access to health care for everyone, implies that women are more deserving of care if they are giving birth than if they are not.
“I think it’s really important not to just pigeonhole a woman as a child bearing vessel,” she said. “Access to care for that woman as an autonomous, independent person, regardless of whether she plans to get pregnant or not, is very important.”
State Sen. Hob Bryan, chairman of the Senate Public Health Committee, joins Mississippi Today’s Adam Ganucheau and Bobby Harrison to discuss the state’s growing hospital crisis. Bryan’s committee is hosting a hearing to discuss potential long-term solutions.
Compared to other states, Mississippi ranks at the bottom of mosts lists concerning health issues and access to health care. Mississippians are also faced with another serious problem: the closure of hospitals.
Mississippi Today photographed shuttered hospitals across the state as more and more are closing due to rising cost within the industry. Currently, six hospitals have closed in Mississippi since 2005. Dozens more are expected, according to top health officials in the state.
Patient’s Choice Medical Center of Humphreys County in Belzoni., Miss., Wednesday, November 9, 2022. The rural hospital closed in August 2013. Credit: Eric Shelton/Mississippi Today
Patient’s Choice Medical Center of Humphreys County in Belzoni., Miss., Wednesday, November 9, 2022. The rural hospital closed in August 2013. Credit: Eric Shelton/Mississippi Today
A sign directing to the emergency room at Patient’s Choice Medical Center of Humphreys County in Belzoni., Miss., Wednesday, November 9, 2022. The rural hospital closed in August 2013. Credit: Eric Shelton/Mississippi Today
Kings Daughters Hospital in Greenville, Miss., Wednesday, November 9, 2022. The hospital closed in March 2005. Credit: Eric Shelton/Mississippi Today
A historical marker for the Kings Daughters Hospital in Greenville, Miss., Wednesday, November 9, 2022. The hospital closed in March 2005. Credit: Eric Shelton/Mississippi Today
Pioneer Community Hospital of Newton on Thursday, Nov. 10, 2022. The hospital closed in December 2015. Credit: Eric Shelton/Mississippi Today
Merit Health Natchez-community Campus in Natchez, Miss., Friday, November 11, 2022. The hospital closed in November 2005. Credit: Eric Shelton/Mississippi Today
Kilmichael Hospital in Kilmichael, Miss., Thursday, November 10, 2022. The hospital closed in January 2015. Credit: Eric Shelton/Mississippi Today
Southern politicians have a long history of opposing efforts to provide government-sponsored health care for their constituents.
In 1947, President Harry Truman proposed legislation that essentially would provide universal health care paid through fees and taxes. Remember, health care options for working people in those days were even more dire than now with fewer people having employer-based health insurance.
Truman’s proposal was killed in part by Southern Democrats in the U.S. House and Senate. Nobel Prize-winning economist Paul Krugman wrote in his book, “The Conscience of a Liberal,” that Southern politicians opposed the plan of the Democratic president because they feared that it would lead to a government mandate to integrate hospitals.
“Keeping Black people out of white hospitals was more important to Southern politicians than providing poor whites with the means to get medical treatment,” Krugman wrote.
Southern politicians, as it turns out, are still not crazy about government-sponsored health insurance.
A quick glance at a map of the states that have and have not expanded Medicaid is startling. Of the 11 states that have not expanded Medicaid, eight (if Texas is included) are Southern states.
The map of the non-expansion states, a matter of fact, looks a lot like the footprint of the collegiate Southeastern Conference sports league with the exception of Louisiana, Arkansas, Kentucky and Missouri. Those four states have expanded Medicaid. Granted, most would say that Missouri is not a Southern state, but it is in the SEC.
At any rate, it is the SEC states, led by Southern politicians, now Republican Southern politicians, who are again resisting efforts to expand government-sponsored health care to help their poor constituents.
No longer, of course, are hospitals segregated. They were integrated in the 1960s, according to Krugman, when another government-sponsored program was enacted: Medicare, which provides health care to the elderly.
While it has been established by various studies that the largest percentage of people who would benefit from Medicaid expansion are people of color, it is important to point out that there are many white citizens who also would benefit.
Medicaid expansion, as is allowed as part of the Patient Protection and Affordable Care Act, provides health insurance for primarily the working poor — for people earning up to 138% of the federal poverty level, or $18,754 per year for an individual. In Mississippi, the traditional Medicaid program covers, generally speaking, poor pregnant women, poor children, certain groups of poor retirees and the disabled, but not the working poor.
The federal government pays the bulk of the health care costs for those on Medicaid expansion. When Southern politicians express their opposition to Medicaid expansion, they often simply proclaim they “are against Obamacare” as if that is enough reason to oppose it.
“I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I don’t know how many ways I can explain this to y’all,” Republican Gov. Tate Reeves said in response to reporters’ questions.
When the nation’s only Black president — Barack Obama — passed through Congress in 2010 the Affordable Care Act, almost all Republicans were opposed to “Obamacare.” But now solid Republican states like Montana, North Dakota, Utah and Idaho have embraced Medicaid expansion. In Republican-controlled South Dakota, voters just approved a ballot initiative to adopt Medicaid expansion. For the most part, it is just Southern politicians eschewing Medicaid expansion.
John Bell Williams also was against expanding health care when he served in the U.S. House representing Mississippi. As a congressman, he voted against Democratic President Lyndon Johnson’s plan to enact a Medicaid program for a small population of the underprivileged.
But as governor, Williams later called a special session in 1969 and urged the Legislature to opt into the Medicaid program.
In a speech to the Legislature, Williams said, “Let us not delude ourselves into the false notion that we can — or will — evade the burden of caring for these unfortunate people. Our society, through the instrument of government, has always shouldered this responsibility, and I am sure it always will.”
Williams went on to say the state could not afford to turn down a federal health care program that would require the state to provide only 20% of the matching funds. He spoke of the economic impact it would have on the state.
“The simple fact is that someone pays for health services, and we must decide, who will do it and how,” he explained.
The special session lasted from July 22 to Oct. 11. In the end, the Mississippi Legislature opted into the program, proving that Southern politicians did not always oppose improving health care for their poor constituents.
Whether that will happen with Medicaid expansion remains to be seen.
La crisis de atención médica de Mississippi ha llegado a un punto sombrío, catastrófico e inevitable.
Los hospitales están cerrando y muchos más están al borde. Ya se están recortando servicios de salud esporádicos. Cientos de miles de habitantes de Mississippi no pueden pagar la atención que necesitan. Demasiada gente está muriendo.
Lo peor de todo es que los líderes de nuestro estado no parecen tener prisa por ayudar.
En momentos tan sombríos, es difícil no reflexionar sobre algunos “qué pasaría si”. Hoy podría haber sido un día celebrado como una victoria para el futuro de Mississippi, uno que realmente cambió la trayectoria del estado. Una abrumadora mayoría de republicanos y demócratas se dirigirían a las urnas y decidirían hacer por sí mismos lo que sus funcionarios electos se han negado a hacer durante más de una década: expandir Medicaid.
Expandir Medicaid, como lo han hecho otros 38 estados y dos más están a punto de hacerlo, abordaría de inmediato algunos de los aspectos más urgentes de la crisis. Brindaría atención médica a cientos de miles de habitantes de Misisipi pobres y trabajadores que no pueden pagar viajes al médico para atención básica o emergencias. Le daría un empujón inmediato a las docenas de hospitales que luchan por equilibrar los presupuestos y mantener sus puertas abiertas. Aportaría a nuestro estado más pobre de la nación más de mil millones de dólares en nuevos ingresos cada año. Crearía decenas de miles de nuevos puestos de trabajo y salvaría innumerables vidas y medios de subsistencia.
Pero no habrá tal celebración hoy.
El año pasado, la Corte Suprema de Mississippi emitió un fallo sin precedentes que eliminó el proceso de iniciativa electoral de Mississippi, que otorgaba a los votantes el poder directo de cambiar las leyes. Esa decisión judicial ampliamente impopular detuvo una campaña bipartidista para recolectar firmas para poner la expansión de Medicaid en la boleta electoral este noviembre. Y los líderes legislativos estatales, muchos de los mismos que han rechazado la expansión de Medicaid durante más de 10 años, rompieron sus promesas de restaurar ese poder a los votantes.
Desde que lanzamos en 2016, Mississippi Today se enorgullece de responsabilizar a los funcionarios electos y ha brindado a los habitantes de Mississippi la información que necesitan para hacer lo mismo. Durante meses, nuestros reporteros políticos y de atención médica han cubierto de cerca la creciente crisis y sus efectos. Pero ningún problema merece un escrutinio más centrado e intensivo que la inacción de nuestros líderes durante este tiempo.
Entonces, esta semana, estamos lanzando un proyecto a largo plazo que se enfoca en la crisis inminente y las posibles soluciones, incluida la expansión de Medicaid.
Más de una docena de empleados de Mississippi Today han estado trabajando en este proyecto durante varias semanas. Seremos minuciosos e independientes, duros y justos. Pero, por encima de todo, seremos obstinados en nuestra búsqueda de la verdad.
Nuestro proyecto, ante todo, definirá minuciosamente el alcance de la crisis de atención médica de Mississippi. Mostrará cómo cientos de miles de habitantes de Mississippi que trabajan no pueden pagar la atención preventiva básica que mantiene a raya las visitas al hospital más costosas y las debilitantes deudas personales. Mostrará cómo Mississippi tiene más hospitales rurales en riesgo inmediato de cierre que cualquier estado de la nación y lo que eso significa para tantas comunidades en todo el estado. Mostrará cómo la inversión abismalmente baja del estado en salud pública afecta negativamente a todos los habitantes de Mississippi, incluso a aquellos que tienen seguro médico privado y pueden obtener la atención que necesitan.
También definiremos qué es exactamente Medicaid. La política federal es torcida e increíblemente difícil de entender. El término “expansión de Medicaid” en sí mismo se ha convertido en un arma por parte de políticos oportunistas, utilizado como una cortina de humo para evitar hablar seriamente sobre sus méritos. Nuestro objetivo es eliminar la jerga y el ruido político para mostrar los efectos directos de la política, cómo podría cambiar vidas en todo el estado y qué podría ganar el estado al aprobarla.
Y quizás lo más importante, confrontaremos directamente la política de la crisis. A pesar de que los gritos de intervención estatal han crecido en ambos lados del pasillo político, un puñado de funcionarios electos aparentemente ha decidido que no es digno de atención. Regularmente invocan el nombre del expresidente Barack Obama, quien defendió el programa federal de salud en cuestión, como la principal razón para no expandir Medicaid. Ignoran los estudios económicos no partidistas que muestran los enormes beneficios para el estado. Con demasiada frecuencia, aparentemente incluso han ignorado la crisis de atención médica en sí.
Muchos de estos funcionarios electos han dicho constantemente que no creen que el estado pueda permitirse expandir Medicaid. Siempre escucharemos y compartiremos sus explicaciones al respecto, y buscaremos comprenderlas mejor. Pero no podemos ignorar el contexto apropiado de los expertos estatales y nacionales que tienen conjuntos de datos que muestran lo contrario. Y hablaremos con los funcionarios electos en otros estados, incluidos los líderes en docenas de estados rojos que han ampliado Medicaid, sobre cómo les está yendo bien en su decisión.
Esperamos que nuestro periodismo obligue a los líderes de nuestro estado a al menos reconocer y tener en cuenta los desafíos de atención médica que todos enfrentamos. Más allá de eso, los presionaremos respetuosamente con preguntas sobre posibles soluciones.
Algunos cuestionarán el momento de este proyecto. Los legisladores generalmente ignoran abordar los problemas principales en las sesiones legislativas durante los principales años electorales en todo el estado, como en 2023. Desde nuestra perspectiva, no hay mejor momento para plantear estas preguntas que durante un año electoral.
Otros nos acusarán de partidismo o de propugnación. Una realidad importante que consideraremos a diario mientras servimos al público: una gran mayoría de los habitantes de Mississippi, independientemente de su inclinación política, apoya la expansión del acceso a la atención médica para los trabajadores pobres. La gran mayoría de los habitantes de Misisipí apoya la aceptación de fondos federales para ayudar a mantener abiertos los hospitales. Y nadie puede cuestionar que todos los habitantes de Mississippi quieren un futuro mejor para sus hijos y para ellos mismos.
Dentro de un año, cuando los 174 escaños legislativos y los ocho cargos estatales estén en la boleta electoral, cada votante tendrá la capacidad de comprender íntimamente cuál es la posición de sus líderes sobre la crisis de atención médica y qué han hecho, o dejado de hacer, para abordarla. . Nos aseguraremos de ello.
Si tiene preguntas, sugerencias o comentarios sobre este proyecto, comuníquese con el editor en jefe Adam Ganucheau en adam@mississippitoday.org.
