Perhaps no other federal-state policy has been studied and debated more than Medicaid expansion per the federal Affordable Care Act, including its potential impact on Mississippi — one of just 12 states that has not expanded the program.
A Kaiser Family Foundation report notes there have been more than 400 studies on the topic nationwide. And in Mississippi, the poorest and unhealthiest state in the nation, numerous studies have focused on what expansion would mean. A majority project net positive benefits economically, health-wise or both.
Expansion would mean someone making $18,754 a year (138% of the poverty level) would be eligible for health care coverage through the federal-state program. The federal government would pay 90% of the costs for those covered, with the state paying 10%.
When Medicaid expansion began Jan. 1, 2014, the federal government paid 100% of the costs, stepped down to 90% over years. Mississippi missed out on the larger matching rates from the federal government.
But under the recent American Rescue Plan, the 12 states that have not expanded Medicaid have been offered a financial incentive to do so. That equates to more than $700 million for Mississippi, and more recent studies have factored in those incentives.
The studies on Medicaid expansion in Mississippi
• Mississippi University Research Center/IHL, 2021:This analysis of the fiscal and economic impact of expansion was authored by state Economist Corey Miller and senior Economist Sondra Collins. It found expansion would add about 230,000 adults to Mississippi’s Medicaid rolls between 2022 and 2027. It would produce an average of 11,000 new jobs a year during that time and provide an additional $44 million a year to the state general fund.
The study found that expansion would increase the state’s gross domestic product by more than $700 million a year over five years, increase personal income between $539 million and $812 during the same period and increase the state’s population between 3,300 and 11,500 annually over the same period.
• Commonwealth Fund study, 2021:The study estimates expansion would cost the state $956 million over five years, while generating $1.2 billion in savings for a net gain to state coffers of $212 million. The study estimates expansion would provide coverage for about 230,000 adults.
• Urban Institute/Robert Wood Johnson Foundation national study, 2020: This was a study of the impact of expansion on the then 15 states that had not expanded Medicaid. The study projected that expansion in Mississippi would bring an increase of 207,000 enrollees and an increase in state Medicaid costs of $177 million a year, but did not attempt to calculate any increased revenues or savings.
• Perryman Group study of Mississippi Cares plan, 2019:This was a study of the Mississippi Hospital Association’s “Mississippi Cares” alternative expansion plan. MHA proposed creating a public-private partnership, expanding eligibility to adults earning up to 138% of the poverty level, but imposing a $20 a month premium on enrollees and a $100 copay for non-emergency use of hospital emergency rooms. Hospitals would cover remaining state costs. The Perryman study projected the plan would create an additional 36,000 jobs a year on average for the first 11 years and provide an increase in state tax revenue, a decrease in private insurance premiums and a reduction in uncompensated care costs of $252 million a year. The plan also included a requirement that unemployed beneficiaries enroll in job training or education programs.
• University of Alabama Birmingham study for Mississippi Health Advocacy Program, 2013:This study, by UAB’s Department of Health Care Organization and policy, modeled the impact of expansion on enrollment, state and federal costs, employment and state tax revenue from 2014 to 2020. It projected expansion would result in 212,362 more enrollees by 2020, would generate 19,318 additional jobs in 2020, with $200 million in additional state and local tax revenue. It projected an overall state budget savings of $34 million in 2020 and projected expansion would produce $2 billion in economic activity annually.
• Kaiser Foundation/Urban Institute national study, 2012:This study projected the effect of expansion on costs and enrollment nationally and by state from 2013 to 2022. The study projected expansion in Mississippi would cost the state about $1 billion for the period, and result in an additional 231,000 enrollees. The study listed the additional costs without estimates of any savings or increases in tax revenues.
• Mississippi University Research Center/IHL, 2012:This study projected the impact of expansion on Medicaid costs, enrollment, and net economic impact on the state budget from 2014-2025. The study used three scenarios, high, medium and low participation, predicting that high participation of an additional 310,000 enrollees was most likely. It predicted the state’s cost of expansion would be about $118 million by 2020, but that expansion would create about 9,000 new jobs a year and have a net positive impact on the state budget of nearly $65 million by 2020.
• Milliman Inc. study, 2010, 2012: The Mississippi Division of Medicaid contracted this analysis of Mississippi Medicaid’s budget exposure to the ACA from fiscal 2011-2020, and it was updated in 2012 and is still referred to frequently by opponents of expansion. The report modeled three scenarios – low, moderate and high enrollee increases and said moderate or low scenarios were most likely. The report projected under the moderate scenario that 243,000 additional adults and 67,000 more children would enroll and the state share of Medicaid costs would increase by $1.26 billion over the time period, including costs for current and additional enrollees. It estimated that by fiscal 2020, the state would see increased costs of $280 million a year.
The 2012 report modeled enrollment and costs from fiscal 2014-2020 under various scenarios. Under the higher enrollment scenario, it estimated expansion would cost the state $155 million a year by 2020. It focused on the Medicaid budget and did not estimate any cost offsets from other programs or from additional tax revenue.
The Mississippi State Board of Education on Thursday approved a multi-million dollar contract to a company whose vice president chaired the state board until last spring.
The board voted 5-2 to approve the contract to the PATH Company to administer a loan program established by the Legislature earlier this year. The contract will pay up to $3.6 million over a four-year period, providing $1.2 million in the first year. Two members of the company’s leadership have ties to state government: Senior Vice President of Business Development Jason Dean is the former chair of the State Board of Education, and Co-Founder and Principal Nathan Wells is the former chief of staff to Speaker of the House Phillip Gunn.
The Educational Facilities Revolving Loan Fund makes money available to school districts as a zero-interest loan for repairs and renovations of existing school buildings and new construction for pre-K programs or career and technical education facilities. In its first year of operation, the Legislature allocated $40 million to the revolving loan fund.
The company will be responsible for reviewing the construction plans of districts to ensure that they are “critical infrastructure improvements” and adhere to building codes, as state law requires, and for tracking the repayment of the loans.
When asked by Mississippi Today about the possible conflict of interest with Dean’s employment, the Mississippi Department of Education pointed to the Public Procurement Review Board manual, which establishes that former membership to a board is only considered a conflict of interest if it has been less than one year since the former member exited the board. Dean left the board in April 2021.
Dean told Mississippi Today the contract was awarded through a public competition that numerous other construction management companies could have applied to, but did not.
“Obviously, I know people that are on the State Board of Education,” Dean told Mississippi Today. “I did not contact them and use any personal relationship at any point to influence the decision. I wanted it to be awarded to us objectively based on merits.”
Bill Jacobs, a state board member, questioned spending such a large amount for reviewing construction plans and financial record keeping, and asked why PATH Company was overseeing the loan repayment program instead of an accounting firm or similar financial entity.
Felicia Gavin, chief of operations for the Mississippi Department of Education, said the law creating the program allows no more than 3% of the funds to be spent on administrative costs, which the contract adheres to. Gavin also said that while the PATH Company was the only group to apply for this contract, the proposal met all the criteria, including their financial management abilities. On the company’s website, its work is described as “help(s) entities utilize technology to create better efficiencies in the areas of energy, water, and/or operations.”
Dean added that PATH has internal financial managers, and the company stated in its proposal that it plans to bring in an additional accounting firm to assist in the financial management of the loans.
Flush with $2.3 billion in federal pandemic relief funds, school districts across the state are working to spend them on infrastructure improvements, technology, and catching up on learning lost in the pandemic.
The Elementary and Secondary School Emergency Relief (ESSER) Fund was created initially by the Coronavirus Aid Relief and Economic Security (CARES) Act and then subsequently replenished in two other pieces of federal legislation, creating three separate pots of money for the state and districts to spend.
Mississippi Today reviewed the spending plans and spoke to local officials in three school districts which collectively received roughly $207 million: the Jackson Public School District, Ocean Springs School District, and Starkville-Oktibbeha Consolidated School District. Across the districts, the major spending themes are reopening schools safely, learning loss recovery, and infrastructure improvements.
A national analysis of district spending plans by FutureEd, an education policy think tank at Georgetown University, found that districts with higher poverty levels are receiving significantly more ESSER dollars per student, nearly 10 times more when comparing the highest and lowest poverty districts. FutureEd said this difference stems from Congress allocating the funds using the Title I funding formula, which distributes federal funding to schools based on the number of low-income students enrolled.
FutureEd also found that the higher the poverty rate in a district, the more likely administrators were to allocate money to heating, venting, and air conditioning (HVAC) updates and purchasing new instructional materials.
For example, in the Jackson Public School District, every school is budgeted to receive HVAC renovations, which are also often accompanied by window replacements or roof repairs. Chief of Staff William Merritt explained that these additional repairs are necessary to ensure that the new HVAC systems can run effectively.
Merritt said it would have been ideal to be allowed to use the federal dollars for building new facilities, since the district’s aging infrastructure means that repairing one problem often means finding another, but “that’s something that we can’t necessarily do at this time,” referencing the federal regulations that limit new construction.
Statewide, districts are using, on average, nearly half of their money from the third and largest pot of federal dollars on infrastructure. Most of it has gone to HVAC upgrades, buses, outdoor learning spaces, bathroom upgrades, technology, and new floors.
All three of the districts Mississippi Today spoke to are investing in HVAC upgrades. Leaders said these upgrades are a good preventative measure against airborne diseases like COVID-19, and a needed long-term investment because many buildings have outdated units.
District leaders also explained that the influx of federal dollars has created a supply and demand problem for contractors and parts. Coupled with the national supply chain issues, upgrades have been more costly in some cases and districts are pressured to get all of their projects done on time.
National leaders have recognized this pressure, giving states the ability to apply for extensions up to 14 months past the original deadlines. Since the funding came in waves, the spending deadlines do as well. The deadlines to have the money obligated for each pot are Sept. 30 of 2022, 2023, and 2024, but a grace period is built in that gives schools a few extra months to disperse final payments. Per the new extension option that is available, these initial deadlines to award contracts will still be in place, but the grace period to make payments on those contracts has been extended.
The Mississippi Department of Education confirmed that they are applying for an extension on the first round of federal funding.
The first pot of money, which districts began receiving in the summer of 2020, was targeted to reopening schools. It was used to make a significant investment in sanitation, initially meeting the immediate need for masks and cleaning supplies, later purchasing disinfectant sprayers with additional funding.
Anna Guntharp, assistant superintendent in the Starkville-Oktibbeha Consolidated School District, said that initial emphasis on personal protective equipment came from Centers for Disease Control and Prevention guidance, but that they have found it to be a good practice to keep generally even as public understanding about how COVID spreads has changed.
“There’s always a risk of transmitting viruses of any kind in a school,” Guntharp said. “Going forward, during flu season or even common cold season, we want to keep our kids safe. I think it was still money well spent even post COVID-19.”
Reopening efforts also included significant purchases of technology. The push to get each student a device saw significant support from the Legislature and Mississippi Department of Education, but districts also spent millions on laptops, tablets, video conferencing cameras, improving broadband connectivity, licensing virtual learning programs, and digital textbooks.
This investment in technology has long-lasting benefits for the students in the Jackson Public School District, according to Merritt, the chief of staff. The district, which often struggles with school closures caused by water pressure issues, will now be able to pivot to virtual instruction for other circumstances outside of a spike in disease transmission to avoid lost school days.
Extending instructional time is a key tactic to addressing the national decline in student achievement since 2019, frequently referred to as pandemic learning loss. This decline is one of the major focuses of the federal funding, with Congress creating a requirement for the third and largest pot of money that at least 20% must be spent addressing learning loss.
Districts are primarily pursuing two methods to address this decline: interventionists to work directly with students on concepts they’re struggling with in their larger classes, and after school and summer school programs to increase classroom hours.
Tonya Bolton, director of federal programs for the Ocean Springs School District, said the district has been analyzing data for each school to determine individualized areas of need, focusing on concepts from earlier grades that students may have missed and getting them up to grade level. Bolton said internal data shows their efforts have been effective enough that they may continue to invest money in having interventionists even after the federal funding runs out.
Guntharp said approximately 14% of students in the Starkville-Oktibbeha School District are currently working with interventionists, and the district is also looking for ways to afford retaining the ones they hired after the district runs out of federal funds.
Laura Anderson, associate director of the Edunomics Lab, said increased per-student spending doesn’t always lead to better outcomes, which makes it crucial for districts to constantly evaluate the effectiveness of their learning loss recovery plans – a sentiment education researchers have also echoed in recent reports on district level learning loss.
“We have this infusion (of money); what are our kids getting for it?” Anderson asked. “And if we don’t think that we’re getting the results that we wanted for our kids, how do we pivot? Districts have to be told it’s okay to be nimble and to make those changes.”
Los oficiales del Centro Médico de la Universidad de Mississippi dijeron el viernes que las negociaciones para hacerse cargo del Hospital Greenwood Leflore en dificultades han terminado y que no es posible llegar a un acuerdo.
Sin un acuerdo con UMMC, el hospital podría cerrar antes de fin de año.
“A pesar de los mejores esfuerzos de todas las partes involucradas, nos ha quedado claro que un acuerdo entre el Centro Médico de la Universidad de Mississippi y el Hospital Greenwood Leflore no será posible”, dijo el Dr. Alan Jones, vicerrector asociado de asuntos clínicos en UMMC.
Dijo que un acuerdo no es posible debido a varios factores, el principal es “las realidades actuales de la economía de la atención médica que enfrentan todos los sistemas de salud en este entorno desafiante”
El presidente del Concejo Municipal de Greenwood, Ronnie Stevenson, le dijo a Mississippi Today que la decisión de UMMC fue un shock cuando se enteró alrededor de la hora del almuerzo el viernes.
UMMC y Greenwood Leflore habían estado en conversaciones sobre un posible acuerdo de asociación desde el verano. El CEO interino de Greenwood Leflore, Gary Marchand, dijo al personal la semana pasada que ningún acuerdo estaría listo antes de principios de 2023, a pesar de las esperanzas anteriores de completar el proceso para fines de año.
El Ayuntamiento de Greenwood y la Junta de Supervisores del Condado de Leflore, los propietarios conjuntos del hospital, votaron la semana pasada para aportar casi $10 millones para cubrir las deudas pendientes de Medicare y los costos de mantenimiento diferidos que UMMC dijo que no quería asumir si se hacía cargo de las operaciones.
“Estoy muy decepcionado con su decisión”, dijo Stevenson. “Nos han retenido durante meses, pensando que esto iba a pasar, y nosotros, como ciudad y condado, cumplimos con todas sus demandas o acordamos cumplir con todas sus demandas, y que se retiraran en el último minuto, dejándonos seco así, es difícil de digerir en este momento”.
Stevenson dijo que los líderes locales no saben de otro socio potencial para operar el hospital.
“No teníamos un Plan B”, dijo. “Pero tenemos que ir a buscar uno”.
Mientras, es probable que el hospital tenga que seguir recortando empleos y servicios en un esfuerzo por mantener las puertas abiertas el mayor tiempo posible, dijo.
El presidente de la Junta de Supervisores del Condado de Leflore, Robert Collins, dijo en un comunicado que los supervisores “siempre habían estado preocupados” de que un acuerdo entre UMMC y el Hospital Greenwood Leflore no se llevara a cabo.
“Entendiendo que no somos expertos en atención médica, hemos contratado los servicios de consultoría de Samuel Odle y (sic) un ejecutivo de atención médica experimentado”, dijo el comunicado. “Señor. El papel de Odle es ver la situación y asesorar a los supervisores y a la comunidad sobre las opciones viables para mantener (sic) la atención médica en nuestra comunidad”.
Marchand les dijo a los empleados el viernes por la mañana que el hospital despediría hasta 80 empleados para reducir los costos mientras continuaban las negociaciones con UMMC. El memorando no contenía ninguna indicación de que el acuerdo de asociación se hubiera retirado de la mesa.
Un comunicado de prensa del Hospital Greenwood Leflore sugiere que la decisión fue una sorpresa para los funcionarios del hospital.
“Aunque ciertamente podemos entender y apreciar el desafío de brindar servicios de atención médica en la era posterior a la pandemia, esta decisión no se esperaba en función del progreso que se había logrado con respecto a una transacción de arrendamiento”, dijo el comunicado. “Las realidades financieras de brindar servicios de atención médica están afectando a ambas organizaciones”.
Cuando se le preguntó si el estado intervendría para ayudar al hospital, el vicegobernador Hosemann dijo que estaba decepcionado de que las partes no pudieran llegar a un acuerdo.
“Los problemas financieros que enfrenta el cuidado de la salud se están volviendo universales en nuestro estado. Necesitamos un plan universal para abordarlos”, dijo en un comunicado a Mississippi Today.
El presidente de la Cámara, Philip Gunn, no respondió de inmediato el viernes por la tarde. Los legisladores estatales viajaron a Jackson esta semana para una sesión especial para aprobar un acuerdo de incentivo fiscal de $246 millones para ayudar a una corporación de otro estado a expandir sus operaciones en el estado. El gobernador Tate Reeves, quien centró sus comentarios públicos esta semana en la creación de empleos del proyecto, no incluyó políticas para el cierre de hospitales rurales ni ninguna otra necesidad apremiante que enfrenta el estado en su llamada a sesión especial.
Los funcionarios de ambos hospitales dijeron que continuarán discutiendo los servicios médicos en Greenwood y el condado de Leflore, incluida la operación de UMMC de una clínica de pediatría general y una clínica de obstetricia y ginecología. UMMC pronto también administrará una clínica de medicina interna y atención primaria en el área.
“Continuaremos evaluando otras oportunidades a medida que surjan para mantener algunos servicios de atención médica en la comunidad”, dijo Jones.
Stevenson dijo que el hospital es fundamental para Greenwood y el condado de Leflore.
“Esta comunidad necesita un hospital”, dijo. “No queremos tener que ir corriendo a Jackson… Queremos salvar vidas aquí, y tener un hospital comunitario salvará vidas”.
Desde 2005, han cerrado cinco hospitales rurales en Mississippi.
El oficial de salud estatal, el Dr. Daniel Edney, aludió a la amenaza continua al Hospital Greenwood Leflore durante la reunión de la junta estatal de salud el mes pasado, cuando describió la infraestructura de atención médica en el Delta como “muy frágil” y dijo que al menos seis hospitales en la región son enfrentando serios desafíos financieros. En ese momento, las negociaciones entre UMMC y Greenwood Leflore parecían estar encaminadas.
“A pesar de lo que se ha informado en los medios, actualmente no hay soluciones para esos hospitales”, dijo. “Nadie viene al rescate”.
Nota del editor: Kate Royals, editora de salud comunitaria de Mississippi Today desde enero de 2022, trabajó como escritora/editora para la Oficina de Comunicaciones de UMMC desde noviembre de 2018 hasta agosto de 2020, escribiendo comunicados de prensa y artículos sobre las escuelas de odontología y enfermería del centro médico.
Andrés Fuentes
Andrés Fuentes es periodista de FOX8-TV en Nueva Orleans y traductor de Mississippi Today. Antes de que el nativo de Nueva Orleans regresara, era periodista para WLOX-TV en Biloxi, Mississippi.
Legislative leaders and Gov. Tate Reeves have agreed on a revenue estimate that will result in lawmakers having about $500 million more than last year to spend when they convene in January to start work on a budget for the new fiscal year.
Members of the Legislative Budget Committee, including House Speaker Philip Gunn and Lt. Gov. Delbert Hosemann, met with Reeves Wednesday morning to develop the official revenue estimate of $7.52 billion for the new fiscal year, starting July 1. The revenue estimate used by House and Senate leaders this past April when legislators passed the budget for the current fiscal year was nearly $7 billion.
The 7% increase in the revenue estimate continues a trend of unprecedented growth in tax collections for the state. Mississippi, thanks in part to federal spending and inflationary growth, now has a surplus of more than $2 billion.
The estimate for the upcoming fiscal year, though, based on the estimate made Wednesday, indicates that legislative leaders and the governor believe that revenue growth will be slowing. The new revenue estimate represents only an 0.3% increase over what financial experts believe will be collected in taxes during the current fiscal year.
The estimate was recommended to the legislative leaders by state Economist Corey Miller and four other state financial experts. State law mandates that the governor and members of the Legislative Budget Committee agree on a revenue estimate before the start of each legislative session.
Hosemann, who presides over the Senate, did not oppose the estimate for the fiscal year beginning July 1, but pointed out that a recession is likely.
And a recession could result in a dip in revenue.
In response to questions from Hosemann, Miller said anticipated additional interest rate hikes by the Federal Reserve in an effort to curtail inflation “could be enough to tip us into a (national) recession.”
Reeves and Gunn both have advocated for eliminating the state income tax while revenue collections are strong. The income tax accounts for about one-third of general fund revenue. The sales tax is the only revenue source larger than the income tax, making up about 36% of the general fund.
Reeves told the Mississippi Economic Council during a recent meeting “you have my word that as long as I’m governor I will never stop fighting to fully eliminate the income tax in Mississippi.”
Hosemann has advocated using some of the surplus funds for a one-time rebate to taxpayers.
During Wednesday’s meeting with legislative leaders, Reeves said there is “opportunity there for us to cut government spending to return more money to taxpayers.”
In response to Miller pointing out that state employment growth had stalled this year and was not increasing, Reeves said it is not because of a lack of job openings but because of “the inability and unwillingness of some to enter the labor market.”
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.
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.
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.
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.
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.”
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.”
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.
Rick Cleveland
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 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.
