Wednesday, May 22, 2019

Sid Salter: Embattled State Hospitals Seek Medicaid Safety Net

As noted more often than this writer cares to remember, the fact is that public health care for Mississippi’s poor, working poor, uninsured or underinsured is in the poorest state in the union an expense that will ultimately be borne by the taxpayers.

 When it comes to the provision of health care for the poor, the elderly, the disabled, and children, taxpayers will continue to pick up most of the tab. The only real mystery is whether the lion’s share of those costs is borne by federal, state or local taxpayers or – and this is the more likely outcome – a combination of all three with varying percentages of responsibility.

Currently, Mississippi “pays” for that health care through Medicaid dollars and through the delivery of uncompensated care. Nationally, uncompensated care in the U.S. is estimated to comprise 55 percent of all emergency care delivered. In Mississippi’s state-owned rural hospitals, that percentage is believed to be significantly higher.

So why are Mississippi’s hospitals struggling? Two federal laws virtually dictate that financial stress in poor states.
First, there’s the fact that many of the local government-owned community hospitals in Mississippi were funded through the federal Hill-Burton Act, which originally gave hospitals built with federal dollars a 20-year post-construction mandate to provide free or subsidized care to a portion of their indigent patients. In 1975, Congress enacted an amendment to the Hill-Burton Program, Title XVI of the Public Health Service Act. Facilities assisted under Title XVI were required to provide uncompensated services in perpetuity.

Second, there’s the 1986 Emergency Medical Treatment Act (EMTALA) was enacted by Congress. This act requires any hospital that accepts Medicare payments to provide care to any patient who arrives in its emergency department for treatment, regardless of the patient's citizenship, legal status in the United States or ability to pay for the services – including medical transport and hospital care.

Also applicable under EMTALA is the requirement that every U.S. hospital with an emergency room has a legal duty to treat patients who arrive in labor, caring for them at least until the delivery of the placenta after a baby is born.

The law allows hospitals to bill patients and sue them for unpaid bills, but the odds of making recoveries from indigent patients are extremely low.

It stands to reason that the Mississippi Hospital Association (MHA) and the state’s struggling hospitals they represent are seeking ways to gain additional federal Medicaid dollars to underwrite the fiscal hemorrhaging from the delivery of an estimated $600 million in annual uncompensated care.

Mississippi’s hospitals aren’t concerned whether the ultimate result is called Medicaid “expansion” or “reform”, but they are concerned about making their “Mississippi Cares” program an issue in the 2019 statewide elections.
The “Mississippi Care” proposal from MHA roughly mirrors the “Healthy Indiana” Medicaid expansion program pushed by Republican Vice President Mike Pence while he was the Hoosier State’s governor.

The plan would combine a provider-run insurance company formed and run by the hospitals, patient-paid fees and copays, and the pledge of the hospitals picking up the rest of the costs for up to 300,000 potential new Medicaid low-income qualifiers. As in Indiana, the Mississippi plan would require that the state submit a request for waivers from the federal government.

Without this plan or something very close to it, rural hospitals in Mississippi may be the ones on life support – along with them, the rural patients they struggle to serve.

Election years are notoriously bad times to trot out complex public policy reforms. But in this instance, the question becomes rather simple – do you want available hospital and emergency room care in rural Mississippi communities?

Sid Salter is a syndicated columnist. Contact him at


Anonymous said...

From the origination of Medicaid in 1965 under President Johnson and for the following decades while our state was under democratic control, MS worked closely with the MS Hospital Association maximizing what they got out of the federal government. Until fairly recently hospitals were reimbursed on a cost plus basis. Can you imagine that this was efficient? The result was an overbuilding of hospitals in MS. After the Republicans finally took over the legislative branch, Medicaid reimbursement to MS hospitals changed to a diagnostic based reimbursement. Immediately thereafter, MS hospitals started screaming that they were going broke. All the while, MS has the lowest health outcomes and ratings. We have too many hospitals providing shoddy health care. Seems the market should compress naturally rather than this foolhardy scheme giving a $1.5 Billion soul-sourced contact to the MS Hospitals Associations inexperienced, untested new insurance company. #obamacare

Anonymous said...

Just reviewed propaganda. Smells like a proposal to expand Obamacare without consideration of the realities of the costs to Mississippi taxpayers. The scheme ignores the 80,000 Mississippians who already get federally subsidized healthcare insurance without Mississippi taxpayers paying any of the costs. Appears to be less of a plan – and more of a PR campaign, with a press release and “fact” sheets that are grossly misleading. #emperorsnewclothes #mirrorspenceplanha #obamacare

Anonymous said...

How much does this proposal cost?
Who would pay for it?
What guarantees are there that the state – and the taxpayers – won’t end up subsidizing the MS Hospital Association plan?
What guarantees are there that the state won’t end up bailing out the MS Hospital Association company? (Private insurance companies are backed by investors who take the financial risk, not by taxpayers).
How would a downturn of the economy or uptick in enrollment jeopardize budget stability?
Even if the state did adopt this expensive scheme, what guarantees are there that struggling rural hospitals won’t close?
How does the MS Hospital Association plan control escalating

Anonymous said...

6:33 am Where were the hospitals overbuilt?
I think you miss the problem entirely because you don't see the difference between a profession that provides a service necessary to a functioning society and a business operating for profit.
With the worship of the business model as the solution to everything, you see the "overbuilding" of hospitals in 1 city in this State instead of having hospitals based on getting medical care quickly ( thus efficiently) the to most people.
Medicine is more profitable now. Nationally , we are falling behind the civilized world.

Anonymous said...

How does the Mississippi Hospital Association plan control escalating costs?
Where are the details?

Anonymous said...

This all sounds like the RAT asking to guard the CHEESE!!!

Anonymous said...

Next, @7:41 AM will propose capping compensation for physicians.

Anonymous said...

You are paying for it one way or the other. I just can't figure out why this is so hard for anyone to understand.
The same goes for roads, you can pay to fix them or you can pay to fix your car.

Anonymous said...

Tim Moore: it is time to head the the wall and take your oath... your days are numbered.

Anonymous said...

Compress naturally, 6:33? The city hospitals can barely keep up with the patients that are showing up already! You want to “let nature take its course” in terms of business models when the hospitals haven’t been running on a business model, or should they. I hope your loved one doesn’t spend days in an emergency department waiting on a bed in a hospital because of the “natural compression” of hospitals in the state.

Anonymous said...

I blame Gov Savus from Mabus for closing Mississippi’s charity hospitals in the 1980s.... :)

Dr. Dough said...

Simply put, the MHA has sucked ten of millions out of healthcare to fund this scheme. They should focus on providing healthcare at real rates instead of trying to get the state government to mandate a contract for this boondoggle. Spend the money on patients, not lobbying for an insurance company crony contract.

Anonymous said...

The hospital association created an insurance company so hospitals could be responsible for billing hospitals for care.

Sounds reasonable. What could go wrong?

reasoned_thinking said...

Whether it is Medicaid "expansion" or "reform" it will require incremental spending. Where is that money going to come from, Sid? The State already struggles with balancing its budget and providing all of the requisite services that a functioning government should provide, all the while woefully under-funding it's pension program.

The only way this gets funded it through raising taxes. MS enjoys one of the lower tax environments in the country. This, coupled with the additional incentives offered to many businesses, is arguably the primary (if not only) driver for much of the already meager new business activity in the state that provides jobs and income. Face it, there is really no other reason for a business to locate in MS: We are at or near the bottom in education and healthcare, our social policies (LGBT, abortion, social safety-net) are perceived as regressive, and our infrastructure is sub-optimal. Warm climate, low taxes - that's it. So, raise taxes and put at risk the ability to attract any new commerce to the state and potentially lose businesses currently domiciled in MS to other states.

I know that the healthcare and social safety-net arguments are circular in this context, but therein lies the conundrum for MS. Expanding/reforming Medicaid partially fixes those problems, but at a guaranteed near-term cost but with no guarantees that it will bring in significant new business activity, thus population and tax dollars.

Anonymous said...

An expansion of Medicaid won't stop hospitals from closing nor will it make Mississippi healthier. Redistributing more middle class wealth is not the solution.

Anonymous said...

Did the Hospital Association buy a box at Mississippi State? Salter is smarter than this.

Anonymous said...

Perhaps if the private insurance companies (looking at you BCBS and United Healthcare) were less interested in making such astronomical profits at the expense of their own insured customers and the healthcare providers, there would be some relief for rural providers to have the opportunity to provide quality care for all.

Anonymous said...

There are only three MS hospitals obligated to offer uncompensated care due to Hill-Burton.

Anonymous said...

... were less interested in making such astronomical profits ...

What profit margin would you find acceptable?

I suspect you don't have a clue.

Anonymous said...

I live in a rural area. All 3 of the hospitals in my area are in very deep financial trouble and will close their doors if Medicaid is not expanded. There is no economy in this area and the jobs are gone forever. Everyone in this state should have access to healthcare and that will not be the case for me and others if the hospitals end up closing their doors.

Anonymous said...

5:57 PM:

1. How many times have you used any of the 3 hospitals in your area over the last 10 years?

2. How did you pay for those services if you did use them?

3. How do you know for certain that your 3 hospitals will not close if Medicaid is expanded?

Anonymous said...

Ready, Fire, Aim!
Commenters have not looked at the plan.

No cost to the state. No cost to taxpayers. Win.

WORKING people who qualify will have to pay a monthly coverage amount - THIS HELPS WORKING PEOPLE HELP THEMSELVES. Big Win. Is Honorable too.

It will reduce unnecessary emergency room visits where taxpayers have to ultimately pay. Win.

At least the Hospitals are trying. This is a good start that is proactive. Their attempt and action is much better than "he won't I will"

Anonymous said...

I think you’ve solved your own problem! You live in a rural area and there are 3 hospitals. Duplication of services anyone?

Anonymous said...

4:54 pm A hospital is not a business. It is a service provider. And, BCBS is not supposed to be a business either. Please read the BCBS history.

How both should operate is to make enough money to cover expenses and to maintain the ability to serve those who seek their services. " Profit" goes to keeping up the tools and facilities to deliver the services and to adequately attract and keep competent employees and managers and executives.

So the question is , are dollars coming in being spent well or are they being wasted on excessive " perks" and ads and salaries and middle men and unnecessary travel or purchases that are out of line with the cost of operations. Are the costs of living and salaries in Mississippi balanced with the salaries for similar positions nationally?

Please people, try to understand there's a difference between selling widgets and keeping the nation's potential workforce healthy.

Anonymous said...

MHA tried to get in as a Medicaid Managed Care entity a few years ago but that failed. This is repackaging for round 2.

Rod Knox said...

Don't be so gullible 7:55. Hospitals are all about profits. But here in Tupelo even a great many well educated employees of North Mississippi Medical Center remain convinced that the hospital is a community owned non profit there to help people. You must make an effort to see past the grand smoke screen and curtains if you wish to know the truth. The regional hospital and its affiliates are incorporated in Delaware in order to take advantage of that state's laws protecting the secrecy of financial dealings. A local Tupelo forum became the soap box for complaints against city schools and the hospital years ago and the ever growing waves of mud being thrown resulted in the forum's closure. I do recall that the hospital had bought a $60,000 table for board meetings and had thrown several $million into future discounts to the uninsured to alleviate a possible fine for over charging the 'self pay' patients.

Here's the likely most recent audit

there's a great deal there to consider and a great deal more that requires looking at outlying corporate entities where "revenues" are conveniently moved for discrete distribution.

Anonymous said...

I’ve gone to the site It’s an unrealistic ObamaCare plan with little meaningful detail. A total political ploy. Very typical of MHA. A sole source contract for a company with zero experience. Rebating insurance premiums is illegal and there is no way these poor folks are actually pay their $ 20 per month for this questionable coverage. Where did they get their numbers? Sounds like they are making this crap up as they go along.

Madison Doctor said...

Any doctor who believes hospitals through the MS Hospital Assn will watch out for us is DEAD wrong. The hospital assn will lower physician rates and pocket all of the money to send to MHA’s scheme. I almost had to give my box up at Ole Miss and MHA is buying a box at the redneck MSU... is no one asking where they are getting their money???? Cutting doctors I do say!!!!

Rod Knox said...

Wouldn't it be great if the state auditor took a close look at MHA.

Kingfish said...

Who said he could? Private non-profit.

Rod Knox said...

That's very convenient Kingfish. But in reality what is the political and monetary link between the state house and MHA? I have for years noticed that the MHA had a great deal of influence with state government. And a quick review of the members of MHA and their growing monopolistic situations that somewhat certainly grew from political favors would give reason to look into the situation. Of course when members of state government profit personally from a situation that promotes a few wealthy corporations giving cover to the situation by use of a "publicly spirited non profit" can be very beneficial.... or so it seems.

Anonymous said...

@12:04 PM I bet you believe in UFOs too. Hospitals are some of the most highly regulated and complex operations to run. They make very little profit because of this. If they were cash cows, they would all be owned by wealthy people. And your comment about Delaware is so dumb it’s hard to justify a response.

Anonymous said...

"If they were cash cows, they would all be owned by wealthy people."

So name some welfare recipients who are owners or partial owners of hospitals in MS. We'll wait,
"And, BCBS is not supposed to be a business either. "

Mississippi is the only state I have ever lived in where the state BC/BS program was a privately, owned, for-profit company. Ask them why they're refusing to pay for treatment for the UMMC doc with a brain tumor. Fortunately he has the knowledge and connections to arrange treatment in Houston, TX (presumable at MD Anderson). Someone without those connections would just be sent home to die.

Rod Knox said...

Everywhere I post criticism of North Mississippi Medical Center I step on someone's toes. There seems to be a wide spread for the non profit revenues from that privately (secretly) owned healthcare organization.

Rod Knox said...

In case someone remains skeptical but curious as to the 'non profit' situation of hospitals

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