Wednesday, April 22, 2020

Sid Salter: Pandemic Points Out Escalating Health Care Challenges for Poor

The COVID-19 pandemic has focused a new bright light on a set of old and familiar realities for Mississippi.

First is Mississippi’s persistent, endemic poverty. That poverty begets poor healthcare access and ultimately poor healthcare outcomes. According to the Census Bureau’s American Community Survey, 43 percent of Mississippians had employer-provided health insurance and an additional five percent had other group health insurance.

Medicaid covered another 23 percent while Medicare covered 14 percent and military benefits covered an additional two percent. Some 12.1 percent of Mississippians have no health insurance of any kind.

Remember, those were the percentages before COVID-19 was part of the daily lexicon. Those were the numbers before Mississippi, like the rest of the country, saw tens of thousands in our state lose their jobs and the healthcare benefits that were attached to them.

Without question, Mississippi has a significant number of citizens who have transitioned from insured to uninsured as part of the pandemic. And with that transition comes the rest of the story on how health care is delivered to the poor in Mississippi.

Second is the structure of health care finance in Mississippi. When it comes to the provision of health care for Mississippi’s poor, elderly, disabled, and children, the undeniable and unchanging fact is that taxpayers at the federal, state and local levels will continue to pick up the lion’s share of the tab with those three groups bearing varied and at the same time intertwined percentages of responsibility.

How? Medicaid covers over one in five. The uninsured primarily receive uncompensated care. Nationally, uncompensated care in the U.S. is estimated to comprise over 55 percent of all emergency care delivered. In Mississippi’s state-owned rural hospitals, that percentage is believed to be significantly higher. Mississippi hospitals estimate they delivered $600 million in uncompensated care in 2018.

Two federal laws virtually dictate that unreimbursed spending. 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 is the 1986 Emergency Medical Treatment Act (EMTALA) that 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.

Third, there is the matter of the state’s political reality. Mississippi voters have had multiple opportunities to decide about the straightforward question of Medicaid expansion or “expanding Obamacare” as it is called in the public debate. Candidates who opposed Medicaid expansion have won elections while candidates who favored it have lost elections.

That’s been true at the state level and in federal elections as well. The 2019 statewide elections are a case in point. Eventual gubernatorial race winner Republican Tate Reeves defeated fellow GOP candidate Justice Bill Waller in the GOP primaries and Democrat Jim Hood in the general election. Both Waller and Hood expressly supported Medicaid expansion and had the tailwind of a strong statewide push from the Mississippi Hospital Association for an alternative Medicaid expansion plan that featured a provider-run insurance plan.

Will the jarring impacts of the COVID-19 pandemic change the minds of state voters about public health care finance and how Mississippi deals with indigent care moving forward? Not likely, but the depth and duration of COVID-19’s accompanying economic disaster will weigh on that decision.


Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.

25 comments:

Anonymous said...

Helping the medically needy is political poison. Interesting.

Anonymous said...

It seems these days that a lack of health insurance is the cause of so many problems. Perhaps there should be an equal amount of attention placed on personal responsibility.

Anonymous said...

Another great “rain is wet” article by Sid!

Anonymous said...

What we can't look at is the role health insurance companies, even those initially created to provide at cost health insurance, have played in this health care fiasco.

A lame duck Congress, fearing the Clinton election promise to look into health care, exempted health insurance companies from having to report their operational costs and profits to any federal agency or to Congress.

How much of our insurance costs are going to the CEO's and agents and how many of those designated as " approved providers" pay for the privilege of an exclusive market?

How much do they pay for lobbyists and " donate" to politicians or to increase the social clout of their executives?

We don't know. They don't have to tell anyone.

Tying health care to employment is not economically wise. We once knew that and had, instead, a system of public and charity hospitals that were in operation and could contract directly for drugs and medical supplies and equipment to supplement employment based health care.

When we are opining about " the good old days", we might should see how those things that worked well worked ( we threw out babies with the bathwater in many cases) and how and why they got gutted.

From neighborhood schools and their cultural importance to community hospitals, all could have been re-structured to overcome flaws and be strengthened instead.

In every society ever, when extremists control the political dialogue, bad things happen because we have been distracted by their emotional overreactions and fear mongering.

Bill Barr Fan Club said...

Asking someone else to pay for, or help pay for, your healthcare has nothing to do with "access".

Anonymous said...

No doubt about it @8:33, Nancy Pelosi is an extremist.

Anonymous said...

@8:44 It's sad that all you got from that cogent comment by 8:33. You suffer from Pelosi Derangement Syndrome.

Anonymous said...

It's taken us years to figure out that Salter is a student of the Jerry Mitchell School of Journalism and Neighborhood Organizing.

Anonymous said...

8:27- Rain is wet, however, there are people in this state too stupid or arrogant to accept it. Sometimes people just need to be told the basics because they can’t process 1+1 without a calculator.

Anonymous said...

Cogent? LOL That anonymous troll has been posting a version of that exact same comment here for easily the past half-dozen years.

Anonymous said...

People "too stupid or arrogant to accept" rain being wet that "need to be told the basics because they can’t process 1+1 without a calculator" but somehow they have just enough basic self-preserving sense to seek out and read Sid Salter columns?

Do you actually think about what you've written before tickling the reCaptcha and hitting publish?

Anonymous said...

I'm fairly new, 9:41 AM, but I've noticed that trolls are plentiful on this site. That said, how is his argument invalid?

Anonymous said...

to 9:56 go home to your momma . 9:27 is right

Anonymous said...

I'm fairly new ...

How long have you been reading here?

Anonymous said...

That guy's argument is extremely valid. The elite use both ends against the middle. The middle class. But, there is a cost. The independents or moderates are the largest political party. The bomb throwers out there, left and right, whether screeching at a march or screeching with guns at governors cut their own noses off to spite their faces.

Folks can read, do math, and make decisions on something other than what some Koch Funded or Dem funded shadow group regurgitates. Both sides play the middle for fools.

On COVID, it just doesn't care what your social status is. But growing up sick and poor is not good, and that's not some kid's fault.

The greater good of the 20th Century was public minded civic action. Clean water. Free and clean drinking water. Sanitation. Vaccines. Public health nurses. School nurses. Sound infrastructure. Good public schools. A business environment based on long term success of all members, from CEO to janitor to partners and shareholders. Not just one guy robbing pension plans, endlessly buying and selling other businesses, and collecting 1000 times what the janitor earns.

And tying health care to employment is bad for business and health care, in large part. I am VERY grateful for my healthcare insurance. I spend very little, thanks be to God. And I know there is no Magic Medicare for All plans that could roll out in 3 years.

But there has to be improvement in our investments in the public good. Not just letting the Chinese get filthy rich as we offshore jobs and manufacturing. Not just pie in the sky social engineering. But something in the middle, for the middle.

Anonymous said...

My wife's cancer was overlooked by her doctor until it was critical and the group policy was owned by her employer while administered by Aetna. Surgery was referred to a Jackson hospital and while everything was supposedly authorized properly when all was said and done I was left paying $64,000 dollars, approximately 50% of the total of all bills, and efforts to contest the situation were answered with notice that my wife would be fired if she made any demands for additional funds from the insurance.

And to add insult to injury our son became sick while in a local community college and his absences resulted in his being removed from the rolls unbeknownst to us. His condition worsened and again local doctors seemed lacking so we went to Nashville and $45,000 later learned that his insurance coverage had ended when he was removed from the school's rolls.

Insurance companies in Mississippi seem to be well protected in Mississippi but not much protection is offered to those who pay the premiums.

My wife and I worked hard to provide for ourselves and out kids but we were robbed by the insurance/healthcare mafia. My wife died and my kids are grown and on their own and I'm on Medicare, luckily, and I cannot imagine how people working for $10/hour can keep themselves fed much less pay for insurance, deductables and co-pays and the state of Mississippi doesn't give a damn about them or those like me who think they are middle class and responsible..... FWIW I was earning 3x the average individual income for this state for nearly 30 years while self employed and now feel lucky that I still own my house.

Anonymous said...

... moderates are the largest political party

Who ran for POTUS in 2016 from the Moderate Party?

Anonymous said...

I am sorry for the loss of your wife, compounded by the bullshit you experienced while and after she was fighting for her life.

As far as "my wife would be fired if she made any demands for additional funds from the insurance. " - that sounds like grounds for a lawsuit, if you are so inclined. I would check with a lawyer.

Anonymous said...

WASHINGTON, D.C. -- Significantly more U.S. adults continued to identify as political independents (42%) in 2018 than as either Democrats (30%) or Republicans (26%). At least four in 10 Americans have been political independents in seven of the past eight years, including a record-high 43% in 2014.

Who ran for POTUS in 2016? That guy claiming to be a Republican who was a Democrat for 28 years versus 22 as GOP, whose daughter just switched from Dem to GOP in Fall of 2018. He faced an old chick whose Dad was GOP, pitted against a non-Democrat Socialist, on the "Dem" ticket.

So, good luck with the 26% party. You might need independents and moderates.
What word game were you playing with party labels, again?

Anonymous said...

Boy wait til all these christans need a meal. Let us not forget the rich folks after Katrina and Sandy.

Anonymous said...

Like public schools, a third of the healthcare dollar goes to insurance and medical administrative expense. Its a 'good industry' to work in but NOT to receive services. See https://www.reuters.com/article/us-health-costs-administration-idUSKBN1Z5261

Anonymous said...

Another yawner from Captain Obvious -- err, Sid. Writing from the end of the world (Starkville, that is) can be hard, I reckon.

Anonymous said...

"How long have you been reading here?"

Less than a half-dozen years. Your point?

Anonymous said...

This headline should read "The World is Ending...Minorities and Poor Most at Risk..."

Anonymous said...

I appreciate Sid's deep observations each week.

If not for him, we would not understand what's going on around us.

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In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


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If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

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