Democratic gubernatorial nominee Brandon Presley has pledged that if he is elected governor in November, he will expand the state’s Medicaid program “on Day 1” of his tenure. In today’s parlance, good luck with that.
The structure of Mississippi’s state government makes Presley’s promise, however well-intentioned or sincere, difficult in the extreme. Or as the late Mississippi Supreme Court Justice William N. Etheridge, Jr., wrote in his book “Modernizing Mississippi’s Constitution” in 1950: “The governor is given the chief executive power and a mandate to faithfully enforce the laws. However, that obligation does not carry with it a corresponding grant of power.”
Things haven’t changed dramatically on that score in the last 73 years. The 1890 Mississippi Constitution created a “weak governor, strong Legislature” system of government.
Nearly a century after the 1890 Constitution was adopted, Mississippi’s governor was granted the increased powers of gubernatorial succession and the authority to propose an executive budget. But overall, the 1890 constitution still vests the lion’s share of raw political power in the state Legislature. Therefore, the legislative leadership since 1890 has wielded enormous power.
Presley’s pledge, it would seem, would be predicated on expanding Medicaid via executive order and through obtaining a federal waiver. But spending money to obtain the waiver or to operate an expanded Medicaid program would seem under the law to require assistance, approval, and most importantly, appropriations from the Mississippi Legislature.
Recent polls show incumbent Republican Gov. Tate Reeves leading over Presley’s challenge. Reeves has been consistent and firm in his opposition to Medicaid expansion. But regardless of whether or not Presley can pull off an upset in November, it appears that chances for fiscal relief for Mississippi’s struggling hospitals are improving and that as an institution, the GOP-controlled Legislature is angling toward action in 2024.
Lt. Gov. Delbert Hosemann decisively dispatched challenger Chris McDaniel in the GOP primaries despite McDaniel hammering Hosemann over his support for some form of fiscal help for the state’s hospitals. Hosemann continues to support that concept and is planning legislative hearings on the topic for the 2024 session.
Current GOP House Speaker Philip Gunn of Clinton is a solid opponent of Medicaid expansion. But Gunn’s presumptive successor in 2024, current House Speaker Pro Tempore Jason White, R-West, lives about 17 miles from the hospital in Kosciusko and about 20 miles from the hospital in Lexington. The state’s larger trauma hospitals are a long ambulance ride away from West in any direction.
In other words, White understands the plight of rural hospitals, and like Hosemann, is willing to entertain substantive legislative discussions of solutions to those challenges.
What is also coming into focus is that any legislative solution will be aimed at providing health coverage for the working poor – people who hold jobs but don’t earn enough to afford health insurance. A work requirement will meet with strong opposition, but it appears to be one of the points necessary to get the Medicaid expansion question off-center in the state.
Public health care for Mississippi’s poor, working poor, uninsured or underinsured is an expense that will ultimately be borne by the taxpayers. The only real mystery is whether the lion’s share of those costs is paid by federal, state or local taxpayers or a combination of all three with varying percentages of responsibility.
Currently, Mississippi “pays” for that health care through Medicaid dollars and 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 rural hospitals, that percentage is believed to be significantly higher.
So why are Mississippi’s hospitals struggling? Rural hospitals nationally are struggling because of changes in how rural people access health care.
But in states like Mississippi with extreme levels of poverty and high populations of uninsured or underinsured patients, there are two federal laws virtually dictating financial stress in poor states – the federal Hill-Burton Act and Emergency Medical Treatment Act. At a minimum, Mississippi hospitals provide an estimated $600 million in annual uncompensated care.
Health care coverage for the state’s working poor will without question make the federal mandates for providing uncompensated care easier to shoulder. It would be a welcome start.
Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.
33 comments:
Hospitals don’t need relief from government dollars.
They simply need to reduce the salaries and/or headcount for the non-medically licensed administration staff.
*mic drop*
PS. no I can’t take the pay cut and run for governor.
Removing soft drinks and a few other food items from SNAP would probably solve half of the state's healthcare problems. If you remove diabetes complications and obesity related diseases from the population the unpaid emergency visits go way down. Currently we are paying people to eat unhealthy food and then paying for the resulting bad healthcare outcomes from their poor diet.
People in rural areas sacrifice many conveniences to live there, they can move to a more densely populated town or city for better access to groceries, Healthcare, car maintenance, home repair, education options etc. Those who do live closer to these opportunities should not have to subsidize those who don't.
Poor choices on your part does not create an emergency on my part.
8:44's comment is well thought out and makes all the sense in the world. To 8:36, a qualified administrator is required to run any business. You get what you pay for, and it is obvious that you know nothing about medical administration. 8:53's comment is so stupid it requires no comment.
@8:44
I’m going to educate you.
The SNAP/EBT program is subsidized by the USDA
The reason so much unhealthy food is covered now is completely due to CORN SUBSIDIES from the USDA
Yep, all that HFCS poisoned food has to be consumed because they grow more corn than they should.
It’s literally all corn communism.
The farm families of Mississippi need obese SNAP/EVT benefit recipients to consume huge quantities of this slop to keep their money flowing!
Don't let it go unsaid that a former Democratic Governor's business partner, fellow Oxfordian, lobbyist, Jackson mayoral candidate, and candidate of other races is in the private rural hospital business. I believe 110% that Brandon Presley and Quentin Whitwell are well acquainted.
A lot of Greenwood’s hospital problems is self induced, end of story. The Mississippi Today Cartoon and the not reporting of facts on why Leflore county hospital is failing is on purpose. To not report facts.
"Jason White, R-West, lives about 17 miles from the hospital in Kosciusko and about 20 miles from the hospital in Lexington. The state’s larger trauma hospitals are a long ambulance ride away from West in any direction.
In other words, White understands the plight of rural hospitals,"
Geographic distance or proximity do not automatically confer or deny knowledge or understanding, SID. If it did, you would be a whole lot smarter.
@8:44 yes! I'm in agreement with you. If certain foods were not allowed to those who receive benefits this State wouldn't have such high health care costs.
Cut out the unnecessary like chips, ice cream, sodas, 3 lb bags of candy (you get the picture).
Protect your health
Protect your future
The problem here is not uncompensated care. That's a symptom of the problem.
The problem here is not the working-poor or inability to pay the cost of insurance. Those are symptoms of the problem.
The problem is the extremely high number of our citizens, particularly in the 19 Delta and Part-Delta Counties who could work, but won't...who can contribute, but don't...who demand medical treatment and show up to get it free.
Yep...we can spend money all day long to deal with symptoms but we (apparently) will never attack the real problem.
We, through our state and federal government, have allowed the problem to emerge, exist, fester and grow uncontrolled and, by law, there's not a damned thing we can do about it.
@9:13 AM........no, 8:53's comment makes some sense. Lots of folks in rural areas depend on Dollar General's for a lot of their food needs, and about 95% of what is sold in DG's is pure processed shit. Our overall health as a state is in direct correlation to what we stuff our faces with, and nobody can deny that our eating habits as a whole are terrible.
8:44 - Unfortunately, people who bitch and moan about SNAP never stop to ask or wonder or figure out, why these people are dependent on SNAP in the first place.
The great majority of them are simply piling onto the wagon and riding, never willing to pull. And the rest of us have allowed it to happen.
Tired of hearing how poor some people in Mississippi are. Go to Walmart on your lunch break and see how many people are walking around with carts full of groceries while talking on the iphone dressed in pajamas. Then follow them outside and see what kind of vehicle they get into. Do nail salons take EBT it appears to be a thriving business in Mississippi.
Good Lord, apparently none of you appreciate how dependent our state is on federal monies. Nor did you bother to look how states that expanded care have fiscally benefitted as a result.
You missed that hospital closed and that BCBS got to start dictating what care you can and can't be covered for in absolutely absurb ways. They have ob-gyns deciding your prostate surgery choice of doctors and treatment that will be covered. An ob-gyn just missed the underlying illness and denied medication I've taken for decades thinking it was related to something else entirely! Apparently, they think if I threw an embolism, it'd save them money!
Nor do you seem to understand that everything would cost you more or be in less supply without those dollars.
IF federal food monies disappeared, your groceries would be more, not less.
YOU seem not to understand that the dollars for health care don't go into some other Mississippi fund.+
I can only think most of you , lucky for you, without any medical issues due to youth ( I was 40 before I ever met a deductible) or unobservant. However , long before 40, I had friends and relatives who needed care so I've watched what has happened in our system. You all have made things worse not better.
Oh it just may be that you failed to get the prenatal and routine care in childhood that you needed and your brains suffered.
It's true Pressley can't unless he miraculously wins and wins by a lot. That would likely scare the beejesus out of quite a few legislators.
Why so many here are determined to keep Mississippi on the bottom rungs of society is beyond me.
When you empower bean counters, they let the plants die as they are too busy counting the beans to make sure the bean stalks are watered enough to produce more.
@9:21 - who's holding a gun to these snap recipients heads forcing them to consume this overgrowth of corn?
First thing you do is not let anyone living on someone else's money, vote.
That would be anyone claimed as a dependent, or getting any income not from their OWN labor, earned retirement plan, or investments. That includes folks getting a "refund" of income taxes they never paid.
You should not be able to vote for me to give you my money when you're not contributing.
The Farm Families of Mississippi need you to subsidize their business, subsidize the rural farm hospitals, subsidize the SNAP/EBT subsidize all their equipment, and subsidize their labor. You basically need to subsidize all of their liabilities and they need to keep all of the profits.
As previously stated, this is basically a Ponzi scheme at best, outright communism at worst.
We need to be honest with ourselves. If you are Farm Family of Mississippi then you are basically a Democrat.
All right, you've had your fun. Get back on the topic of the column.
@10:24
KF, for an investigative journalist, you sure seem to struggle to connect the dots.
It’s all socialism and it’s connected. And the government is the source of the destruction and dependence of these businesses and individuals. Form the producer to the consumer. The result is the steady inflation of the dollar we have had for the last century. The more recent inflation is due to the more recent debt/spending/printing. But all this can-kicking and subsidized socialist garbage is why todays dollar is worth less than a nickel compared to 1923.
@10:45 can you point us to your gig? Really would like to read the writings of an expert.
Imagine your company having difficulty meeting payroll based on the company's cashflow, and so it decides it needs to cut back on staff. But some voice from the crowd says, 'hey, these people need their money, they have kids, they need to keep a roof over their head, etc.' And that is true - they do.
Imagine the federal government seeing this, and deciding to make it a law that companies must meet payroll and cannot reduce the number of employees getting paid. They must do this regardless of whether the company has the money or not. The politicians get themselves re-elected and everyone in DC is happy.
That's what has happened to hospitals. They have to operate as a business just like any other to meet their obligations, pay staff, and deliver services. But the feds made a law that says they have to provide care to anyone who shows up regardless of their ability to pay (Imagine the feds passing a law that said car dealers have to give out cars regardless of an individual's ability to pay). Even if the hospital has no one to bill, or no insurance to file on, they must provide the expensive services because uncle sugar says they have to.
And all those who think Medicaid expansion is the answer, consider where those dollars come from. The feds are already projecting social security and Medicare will be out of money in the next 10 years, so now more states are going to stick their beaks into the money trough and suck out more taxpayer money? How's that going to end well?
12:09 for the win. Exactly. Expansion is not the answer.
At least not to anyone that is employed.
All y’all complaining just want are babies gone hungry and got no doctor when they be sick
Give the freeloader what they won’t or they will give you riots.
Simple as.
How do rural hospitals stay afloat? Emergency room visits and hospital visits.
Does a healthy population go to the hospital often? No.
Until we transition to value based care and pay for outcomes versus professional services, the groans of the end of the fee for service era will continue. It will be all about physician groups and hospitals trying to charge for as many services as possible. The payors will continue managing utilization and trying to minimize the hospitals and the physician groups trying to do so many services.
We can't on one hand want to make Mississippians healthier and on the other hand want them to come to the hospital emergency department for an expensive visit to keep rural hospitals afloat.
We need primary care groups working together with community-based hospital systems to partner in managing populations--and to collaborate to keep them healthy. The payors are the key to this--value-based arrangements where risk is shared with primary care groups and hospitals is the key. In that scenario, when the primary care group works to keep the patients out of the hospital, and saves the insurance company millions, some of those dollars are given back to the primary care group and the hospital system.
Everyone wins. Costs of care are reduced.
Sure seems like they don’t have these problems in Kentucky and Louisiana.
If all of the Double Quicks in the delta just had fresh fruits and veggies for sale instead of fried chicken and potatoes and processed foods. I suspect stores sell what people want to buy. Still no pill for stupid
Conquer Dollar General Diabetes first. How hard is it to eliminate wonder bread, soda, hot dogs, and other processed trash food from EBT cards? We could get a programmer to insert that stipulation in what? ten minutes? Get it done state wide.
Sid, you have fallen into the 30-second ad (Democrat style) on this one, old buddy. Medicaid is not designed to "save hospitals, rural or not". And the hospitals that are struggling are not limited to the rural ones.
Medicaid's purpose is to provide health care, not maintain jobs in local communities.
You are correct on one point - rural hospitals are struggling because of the changing method of providing health care. The Hill Burton facilities built in the 50'2 and 60'2 were scattered all over the state for several different reasons including the lack of transportaion that families have today (one car families compared to three and four car families); specialty medicine; hospitalization vs pharmacuticals; etc etc.
Today, those folks in that poor little ol hospital in Kosciusko head to that hospital for the triage work in case of an emergency prior to shipping off to a regional facility where there are specialists to deal with the problems. And just because there is a hospital with beds there (beds that are not being used in most of these old facilicities) there are not professionals to staff them.
:
Yes, you are correct that Presley's pandering is nothing more than political crap - our Governor is powerless to do any of the three things he is promissing: Medicaid expansion, repeal of the grocery tax (yes, that battle has been fought between various factions of the legisalature for the past two sessions - what makes Brandon think he can walk into the top floor of Sillers and wave some magic wand?) and third - whatever is the milk shake flavor of the day of what he can promise to the low-ed voter: cut car tags I think has been his latest - again, without any discussion of how he will reimburse the local counties/cities for that loss of income (same with eliminating the grocery tax, but I digress.)
Discuss Medicaid expansion in light of health care - not on jobs, saving hospitals (hospitals that no longer operate as such, but lets save them anyway because it sounds good.)
Strengthen the Governor? OK, do that and then see how many of these 30 second ad promises of a chicken in every pot gets done, but without it, no more than when Bilbo was going to build highways out of bricks.
You can really tell that Sydney hasn’t worked in the real world for a very, very long time.
@ 8:44 - "You can really tell that Sydney hasn’t worked in the real world, ever."
There. Fixed it for you.
Rural towns have been dying for decades. Local drug stores, grocery stores, hardware stores etc have been dying too. Local hospitals are not immune. The days of having a local hospital in every small town are gone. The cannot survive with the costs of MRI, PET scan machines, robotic operation machines etc. plus, it’s difficult yo support specialists and other medical personnel like RNs, PTs etc. Are you going to go to a small rural hospital to get bypass surgery or have a hip replaced?
The solution is to have a regional hospital system with them operating emergency clinics in smaller towns. Probably 15 to 20 regional hospitals in Mississippi are enough. They can expand and we should remove the CON requirements.
Do that and expand Medicaid.
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