Wednesday, March 1, 2023

Sid Salter: Is Subscription-Model Healthcare a Real Alternative to Medicaid Expansion?

Mississippians have, like citizens in many Southern states, argued for a long time over the question of Medicaid expansion. The arguments run the gamut from financial to moral to philosophical to purely political and usually intensely partisan.

The debate continues in 2023, a courthouse-to-statehouse election year in the state. In the wake of the Dobbs abortion case decision by the Supreme Court, the current debate has focused on increasing postpartum Medicaid care for mothers from the present 60 days to one year. In the state with the highest rate of infant mortality in the country and as the originating state for the Dobbs anti-abortion decision, an expansion of Medicaid for this purpose more than makes sense.

But the politics of Medicaid expansion in Mississippi is intensely partisan. One conservative advocacy group that has been monolithic in its opposition to Medicaid expansion for more than a decade is the Mississippi Center for Public Policy. The group is still opposing Medicaid expansion in Mississippi – currently on the basis that the Florida model of subscription primary care “ultimately costs less than regular insurance prices with better quality care.”

The bright line explanation for cheaper medical care in the subscription model is that they claim to remove the insurance companies from between the doctor and the patient.

For those with the means to afford private insurance of some kind, the subscription model may well be worth exploring. But as a substitute for Medicaid, serving some of the poorest people in America, the subscription model has many failures and shortcomings.

The subscription model requires a monthly, quarterly or annual payment, usually between $80 to $100 monthly, to pay for routine monitoring, checkups, comprehensive care and tests. But urgent care and specialized care are not covered. There is no health insurance to pick up the massive costs of catastrophic medical events like car accidents or long intervention battles with dread diseases.

Because of the lack of traditional health insurance, experts say subscription primary care customers need a health savings account (HSA) or a high deductible health insurance plan (HDHP) in case a car accident or cancer battle occurs.

To make those monthly primary care subscription payments, HSA contributions and HDHP premiums, there must be a steady stream of income. Perhaps subscription primary care works as a substitute for traditional fee-for-service health insurance. But as a substitute for Medicaid, the more likely outcome is that the Mississippian in poverty will remain uninsured.

As I’ve written before, regardless of one’s politics, taxpayers have and will continue to bear the brunt of healthcare costs for the poor.Two federal laws virtually dictate unreimbursed spending.

Many of the 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.

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. That percentage is believed to be significantly higher in Mississippi's state-owned rural hospitals. Mississippi hospitals estimate they delivered $600 million in uncompensated care.

Second, there is the 1986 Emergency Medical Treatment Act (EMTALA) which 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. 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.

Subscription primary care serves people with resources. Subscription primary care may have a place in Mississippi’s healthcare arsenal, but it’s comparable to a Band-Aid on a severed femoral artery when it comes to Medicaid in Mississippi.


Sid Salter is a syndicated columnist. Contact him at


Anonymous said...

Thar he blows.

Anonymous said...

“Subscription primary care serves people with resources.”

Sid continues to wage war on people that have jobs and make decent life decisions.

F U Sid.

Unknown said...

i'm a believer that everyone needs some skin in the game and am adamant we could easily save 25% of the 600M in E.R. visits via telehealth which will eliminate a lot of unnecessary E.R. visits. For the record that's $150M in savings!

Anonymous said...

"The uninsured primarily receive uncompensated care" Duh

Anonymous said...


Do you reaaly think $80 to $100 per month can be extracted from this bunch?

If so- think again!

Anonymous said...

The costs of health care for the poor are not “uncompensated”. They are paid by people who can pay or have insurance by way of greatly increased prices for medical care. Democrats, in their never-ending quest for the free lunch, either don’t or won’t see this.

Anonymous said...

Salter needs to stick with writing about things he actually knows about, if there are such things.

Anonymous said...

Not sure where Sid is getting his info from but...subscription care is primary care + urgent care. The only thing it isn't is major medical. The purpose of subscription care (or you can be fancy and call it concierge care) is to make the actual care portion of healthcare affordable. You're paying for access and care. Most providers in this space are available afterhours via telehealth and are not concerned with insurance billing codes. Novel stuff, being more interested in healthcare than health insurance.

Anonymous said...

When an individual can pay "out of pocket" the same amount for health care services that one with Blue Cross/Blue Shield (or other insurance companies) pays with a contracted rate for services, then it will be a step in the right direction to reign in healthcare costs. There is a reason why some don't want to have a true and transparent listing of cost for services at different providers. They know that folks will choose to go where the prices are better. And there is a reason why there are growing practices where doctors contract with patients to pay a monthly charge and get a "bundle of goods/services" in the way of medical care for that subscription.

As 1001 pointed out, there are doctors who want to provide care and actually treat patients, rather than be beholden to insurance companies and their matrixes of billing codes.

Anonymous said...

Mark my word, should Medicaid ever get expanded Salter will write a column arguing the expansion of coverage to illegal aliens in Mississippi. Take it to the bank.

Anonymous said...

I'm not opposed to citizens under age 18 recieving Medicare or Medicade.
There are practical considerations and the notion that the majority of these people never worked or tried to work is false.
Here in MS in particular, I know damn well many are those who did lawn work or housekeeping for whites who paid in cash or did minor repairs or painted homes or help with parties.
Some of those were replaced with illegals later.
There are probably many guardrails we could put on making government work better, but not when we are so divided as to be defensive or unreasonable. And, not when we refuse to face that NO organizational structure or system or "program" will ever be perfect. WHEN found, the SANE and practical thing to do is FIX or replace parts .
But thanks to "us/them" thinking, political INSANITY, and yes, racism, we "throw out the baby with the bathwater" without even looking to see what's in the tub!

Anonymous said...


Did they pay into the system with these cash payments????????

Anonymous said...

I’m not sure that plan would have been very helpful for my wife’s cancer treatment. I don’t remember the cost of the surgery but the Chemo Bill before adjustments for insurance was $15,500 per month for 12 months.

Anonymous said...

If you don't feel an obligation to care for your fellow man, do you at least understand what a tremendous drag a sick ass population is on the economy and your pocketbook? Politicians use race and class, just like they do with everything else, to keep people stirred up and not thinking logically, so they can line the pockets of rich corporations who turn around and give them money. They don't even try to hide it. We are a state full of people trying to burn down our front porch so no one else can sit on it.

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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

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Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

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.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.

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Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

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!!!

This is definitely a Beaver production.

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