Wednesday, April 17, 2024

Sid Salter: In Medicaid Debate, Look at Rapidly Increasing Rural Mortality Rates

As Mississippi legislators head to conference on the state’s first sincere consideration of some form of Medicaid expansion, we’ve heard alarms sounded by the right and the left on why the state alternately should or should not expand Medicaid coverage for the state’s working poor.

Proponents of Medicaid expansion celebrate the fact that Mississippi is finally taking steps toward reclaiming a portion of the federal tax dollars Mississippians have been paying to provide expanded Medicaid coverage for the working poor in 40 other states but not in our state where healthcare disparities loom large in the poorest state in the union.

Opponents of the Mississippi House version of Medicaid expansion in Mississippi and the other 10 states across the country that have not expanded coverage make three primary arguments – the state can’t afford the state share of the costs, expanding Medicaid will discourage finding work, and states should not increase enrollment in a “broken program.”

The political wars and the messaging generated by both sides are contradictory and confusing. But a March 2024 U.S. Department of Agriculture Economic Research Service report suggests that for rural Mississippians, the state’s Medicaid expansion debate actually might have life or death consequences.

The report, entitled “The Nature of the Rural-Urban Mortality Gap,” was authored by USDA economists Kelsey L. Thomas, Elizabeth A. Dobis, and David A. McGranahan.

The researchers concluded that “The 2019 age-adjusted natural-cause mortality (NCM) rate for the prime working-age population (aged 25–54) was 43 percent higher in rural areas than in urban areas. This is a shift from 25 years ago when NCM rates in urban and rural areas were similar for this age group.”

More specifically, the report’s findings were: “There is a growing natural-cause mortality gap between rural and urban areas of the U.S.; Over the last 20 years, the difference between age-adjusted natural-cause mortality rates for the overall population in rural and urban areas grew from being 6 percent higher in rural areas than urban areas in 1999 to 20 percent higher in rural areas than urban areas in 2019;

“The rural, prime working-age population was the only group to experience an increase in NCM rates, resulting in an even greater increase in the mortality gap between rural and urban areas. In 1999, the NCM rate for the prime working-age population in rural areas was 6 percent higher than in urban areas, growing to 43 percent higher in 2019; and the more rural the area, the greater the increase in prime working-age NCM rates (or smaller the decrease) over time.”

Why does that matter? The report found that rural working-age people in the South are dying at a higher rate than their urban counterparts – and Mississippi is a rural state.

According to the U.S. Health and Human Services, Mississippi is rural, where 65 (79.3%) of the 82 counties are considered rural areas. Mississippi has three standard metropolitan statistical areas (MSA): the Jackson Metropolitan Area; the Hattiesburg Area; and the Gulf Coast Region. Desoto County, located in North Mississippi, is included in the Memphis, Tennessee MSA. All 82 counties in Mississippi are designated whole or in part as medically underserved areas.

Is the lack of expanded Medicaid a sole-source cause of those health disparities? Of course not. The report’s authors acknowledge high incidences of obesity, smoking, poor-quality diets, and other place-based influences on the mortality gap, along with: “Both hospital closures and physician shortages in rural areas are also a growing concern and could lead to higher rural mortality rates as well.”

They likewise note: “It is plausible that differences in healthcare resources and health behaviors across urban and rural areas could contribute to the stagnation and even increasing mortality rates in rural areas, as the accessibility, quality, and affordability of care could be compromised. Healthcare resources and services vary by population density, often leaving rural areas with limited medical treatment and less accessible options that could adversely impact mortality rates.”

The most germane passage in this study of rural people dying faster than urban neighbors is this one: “Regionally, differences in state implementation of Medicaid expansion under the 2010 Affordable Care Act could have increased implications for uninsured rural residents in states without expansions by potentially influencing the frequency of medical care for those at risk and preventive measures.”

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

19 comments:

Anonymous said...

Did they factor in the number of couches per household? Studies show a direct correlation

Anonymous said...

Health starts with the individual. People have to make better choices. I know for a lot of MS, including the rural working class, the choices are few. I'm all for expansion of Medicaid but that alone will not improve mortality rates at all.

Anonymous said...

Sorry for the double post but I missed Sid's "life or death consequences" blurb. The availability of Medicaid doesn't change human behaviors that are detrimental to a person's health.

Anonymous said...

I wonder if the authors checked the correlation between % of the population already on government managed healthcare and morbidity.

Anonymous said...

Now even the Rs are embracing the redistribution of wealth. Will cats soon be sleeping with dogs?

Anonymous said...

Look at people who are already on Medicaid to see if we need or want more of that. Are they mostly healthy or are they mostly obese and mostly showing abysmal / poorer health than people who aren't on Medicaid?
Who expects new Medicaid recipients to somehow improve overnight , just because we have more people on the program? Not I .

Anonymous said...

For Sid's argument to hold water, you'd have to adjust for all other variables between urban and rural residents to make the case that Medicaid expansion would meaningfully affect mortality. Exercise, diet, education, income, etc. are all major variables.

He said it himself. Hospital closes and physician shortages "could lead" to higher rural mortality rates. But that's not conclusive at all.

Anonymous said...

Mississippi=obese people. How many buffets are there in the rural areas? The Chinese buffet, the Southern Style buffet, KFC chicken buffet? Let's start there...

Anonymous said...

If you are a Democrat, it’s the thought that counts. And all that counts.

Anonymous said...

What you'll never see a columnist write about is the shrinking number of tax-paying citizens and businesses while the number of those on various welfare and assistance programs are growing rapidly. Making matters worse, politicians in Washington apparently want the U.S. financial system to run to the cliff instead of walking to it - so they allow non-citizens to suck the dollars out of our system, too.

Anonymous said...



More money does not cure obesity and lethargy

Saltwaterpappy said...

To our Christian friends, I think that it was Jesus who said something to the effect of "just as you do unto the least of these, you do unto me."

Anonymous said...

@10:10
If you are a Republican, it is the lack of thinking that counts and shows.

Anonymous said...

1:05 PM,
He was talking about personal charity, not government welfare programs. The equivalent would have been overtaxing the Judaeans to give free stuff to people who didn't really earn it, while the tax collectors ended up wasting half of the money. I don't recall seeing that mentioned in the Bible.

Saltwaterpappy said...

If you believe that America is a "Christian Nation", then how can its Christians (and its Christians) justify denying something as basic as reasonable medical care to its working poor. It's my observation that if Jesus lived in America today, that many of those who claim to be Christians would look down upon him.

Anonymous said...

Saltwater pappy, how can a closed doctor's office treat patients? How can a closed hospital provide healthcare services? These facilities must operate as a business just like Walmart does or they have to close. And unlike Walmart, hospitals are required to treat a patient regardless of their ability to pay.
Ask any provider - Medicaid does not pay providers a dollar for every dollar of care provided. Instead, Medicaid pays cents on the dollar and the rest has to be written off. That's what is known as "red ink" and too much of it puts you out of business.
In areas where there is a decent number of private pay and insurance, that helps offset the losses. But in places like the Mississippi Delta where most of the patients are Medicaid, there's just no viable way for a hospital to pay overhead, salaries, etc. and stay open. Increasing the number of cases where the hospital has to trade every dollar for 35 cents is not going to help matters. It will cause hospitals to close permanently.

Anonymous said...

If you thought changing the flag would help race relations in Mississippi then you'll fall for the ruse that Medicaid expansion will save hospitals and make the obese suddenly thinner because all they needed, but couldn't afford, was an appointment with a physician to tell them they were fat and needed to lose some serious weight.

Here's your sign.

Saltwaterpappy said...

If I'm not mistaken, we're already seeing community hospitals around the state closing due to lack of revenue.

Saltwaterpappy said...

9:41--Don't forget those who won't quit smoking, abuse alcohol, and refuse to exercise.


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