Mississippi Today

Who’s opposed to Mississippi Medicaid expansion and why?

Published

1 year ago

November 15, 2022

Who's opposed to Mississippi Medicaid expansion and why?

by Geoff Pender, Mississippi Today
November 15, 2022

Note: This article is part of Mississippi Today's ongoing Mississippi Health Care Crisis project.Read more about the project by clicking here.

While running for governor in 2019, then-Lt. Gov. Tate Reeves was quizzed at a Capitol Press Corps luncheon whether his opposition to expanding Medicaid coverage to working-poor Mississippians was softening.

"I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I don't know how many ways I can explain this to y'all," Reeves said.

Reeves' fellow Republican House Speaker Philip Gunn has frequently given equally deep and erudite explanations of his steadfast opposition to accepting $1 billion a year in federal money to help the working poor and Mississippi's distressed hospitals.

"From what I know about it, we cannot afford it," Gunn said tersely to questions as the 2021 legislative session ended, obviously not wanting to discuss the issue further.

For more than a decade, despite most other states expanding Medicaid and despite hospitals, doctors, economists and experts saying it would be a net benefit to the poorest, sickest, most uninsured and most federally dependent state in the country, most of Mississippi's top elected leaders have refused the offer.

As some hospitals across the state close their doors and others struggle on the brink of collapse — even as the state budget sees record gains from other federal spending — Mississippi leaders' recalcitrance growingly appears more political than pragmatic.

Reeves and Gunn, who can block expansion from their posts, remain steadfast in their opposition. Republican Lt. Gov. Delbert Hosemann has said he's open to the idea, as are a small but growing number of legislative Republicans. But Hosemann avoids even saying the words "Medicaid expansion" and hasn't pressed his colleagues on full expansion. He has, unsuccessfully, pushed for expanding postpartum Medicaid coverage for mothers.

Q&A: What is Medicaid expansion, really?

Notably, all three top leaders declined interviews or comments for this story. Medicaid expansion hasn't gotten a real hearing with the Legislature in years, even as the federal government has tried to sweeten the deal and counter arguments against expansion.

At times, including recently, some state leaders have said they would instead prefer people to have good jobs that provide private insurance. But this has proved elusive, with Mississippi seeing slow job growth, the lowest median income in the nation and among the highest rates of uninsured people.

Mississippi Today compiled a list of the main arguments against Medicaid expansion that opponents have given over the last decade, with counterpoints from proponents:

We can't afford it/it will tank the state budget

"I don't see Medicaid expansion as something that is beneficial to the state of Mississippi," Gunn said in 2021. "I just don't think the taxpayers can afford it. That is what it boils down to is the taxpayers. It is their money. I just don't have the taxpayers calling saying we want you to raise taxes so we can expand Medicaid."

So far, Medicaid expansion hasn't tanked any states' budgets, nor have any been forced to raise taxes to cover ACA Medicaid expansion.

Numerous studies, including those by Mississippi's state economists, say the state — including government coffers — would see a net economic benefit, including growth in GDP and population and the creation of thousands of jobs.

Studies in Arkansas, Kentucky, Louisiana, Michigan, Montana and Virginia showed the states saw a net reduction of more than 4% in spending on their traditional Medicaid programs after expansion. Louisiana's Medicaid expansion in 2016 brought a 33% reduction in uncompensated care costs for hospitals, including a 55% reduction for rural hospitals.

The federal government will quit paying its share

"For us to enter into an expansion program would be a fools errand," then-Gov. Phil Bryant said in 2014. "I mean, here we would be saying to 300,000 Mississippians, 'We're going to provide Medicaid coverage to you,' and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that."

But the Affordable Care Act, including Medicaid expansion, has survived through three presidents, including Republican Donald Trump who wanted to do away with it, and through multiple congresses, including two under Republican control of both chambers. It has survived numerous court challenges (Mississippi has joined in at least a couple of those).

Mississippi leaders made the same argument to postpone adopting the Medicaid program when it was created in the 1960s. It was one of the last states to do so, in 1969. Arguments that the feds would stop funding it and leave Mississippi in the lurch have proved erroneous, and the Magnolia State has enjoyed the highest rate of federal reimbursement for its existing Medicaid program for many years.

It's subsidizing people who won't work/it's more welfare

"We believe all able-bodied folks ought to get off the couch and go to work," state Agriculture Commissioner Andy Gipson, a longtime former lawmaker, said at the Neshoba County Fair in July, mirroring comments many other leaders have made over years. "This is why we oppose Medicaid expansion."

By its definition, covering people who make up to 138% of poverty level income, Medicaid expansion is aimed at helping the working poor.

"These are people that are working," said Tim Moore, president of the Mississippi Hospital Association. "By definition, to be at 138% above poverty, you have to have income from somewhere. In fact these are people that are often working multiple jobs, but still don't have the discretionary income to afford the high cost of premiums."

"Medicaid expansion is not about putting people on the welfare rolls," state Insurance Commissioner Mike Chaney said last year. "This is about expanding health care availability to the poor, the disabled, the folks that fall through the cracks, that are not able to get on the Affordable Care Act."

It would drive up private insurance costs, especially if hospitals help pay for expansion

"If hospitals are going to pay for it, that means that your cost when you go to the hospital is going to go up," Reeves said during a 2019 gubernatorial election debate, referring to Mississippi hospitals offering to pay the state's share of expansion. "If you have private insurance, that means that your insurance rates are going to go up."

Others over the years have warned that expansion in general would drive up private insurance premiums.

But driving down uncompensated care costs for Mississippi hospitals, which has hovered around $600 million a year (lowered temporarily a bit recently because of federal COVID-19 relief money) would allow hospitals to lower prices, Moore said. One recent study said expansion would cut Mississippi hospitals' uncompensated care by an average of $251.6 million a year from 2020-2030. The same study projects private premiums paid each year would also fall by $52.6 million over the same period.

"Treating people with no coverage forces the costs onto everyone else," Moore said. "Plus, if people have coverage, they get care in a more timely, more efficient manner. You have less chronic problems, less higher-cost problems."

As for hospitals paying the state's share of expansion, as MHA proposed with the MS Cares plan in 2019, Moore said that's a moot point now, because Mississippi hospitals are struggling so bad financially now that they couldn't afford to do it.

Medicaid is broken, full of fraud and provides poor health outcomes

When Mississippi lawmakers in 2017 passed an act aimed at preventing fraud in Medicaid and welfare, one concern cited during debate was that there were dead people on Medicaid rolls.

"Are you talking about dead people on the rolls of Medicaid?" one lawmaker asked then-Senate Medicaid Chairman Brice Wiggins, R-Pascagoula. He responded: "I am talking about everybody, yes. It doesn't matter if it is dead people. It doesn't matter if it is people double dipping. They need to be following the law.”

Medicaid doesn't provide money to beneficiaries. It provides health care, and money goes to providers. As several lawmakers pointed out at the time, it would be hard for dead people to be receiving health care.

Many, including some state politicians, appear to conflate Medicaid with "welfare." Medicaid is a state-federal health insurance program that, in Mississippi currently, is available only to the disabled, elderly poor people, poor pregnant women and poor children. An able-bodied adult cannot simply be poor and qualify for Medicaid.

Mississippi has been plagued with fraud, corruption or misspending in Medicaid, welfare and other government programs. But this has been mostly committed by politicians, bureaucrats, business people, or large corporations. Beneficiary fraud in all these programs would appear to be a smaller problem.

It is true that Mississippi Medicaid beneficiaries have very poor health outcomes. But given that a large portion of qualifying beneficiaries are very sickly and poor to begin with, this would appear self-fulfilling prophecy. The aim of expansion is to cover the healthier, working poor and provide more preventive care.

"If you start early and provide health care, the outcome is better," Moore said. "If you put off treating a condition, it gets worse. Diabetes is an example. You have an individual that doesn't have health care coverage and they have neuropathy but put off treatment. They get a hole in the foot that gets infected. Then they lose a leg. Or they lose eyesight or have renal failure. Then all of a sudden they have a disability and can't work, and they have to be taken care of. But we could have prevented it, and we could have managed the cost much better."

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Ex-Mississippi sheriff admits lying to the FBI

Published

10 mins ago

May 7, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell and Ilyssa Daly – 2024-05-07 11:40:49

As sheriff, Terry Grassaree stoked fear into the citizens of Noxubee County by imitating his idol, wrestler “Stone Cold” Steve Austin.

On Tuesday, the 61-year-old former law enforcement officer spoke in a soft voice to District Judge Daniel P. Jordan III as he pleaded guilty to lying to the FBI when he denied that he made a jailed woman take and share sexually explicit photos and videos of herself.

He faces up to five years in prison and a $250,000 fine when he is sentenced on Aug. 7.

Assistant U.S. Attorney Kimberly Purdie told District Judge Daniel P. Jordan III that Grassaree lied to an FBI agent on July 13, 2020, about making a woman behind bars take and share nude photos and videos in exchange for favorable treatment, which included making her a jail trusty.

After she texted the photos from a contraband cell phone, he responded, “Butt is great” and “Body looks perfect.”

Standing next to his attorney, Abram Sellers of Jackson, Grassaree admitted all of what Purdie had said was true.

Grassaree was also charged with destroying evidence and wire fraud. If he had pleaded guilty to all of his charges, he could have faced up to 90 years in prison.

But his story goes far beyond what the former sheriff pleaded guilty to on Tuesday.

The Mississippi Center for Investigative Reporting at Mississippi Today and The New York Times highlighted Grassaree in its series, “Unfettered Power: Mississippi Sheriffs,” which showed how sheriffs can rule like kings in rural counties. They answer to no one and typically face little press or prosecutorial scrutiny.

The investigation published April 11, 2023, revealed that the allegations of wrongdoing against Grassaree have been far more wide-ranging and serious than his federal charges suggest. The investigation included a review of nearly two decades of lawsuit depositions and a previously undisclosed report by the Mississippi Bureau of Investigation.

At a minimum, the documents detail gross mismanagement at the Noxubee County jail in Macon that repeatedly put female inmates in harm's way. At worst, they tell the story of a sheriff who operated with impunity, even as he was accused of abusing the people in his custody, turning a blind eye to women who were raped and trying to cover it up when caught.

Over nearly two decades, as allegations mounted and Noxubee County's insurance company paid to settle lawsuits against Grassaree, state prosecutors brought no charges against him or others accused of abuses in the jail. A federal investigation dragged on for years and finally led to charges in fall 2022.

In a 2020 lawsuit, Elizabeth Layne Reed accused two deputies, Vance Phillips and Damon Clark, of coercing her into having sex. She said the men gave her a cellphone and other perks in exchange for sexual encounters inside and outside the jail. Deputies even put a sofa in her cell.

According to her lawsuit, Grassaree knew all about his deputies' “sexual contacts and shenanigans,” but the sheriff did nothing to “stop the coerced sexual relationships.”

Grassaree has previously denied any knowledge of what his deputies were doing. “Are you a boss?” he asked. “Do your employees tell you everything they do?”

Instead of intervening, the lawsuit alleged, the sheriff “sexted” her and demanded that she use the phone the deputies had given her to send him “a continuous stream of explicit videos, photographs and texts” while she was in jail. She also alleged in the lawsuit that Grassaree touched her in a “sexual manner.”

The lawsuit was settled for an undisclosed amount.

No date has been set for the sentencing of one of those deputies, Phillips, who pleaded guilty last year to bribery, which experts say could have been the perks the woman says she received. Prosecutors asked for his sentencing to be postponed “pending a resolution of another criminal matter,” an obvious reference to Grassaree's case.

The other deputy, Vance, wasn't charged. “I never coerced Reed into sex,” he wrote in his response to the lawsuit, but he never answered whether he had sex with her.

Under Mississippi law, it is a crime for officers to have sex with those behind bars, and the felony carries up to five years in prison.

Nearly two decades ago, Grassaree faced allegations of rape inside the jail that he supervised and lawsuits claiming that he covered up the episodes. At least five people, including one of his fellow deputies, accused him of beating others or choking them with a police baton.

In 2006, after Grassaree and his staff left jail cell keys hanging on a wall, male inmates opened the doors to the cell of two women inmates and raped them, according to statements the women gave to state investigators. One of the women said Grassaree pressured her to sign a false statement to cover up the crimes, according to the state police report.

About a year later, in a lawsuit, four people who had been arrested gave sworn statements accusing Grassaree of violence. Two of the people said he choked or beat them while they were in his custody. A third said he pinned her against a wall and threatened to let a male inmate rape her.

All told, at least eight men — including four deputies and Grassaree himself — have been accused of sex abuse by women inmates who were being held in the Noxubee County jail while Grassaree was in charge.

Now, 18 years after a woman first said that he pressured her to lie about being raped, the former sheriff faces possible prison time.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1955

Published

5 hours ago

May 7, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-05-07 07:00:00

May 7, 1955

The Rev. George Lee was shot to death in Belzoni, Mississippi, after using his pulpit and his printing press to urge other Black Mississippians to vote.

He became one of the first African Americans to register to vote in the mostly Black Humphreys County. And when he helped register more than 90 other Black voters, White leaders spoke with concern over growing African-American power in the Mississippi Delta.

Lee continued his work in the face of threats and electrified crowds of thousands with his speeches, according to Jet magazine.

“Pray not for your mom and pop,” he told the crowd. “They've gone to heaven. Pray you can make it through this hell.”

Weeks later, shotgun blasts hit Lee in the face as he was driving home one night, and his Buick smashed into a house. The sheriff claimed the lead pellets found in his shattered jaw were fillings from his teeth.

Mississippi NAACP Field Secretary Medgar Evers investigated the killing, and FBI tests concluded the pellets were buckshot. No one was ever prosecuted.

More than 1,000 attended Lee's funeral, and his widow, Rosebud, decided to open the casket to show how her husband had suffered. Photographs of his body ran in Jet magazine. A few months later, Emmett Till's mother would do the same for her teenage son when he was killed.

Lee is among 40 martyrs listed on the Civil Rights Memorial in Montgomery, Alabama. A museum in Belzoni now bears his name and that of civil rights leader Fannie Lou Hamer.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Some notable bills that died in the 2024 Mississippi legislative session

Published

6 hours ago

May 7, 2024

Staff Editor

mississippitoday.org – Taylor Vance – 2024-05-07 05:30:00

As the Mississippi Legislature adjourned its 2024 regular session on Saturday, only a fraction of the thousands of bills introduced by legislators survived to become law.

The most notable item that died during the session was Medicaid expansion, a policy that would have allowed thousands of Mississippians to receive health coverage and potentially give struggling hospitals a needed financial boost.

But several other pieces of legislation such as early voting and overhauling the way the state restores voting rights to people convicted of certain felony offenses also died during the session.

Unless Republican Gov. Tate Reeves calls legislators into a special legislative session, lawmakers will now have to wait until their 2025 session next year to introduce any more legislation this year.

Here are some other bills that died after the 2024 legislative session adjourned on Saturday:

Judicial redistricting

House Bill 722 and Senate Bill 2771 would have redrawn the state's circuit and chancery court districts, but negotiations stalled between the House and the Senate on adopting a final map.

The current court districts have largely remained unchanged for 30 years. Senate Judiciary A Committee Chairman Brice Wiggins, a Republican from Pascagoula who was the Senate's lead negotiator, believed the Legislature should use population data and the number of active court cases in each district to substantively redraw them.

Wiggins sent the House a plan that passed the Senate 32-13. But the House didn't agree to the Senate plan, and it did not reveal its own redistricting proposal.

House Judiciary B Chairman Kevin Horan, a Republican from Grenada and the main House negotiator, said he wanted to agree on a plan this year, but he thought there were too many stakeholders, such as judges, whom he believed did not have their opinions considered in how the new districts should look.

“This issue is too important for them to not have their voices heard,” Horan said.

Both committee leaders told Mississippi Today they intend to conduct hearings in the summer or the fall to hear from judges, district attorneys and officials from the Administrative Office of Courts on what metrics should be considered for new districts.

Lawmakers have until 2025 to agree on a set of new maps. If the two chambers cannot reach a compromise by early next year, Mississippi Supreme Court Chief Justice Michael Randolph will be tasked with redrawing the new chancery and circuit court districts.

Mobile sports betting

House Bill 774, the Mississippi Mobile Sports Wagering Act, would have legalized mobile sports betting and allowed Mississippi to join more than two dozen other states where the practice is legal.

Sports wagering has been legal in Mississippi for years, but online betting has remained illegal in part from fears the move could erode profits of the state's brick and mortar casinos located along the Mississippi River and the Gulf Coast.

The initial proposal would have required betting companies to contract with casinos, but some lawmakers raised concerns that the legislation did not offer any incentives for major betting companies to partner with smaller casinos.

The two chambers passed different versions of the same bill, and they couldn't reach an accord during the conference committee process.

Senate Gaming Chairman David Blount, a Democrat from Jackson, told Mississippi Today that there was division among casino owners on how the legislation would impact physical casinos and their employees and offered little protection for people who struggle with gambling addiction.

Blount said he hopes casino owners and lawmakers will continue to discuss the issue during the off season and debate the issue more next year.

Replacing Mississippi's white supremacist statues in Washington

Senate Bill 2231 and House Concurrent Resolution 12 would have replaced Mississippi's statutes of J.Z. George and Jefferson Davis, two white supremacists, in the U.S. Capitol in Washington.

Other Southern states such as Alabama, Florida and Arkansas, have replaced their statues of white supremacists, but Mississippi remains the only state in the nation with two Confederate leaders in the National Statuary Hall Collection in Washington.

Federal law allows for states to replace their statues, but a majority of lawmakers in both legislative chambers must vote to approve the replacement, and the state is required to pay for the costs of replacing the statues.

House Rules Chairman Fred Shanks, a Republican from Brandon, previously said he did not know much about the National Statuary Hall Collection, but that he would study the issue.

Early voting

Senate Bill 2580 would have established in-person early voting and let Mississippi join 47 other states that authorize the practice in some form.

The bill would have allowed 15 days of no-excuse early voting before election day and required voters to submit a valid photo ID to cast a ballot. It would have replaced in-person absentee voting.

The bill passed the Senate overwhelmingly, but House Elections Chairman Noah Sanford, a Republican from Collins, said he received concerns about the proposal from some county circuit clerks, the local officials who administer elections.

Instead, Sanford said he would like to conduct some hearings in the summer or fall to examine the issue further and allow circuit clerks and others to present information. He said that after the hearings he would be more open to passing early voting legislation.

Restoring a ballot initiative

For the third straight year, lawmakers could not agree on a way to restore Mississippi's ballot initiative process.

House Concurrent Resolution 11 and Senate Bill 2770 would have created a process for voters to bypass lawmakers and place issues directly on a statewide ballot for consideration. The process would only allow voters to amend laws and not the constitution.

The House passed a proposal that would have created an initiative process that organizers to gather signatures from 8% of the number of registered voters during the last governor's race, which the Secretary of State's office estimated to be around 166,000.

Senate leaders proposed a plan that would have required petitions to gather signatures from 10% of the registered voters from the last presidential election – more than 200,000 signatures of registered voters – to place an issue on the ballot. The Senate chamber rejected that proposal.

Both the House and Senate plans would have restricted voters from considering any initiative related to abortion.

Mississippians have not had an initiative process since 2021, when the Mississippi Supreme Court ruled it invalid because of a technicality over the state's congressional districts.

Felony suffrage overhaul

House Bill 1609 would have automatically restored voting rights to people convicted of nonviolent felony offenses, as long as they had not committed another felony within five years of completing the terms of their sentence.

The legislation passed the House by a bipartisan majority, but Senate Constitution Chairwoman Angela Hill killed the measure by not bringing it up for a vote.

Under the Mississippi Constitution, people convicted of any of 10 felonies — including perjury, arson and bigamy — lose their voting rights for life. A 2009 opinion from the Mississippi Attorney General's Office expanded the list of disenfranchising felonies to 22.

The constitutional provision stems from Jim Crow-era policy where the framers of the 1890 constitution chose disenfranchising crimes thought to be more likely committed by Black people.

Mississippi is one of only a handful of states that does not automatically restore voting rights to people who complete their sentences. Instead, two-thirds of lawmakers in both chambers must agree to restore the suffrage to individuals in a piecemeal fashion.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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