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Q&A: Harvard public health dean talks Medicaid expansion and heartbreaking mortality rates of Delta mothers

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Q&A: Harvard public health dean talks Medicaid expansion and heartbreaking mortality rates of Delta mothers

Michelle Williams, a renowned epidemiologist and dean of the Harvard T.H. Chan School of Public Health, caught up with health editor Kate Royals following the Legislature's decision to expand postpartum Medicaid coverage.

Harvard University's School of Public Health has an active program focused on the maternal mortality rate in the Mississippi Delta. Williams has also paid close attention to Mississippi's debate over Medicaid expansion.

While Williams says she is heartened by Gov. Tate Reeves' decision to extend postpartum coverage, the esteemed public health expert says the new doesn't go far enough.

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Kate Royals: Tell me about the school's work in the Mississippi Delta.

Michelle Williams: We have a long history of collaborating on research and education in the Delta, in partnership with state officials, community health centers and local colleges, Mississippi State and the University of Mississippi.

When you about health in Mississippi, the focus is often on the dire statistics, such as sky-high infant and maternal mortality. But it's important to know that the state has a history of truly important innovation. For instance, the first community health centers sprang up in Mississippi — an outgrowth of the movement. Our collaborations aim to build on and nurture those innovations.

We gather regularly with our partners to discuss and develop health care programs. We work together on research grants, too. As one example, we would love to secure funding to enable state health officials to make regular home visits to new moms in the Mississippi Delta; we would then evaluate the impact of the program and widely disseminate lessons learned.

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Finally, we organize academic exchanges so students in Mississippi spend time at Harvard and vice versa, with opportunities to get involved in research and community projects. I recently talked to one of our (master's of Public Health) students who is in Clarksdale for her fieldwork practicum, working with a program called “Baby University” that teaches new about early childhood development and gives them tips for supporting their babies' growth.

Royals: You have cited some pretty startling statistics about outcomes for mothers – particularly Black mothers – in Mississippi compared to other countries. What were those?

Williams: I'm glad you asked, because I think these are statistics that every policy maker – and every citizen – should know.

For Black women in Mississippi, the mortality rate is 65.1 deaths per 100,000 births, according to the state Department of Health.

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That's a horrifying number. To put it in context, Black women in Mississippi are nearly 20 times more likely to die from complications of pregnancy or childbirth than women in Greece, Poland, or Slovenia. They're nearly 8 times more likely to die than women in Turkey.

The mortality rate for white women in Mississippi is lower, at 16.2 deaths per 100,0000 live births, but that is still far above the U.S. average. They are at least three times more likely to die from complications of pregnancy or childbirth than women in the UK or Canada.

Each of those deaths is a tragedy with long-lasting effects: Too many young, promising lives cut short; too many who grow up without the love and support of their mothers; too many families who struggle with grief for the rest of their lives.

It is heartbreaking but it is also, quite frankly, infuriating. We know why maternal mortality rates are so high among Black women. They are high because of the devastating impacts of structural racism and individual bias, including lack of access to appropriate care. That we allow this to continue to happen, in the wealthiest country in the world, is unforgivable.

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Royals: What do you believe, from your research and experience, will be the benefits of extending the health care coverage of mothers on Medicaid for women and babies in Mississippi?

Williams: We know from state data that 42.5% of pregnancy-related maternal deaths in Mississippi occur between 60 days and a year after childbirth. That's the precise period that would be covered by the Medicaid expansion bill now on the governor's desk.

I am certain that having access to care in this period will save lives. Remaining on Medicaid will give new mothers … access to mental health care, which is critically important for not only a mother's health but also the health of her children. It will also allow women to get care for chronic conditions such as high blood pressure, diabetes and obesity. That's important because cardiovascular conditions are the most common cause of pregnancy-related maternal deaths in the state.

There are many other benefits as well. Extending Medicaid coverage should help more young mothers get … screened for cancer. This is crucial because Mississippi has among the highest mortality rates in the nation for breast, cervical and colorectal cancer, all of which can often be treated successfully if detected early.

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The bill should also help new mothers get access to contraception to help them control the spacing of future pregnancies. Given that abortion is now banned in Mississippi, with very limited exceptions, access to effective birth control is critical.

Finally, I want to emphasize what I mentioned earlier: Extending Medicaid will improve the odds not only for the mom, but for the newborn – and for any other children in the family. This generational effect is particularly important in Mississippi, which has long had the highest infant mortality rate in the U.S.

As every parent knows, the first year of a child's life is wondrous, but it can also be tiring, isolating, and stressful. Parents are better equipped to navigate those stresses and support their children through this crucial phase of development if they have access to the care they need to keep themselves healthy.

Royals: I understand you applaud Mississippi for passing extended postpartum coverage but maintain there's much more to be done. Can you say more about that, and how Medicaid expansion factors in?

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Williams: Absolutely. That's a great question.

The extension is critical for all the reasons I mentioned above. But the state could – and should – enact the full Medicaid expansion allowed under the Affordable Care Act. So far, I believe 39 states plus D.C. have taken advantage of this provision to extend Medicaid to nearly all adults with income up to a certain level, typically about $20,000 a year for a single person. That would cover not just new mothers, but all adults who meet the income guidelines.

One particular group that would benefit is young women who are not yet pregnant but might conceive in the near future. It would give them access to the care they needed to get chronic diseases like hypertension and diabetes under control. That could be a changer in reducing maternal mortality.

And of course, Medicaid is not the only way to protect public health.

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I firmly believe that Mississippi must restore physicians' freedom to deliver the full range of health care for every resident, including gender-affirming care and abortion. State policy makers must also address the environmental factors that threaten health and well-being. That includes the unconscionable water crisis in Jackson, air pollution in , and the lack of access to fresh fruits and vegetables in “food deserts” across the state.

Williams cited the following articles in her responses:

Health Status : Maternal and infant mortality

Mississippi State Plan for Comprehensive Cancer Control 2018-2022

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A Mississippi community is ‘grateful' for more air testing, but skeptical of what comes next | WWNO

Food Deserts in Mississippi

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

Mississippi Today

Legislation to strip key power of PERS Board passes both chambers

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mississippitoday.org – Bobby Harrison – 2024-04-27 15:39:23

Legislation that strips significant power from the board that governs the 's public employee pension program has passed both chambers of the .

Under the legislation set to go to Gov. Tate Reeves during the final days of the 2024 , the Public Employees Retirement System Board would no longer have the authority to increase the contribution rate levied on governments (both on the state and local level) to pay for the massive retirement system.

The legislation, which passed both chambers in recent days, was a reaction to the decision by the board to increase by 5% over a three-year period the amount local governments contribute to each employee's paycheck for their retirement. Under the PERS Board plan, the employer contribution rate would have been increased to 22.4% over three years, starting with a 2% increase on July 1.

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The board said the increase was needed to ensure the long-term financial stability of the system that pays retirement for most public employees on the state and local levels, staff of local school districts and universities and community colleges.

City and county officials in particular argued that the 5% increase would force them to cut government services and lay off employees.

Under the bill passed by the Legislature there still would be a 2.5% increase over five years — a .5% increase in the employer contribution rate each year for five years.

In addition, legislative leaders said they plan to put another $100 million or more in state tax dollars into the retirement system in the coming days during the appropriations .

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Under current , the PERS Board can act unilaterally to increase the amount of money governmental entities must contribute to the system. But under the new bill that passed both chambers, the board can only make a recommendation to the Legislature on increasing the employer contribution rate.

The PERS Board also would be required to include an analysis by its actuary and independent actuaries on the reason the increase was needed and the impact the increase would have on governmental entities.

In the 52-member Senate, 14 Democrats voted against the bill. Only one House member voted against the proposal.

Sen. David Blount, D-, said the bill failed to address the financial issues facing the system. He said a permanent funding stream is needed.

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Blount said, “You are moving in the wrong direction and weakening the system” with the bill the Legislature approved. “Is it painful? Is it going to cost more money? Yes, but we need to do it” to fix the system.

The system has assets of about $32 billion, but debt of about $25 billion. But Sen. Daniel Sparks, R-Belmont, and others argued that the debt was “a snapshot” that could be reduced by strong performance from the stock market. The system depends on its investments and contributions from employers and employees as sources of revenue.

The system has about 360,000 members including current public employees and former employees and retirees.

The legislation states that no changes would be made for current members of the system. The legislation does reference looking at possibly changing the system for new employees. But that would be debated in future legislative sessions.

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The bill does not include an earlier House proposal to dissolve the PERS Board, which consists primarily of people elected by the members of the system, and replace them with political appointees.

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

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Mississippi Today

A solution to the Republican impasse on Medicaid expansion

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mississippitoday.org – Adam Ganucheau – 2024-04-27 15:21:27

Kathleen O'Beirne knocked loudly on Sen. Kevin Blackwell's office door in the basement of the Mississippi Capitol on Saturday morning.

O'Beirne, a Ridgeland resident and mother of two , has been closely tracking the back-and-forth debate on expansion, which Blackwell, as chairman of the Senate Medicaid Committee, is leading for the Senate. She and a group of other concerned citizens simply wanted a word with the Republican leader.

But there was no answer at the door, and there would be no conversation. So O'Beirne and the others took blank sheets of copy paper and began writing letters. When they finished writing, they taped the letters to Blackwell's door.

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“I'm here because of the human cost of not expanding health care coverage to poor Mississippians,” O'Beirne said outside Blackwell's office. “But I'm also here because I'm a taxpayer. And I see that our senators are about to pass up literally billions in federal tax dollars that you and I and most other Mississippians already pay. We have the chance to bring all of that money back to the state of Mississippi, but we're about to walk away from it for no good reason.”

Kathy Knight, left, of , and Kathleen O'Beirne of Ridgeland, hold a sign urging lawmakers to fully fund a Mississippi Medicaid expansion plan, while Jack Reed Jr., a former mayor and a long time northeast Mississippi businessman, right, joins a group of small business owners who urged the same during a Tuesday, April 23, 2024, news conference at the state Capitol in Jackson, Miss. (AP Photo/Rogelio V. Solis)

As O'Beirne and other Mississippians have closely followed, Blackwell has been as dug-in as any lawmaker during the Medicaid expansion fight. This week, after agreeing to hold public conference committee meetings to debate Medicaid expansion, he refused to meet a second time with his House counterparts. He has seldom engaged with House Republican leaders in private, either.

He did, however, choose to speak to a gaggle of reporters on Friday after the Senate sent a compromise plan to the House for consideration. In the interview, he drew hard lines against any additional compromise with the House, specifically around a work requirement, and even doubted whether his own plan had the necessary from his Republican Senate colleagues.

READ MORE: Blackwell says Senate won't budge on Medicaid work requirement

Blackwell and some Republican senators have long maintained that any expansion deal must include a requirement that Medicaid recipients work, which is a conservative policy desire that the federal government has struck down in 13 previous expansion states. a stringent work requirement, health care advocates and legal scholars believe, would effectively kill any expansion plan.

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But in the plan the Senate put forward on Friday, they would still mandate the requirement. It would also force the state's attorney general to sue the feds over any rejection and hope that a conservative 5th Circuit Court of Appeals allows the work requirement to go into effect. Unless a work requirement was granted by either the federal Medicaid agency or the federal courts, expansion could not go into effect under the Senate plan.

READ MORE: The unlikely Mississippi politician who could tank Medicaid expansion

However, an earlier House proposal also included a work requirement but would allow expansion to go into effect if the state could not convince the federal government to allow it. House leaders have not yet publicly responded to the Senate plan they received on Friday, but the work requirement piece has been the main topic of deliberations on that side of the building. 

The House and Senate Republican remained at an apparent impasse as of midday Saturday and adjourned for the day without giving any public updates on expansion negotiations. Both chambers were working into the evening Saturday and will work again Sunday to hammer out final agreements on a $7 billion state budget.

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None of that sat right with O'Beirne, inspiring her to back to the Capitol on Saturday and make the unannounced visit to Blackwell's office. When asked what message she was trying to deliver to Blackwell, she said: “Well, a compromise.”

O'Beirne then summed up what she wrote in her note to Blackwell:

“I'm a recovering lawyer, so I'm used to resolving litigation. I think there's a very obvious compromise that the Senate and the House could come to if they were willing to do the work. 

My suggestion is to keep the Senate's work requirement. Keep the provision that says if CMS kicks back the work requirement, then the has to sue the feds. But also, keep the House provision that will allow Medicaid expansion to go into full effect, even if CMS kicks back the work requirement.

So you go on and you start pulling down those billions of federal dollars that the state and people get health care coverage. Then in the meantime, let the lawyers and government officials sort out the work requirement business. To me, that's a win-win-win. 

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Now, I'm sure Lt. Gov. Hosemann, Sen. Blackwell and other leaders are mulling that over. Maybe they've already had that thought. To me, it's such an obvious compromise that takes full advantage of our tax dollars. It's not wasting our tax dollars. It's helping communities. It's helping hospitals. It's helping doctors. It's helping needy patients. It is just an all around win that I sure hope they can get to.”

Kathleen O'Beirne

Such a compromise would require some careful drafting of the legislation, experts say, and whether it checks enough boxes for Blackwell and the hard-line senators is anyone's guess. But O'Beirne, a self-described “pragmatist,” felt led to share it with Blackwell on Saturday.

“I really do think there's a path here,” O'Beirne said. “It seems like a very simple solution right under our noses that Senate leaders are about to pass up. How frustrating would it be to come all this way to get nothing?”

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READ MORE: These Republicans wanted a Medicaid work requirement but couldn't get approval. So they got creative.

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

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Mississippi Today

Lawmakers send MAEP education funding formula rewrite to governor

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mississippitoday.org – Bobby Harrison – 2024-04-27 13:25:23

A new school formula has been approved by the that, like the long-standing Mississippi Adequate Education Program, will rely on an objective mechanism to determine how much state funding is needed to operate schools.

The push to replace MAEP has been one of most contentious issues facing legislators in the final days of the 2024 . There have been efforts for years to replace the formula by those who say the state could not afford it.

On Saturday the 52-member Senate with three dissenting votes passed on to the governor a compromise proposal to replace MAEP. The House had unanimously passed it late Friday.

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“The whole point of us doing this is to make certain our school districts are treated as fairly and as best we could,” said House Education Chair Rob Roberson, R-Starkville. He said the new formula will additional money for poor districts and for low-income and special-needs students.

Roberson's original bill did not include an objective funding formula, which had been the hallmark of MAEP. Senate Education Chairman Dennis DeBar, R-Leakesville, who was reluctant to rewrite MAEP, finally acquiesced, but was insistent that any rewrite include an objective formula that took out of the hands of politicians – namely legislators – the amount of money needed for the operation of local school districts.

On Saturday, DeBar told senators that if the Senate had not insisted on an objective funding formula, the Legislature could have “willy nilly” decided the level of education funding.

“This formula will allow for predictability over time. Whereas the House bill did not,” DeBar said. “It (the House plan) was a one-year thing where the Legislature could in and decide to increase or decrease funding for education. This will hold our feet to the fire in the Legislature and ensure our schools are funded.”

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House Education Vice Chairman Kent McCarty, R-Hattiesburg, told House members that the objective funding formula made the original House proposal stronger.

“I think this is a good addition to the bill,” he said. Like MAEP, the formula will be recalculated every four years and in the intervening years there will be an inflation factor added to the funding.

Under the new formula, schools will receive per student the average teacher salary divided by 14, which represents the average student-teacher statewide ratio. In addition schools will get another 20% of that amount for administrative costs, 30% for ancillary costs and money for operations and maintenance based on the three-year, per-square- average of the school district's operations and maintenance costs.

On top of that, the school districts will receive additional funds for students in certain categories, such as for special-education students, those living in poverty, or living in of high poverty and for students who do not speak English as their primary language. The additional money provided to categories of students was a key component of the original House bill.

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Like MAEP, local school districts will be required to pay a portion of the cost. But wealthier districts will be required to pay more than districts with a smaller local property tax base. No district will be mandated to pay more than 27% of the cost.

Sen. Hob , D-Amory, one of the architects of MAEP in 1997, was one of the three no votes.

While Bryan said there appeared to be good features to the new funding plan, more time was needed to study it.

“It is simply not possible to enact a funding formula for public education in this legislative session where we know what we are doing,” he said. “We don't have enough time for people to look at the new proposal, consider alternatives.”

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Bryan pointed out that if MAEP was unpredictable for school districts it was because of the Legislature's refusal to fully fund it. He said it is possible – even likely – that the same will occur with the new formula.

MAEP had language saying the formula “shall” be fully funded, But the full funding mandate was ignored every year since the program was fully enacted in 2003 except for twice.

Under the first year of the new formula, which goes into effect with the beginning of the new fiscal year on July 1, K-12 education is supposed to receive an additional $230 million.

The additional funding will bring the education budget to $2.94 – about $50 million less than MAEP would have provided if fully funded.

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DeBar said that based on inflation it will take about $50 million more in funds to fully fund the new formula next year.

The new formula will be called simply the Mississippi Student Funding Formula.

Sen. Angela Hill, R-, voted against the proposal because she feared that like MAEP the new formula would make a commitment over time the state could not afford. Plus, she said she was concerned about the money going to educate students who spoke English as a second language. Hill said she wanted more details on that feature of the bill.

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

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