Mississippi Today

Hospitals, business leaders suffering FOT — Fear of Tate — on Medicaid expansion

Published

2 months ago

March 25, 2024

mississippitoday.org – Geoff Pender – 2024-03-25 13:40:34

Mississippi's business leaders and hospitals each have formidable lobbies, and neither has been shy over the years about nudging a reluctant state Legislature in one direction or another if it dawdles on an important issue.

But their relative silence (only recently) on the most profound issue before lawmakers in a generation — expanding Medicaid coverage to the working poor — has been deafening.

It could be a life-or-death issue for tens of thousands of people in the poorest of states with many Third World health metrics. It's a monumental issue for the fiscal stability of foundering rural hospitals. It's a crucial workforce issue for businesses and economic development. It's a major financial issue for the state.

FAQ: What is Medicaid expansion, really?

So why are we mostly hearing crickets from two of the most powerful groups in the commonwealth, on an issue in which they've both got serious skin in the game?

They appear to be suffering a condition known as Fear of Tate, or FOT. It's a condition peculiar to the Magnolia State, now into the second term of Gov. Tate Reeves. It usually presents any time there's a partisan politically charged issue before our leaders. It manifests itself in timidity or political rhetoric replacing thoughtful approach, and bad, sometimes unworkable or downright asinine policy proposals that poorly serve the average Mississippian.

Reeves has worked hard to instill FOT. He plays partisan political hardball. His main policy is “no.” He holds political grudges until the end of time and will get even if possible. And he's managed to tamp down business lobby influence and darned-near snuffed out the hospital association lobby.

The Mississippi Hospital Association — then including leaders from the state's largest hospitals — had for years been a vocal advocate for accepting billions of federal dollars to expand Medicaid coverage to working poor and uninsured Mississippians, like most other states have done. Hospitals had grown weary of eating hundreds of millions of dollars a year in costs of treating uninsured Mississippians.

Hospitals did some quick math, and figured $1 billion a year in federal money was more than $0. The hospital association started a ballot-initiative drive to sidestep Reeves and the Legislature and put the issue directly to voters. When the state Supreme Court derailed that drive, the hospital association's PAC plunked down $250,000 on the campaign of Reeves' opponent last year, Democrat Brandon Presley, a vocal supporter of Medicaid expansion.

Well, Reeves understandably didn't like that. It's unclear what cajoling he did, but the next thing you know, the state's largest hospitals appeared to catch a case of FOT. They left the Mississippi Hospital Association like it was on fire, and soon thereafter, its longtime director was fired. Just like that, a major political lobby and its efforts at Medicaid expansion were defanged.

But Reeves, steadfast in his opposition to Medicaid expansion, still faced the problem that the proposal was gaining popularity with the public and among some GOP legislative leaders. And despite two terms at lieutenant governor and one as governor, he still had squat for an alternative plan to help poor working Mississippians and struggling hospitals.

Reeves, just 47 days before the 2023 election, came up with a plan to help the hospitals (though his message for uninsured working folks has remained to get a better job with insurance). But he apparently also came to the conclusion that Medicaid and federal help is the only realistic game in town, so he enacted his own Medicaid expansion — expansion of payments to hospitals, and levying a tax on them to cover the state's share.

Major hospital leaders were pleased with the proposal for them to get about $700 million more in Medicaid money. They appeared to back down on the push for expanded coverage to the working poor.

And since then, some legislative leaders say, hospitals are not coming out strong for the Medicaid expansion because they fear Reeves might taketh away — somehow rescind the increased payments to hospitals. But it would appear, under current state law and federal Medicaid approval for a “waiver” to allow the increased payments, the Reeves administration could not really do that without legislative approval.

Now, after Reeves' reelection, the Republican-led state House has passed a Medicaid expansion bill. But the Senate, despite Lt. Gov. Delbert Hosemann having expressed openness to expansion for years, has hung fire. Some House and Senate leaders and others at the Capitol say the Senate is seeing an outbreak of FOT on expansion.

The Senate has let its own bill die without a vote, and despite saying it has its own plan forthcoming, it still has not been made public, despite deadlines and the end of the legislative session looming. Reeves has reportedly been threat—er—lobbying senators against expansion, and leaked details of the Senate's draft plan show it's pretty much a non-expansion expansion. It would leave hundreds of millions of federal dollars on the table, causing state taxpayers to pay more, and it would insure far fewer Mississippians than the House plan. If enacted, Mississippi would remain on the list of non-expansion states. Some experts and expansion advocates have said it's likely unworkable and would not receive federal approval.

Now for the business lobby, which itself appears to have developed FOT on Medicaid expansion.

Back in July of 2021, Scott Waller, president of the Mississippi Economic Council — the state's chamber of commerce — said business leaders were preparing to weigh in on Medicaid expansion, and soon.

He said MEC, which has about 11,000 members from 1,100 companies, would soon begin a research drive, including measuring public opinion and polling MEC business leaders on Medicaid expansion and other health care issues. He said he expected the group would take a position and make policy recommendations on expansion before the 2022 legislative session started, because “a healthy workforce is a vital component of moving our state and economy forward.”

But that didn't happen then, and it still hasn't happened.

MEC last week issued a social media statement, ostensibly on Medicaid expansion, that was so milquetoast and timid that many legislative leaders questioned what it meant.

“Providing healthcare for working Mississippians is vitally important. It remains MEC's stated position that legislative leaders ‘find workable solutions and help shape a plan to increase access to healthcare for working Mississippians that explores all available options.'”

Asked for an explanation of what exactly this statement meant and whether MEC supports the expansion plan the House passed nearly a month earlier, Waller said the statement “stands for itself.” He said, “What was stated is the stated position of our board … that the Legislature find a solution.”

If Republican House leaders were hoping for business backing and cover for the bill they had passed nearly a month earlier, that wasn't it. Just a vague tweet.

The Mississippi Manufacturers Association showed a little more backbone, and actually appeared to endorse the House plan.

“In late Feb., (Speaker) Jason White and the House passed Healthy MS Works, expanding healthcare access to 200,000 Mississippians,” the MMA statement said. “MMA supports improved access to quality healthcare, especially in rural areas, and efforts to promote a healthier workforce.”

But this wasn't from a Capitol rally, with MMA members front and present on the rotunda steps to get lawmakers' attention. It was a social media post on a Friday when most lawmakers had already gone home for the weekend.

To date, the most vocal support for expanding Medicaid coverage has come from the religious community, health advocates and doctors and nurses. Groups of preachers and doctors held rallies last week calling on lawmakers to help the Magnolia State's working poor and uninsured. Mississippi's American Cancer Society chapter has done yeoman's work advocating for expansion, and appears to be the only group spending major resources on a public awareness campaign on TV and radio.

Some House members — and some Senate advocates of expansion — have lamented the lack of robust support from two powerful lobbies, whose members at times past have quietly lobbied them to accept the billions of federal dollars being offered, expand Medicaid and help create a healthier workforce.

But as lawmakers attempt to gather and hold a veto-proof majority for an expansion plan under the governor's threats, FOT appears to be making that harder.

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 1862

Published

4 hours ago

May 13, 2024

Staff Editor

MAY 13, 1862

During the Civil War, Robert Smalls and other Black Americans who were enslaved commandeered an armed Confederate ship in Charleston. Wearing a straw hat to cover his face, Smalls disguised himself as a Confederate captain. His wife, Hannah, and members of other families joined them.

Smalls sailed safely through Confederate territory by using hand signals contained in the captain's code book, and when he and the 17 Black passengers landed in Union territory, they went from slavery to freedom. He became a hero in the North, helped convince Union leaders to permit Black soldiers to fight and became part of the war effort.

After the war ended, he returned to his native Beaufort, South Carolina, where he bought his former slaveholder's home (and allowed his widow to live there until her death). He served five terms in Congress, one of more than a dozen Black Americans to serve during Reconstruction. He also authored legislation that enabled South Carolina to have one of the nation's first free and compulsory public school systems and bought a building to use as a school for Black children.

After Reconstruction ended, however, white lawmakers passed laws to disenfranchise Black voters.

“My race needs no special defense for the past history of them and this country,” he said. “All they need is an equal chance in the battle of life.”

He survived slavery, the Civil War, Reconstruction and the beginnings of Jim Crow. He died in 1915, the same year Hollywood's racist epic film, “Birth of a Nation”, was released.

A century later, his hometown of Beaufort opened the Reconstruction Era National Monument, which features a bust of Smalls — the only known statue in the South of any of the pioneering congressmen of Reconstruction. In 2004, the U.S. named a ship after Smalls. It was the first Army ship named after a Black American. A highway into Beaufort now bears his name.

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

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Mississippi Today

Podcast: House Minority Leader reflects on breakdown of Medicaid expansion negotiations

Published

4 hours ago

May 13, 2024

Staff Editor

Rep. Robert Johnson, D-Natchez, the House minority leader, talks with Mississippi Today's Bobby Harrison and Taylor Vance on how efforts to expand Medicaid broke down during the chaotic final days of the 2024 legislative session. He hopes those efforts are revived in the 2025 session.

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

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Mississippi Today

Lawmakers move to limit jail detentions during civil commitment

Published

7 hours ago

May 13, 2024

Staff Editor

mississippitoday.org – Kate Royals – 2024-05-13 05:00:00

This article was produced for ProPublica's Local Reporting Network in partnership with Mississippi Today. Sign up for Dispatches to get stories like this one as soon as they are published.

Mississippi lawmakers have overhauled the state's civil commitment laws after Mississippi Today and ProPublica reported that hundreds of people in the state are jailed without criminal charges every year as they wait for court-ordered mental health treatment.

Right now, anyone going through the civil commitment process can be jailed if county officials decide they have no other place to hold them. House Bill 1640, which Gov. Tate Reeves signed Wednesday, would limit the practice. It says people can be jailed as they go through the civil commitment process only if they are “actively violent” and for a maximum of 48 hours. It requires the mental health professional who recommends commitment to document why less-restrictive treatment is not an option. And before paperwork can be filed to initiate the commitment process, a staffer with a local community mental health center must assess the person's condition.

Supporters described the law, which goes into effect July 1, as a step forward in limiting jail detentions. Those praising it included county officials who handle commitments, associations representing sheriffs and county supervisors, and the state Department of Mental Health.

“This new process puts the person first,” said Adam Moore, a spokesperson for the Department of Mental Health, which provides training, along with some funding and services related to the commitment process. “It connects someone in need of mental health services with a mental health professional as the first step in the process, before the chancery court or law enforcement becomes involved.”

But some officials involved in the commitment process said that unless the state expands the number of treatment beds, the effect of the legislation will be limited. “Just because you've got a diversion program doesn't mean you have anywhere to divert them to,” said Jamie Aultman, who handles commitments as chancery clerk in Lamar County, just west of Hattiesburg.

Although every state allows people to be involuntarily committed, most don't jail people during the process unless they face criminal charges, and some prohibit the practice. Even among the few states that do jail people without charges, Mississippi is unique in how regularly it does so and for how long. Under Mississippi law, people going through the commitment process can be jailed if there is “no reasonable alternative.” State psychiatric hospitals usually have a waiting list, and short-term crisis units are often full or turn people away. Officials in many counties see jail as the only place to hold people as they await publicly funded treatment.

Idaho lawmakers recently dealt with a similar issue. There, some people deemed “dangerously mentally ill” have been imprisoned for months at a time; this spring, lawmakers funded the construction of a facility to house them.

Nearly every county in Mississippi reported jailing someone going through the commitment process at least once in the year ending in June 2023, according to the state Department of Mental Health. In just 19 of the state's 82 counties, people awaiting treatment were jailed without criminal charges at least 2,000 times from 2019 to 2022, according to a review of jail dockets by Mississippi Today and ProPublica. (Those figures, which included counties that provided jail dockets identifying civil commitment bookings, include detentions for both mental illness and substance abuse; the legislation addresses only the commitment process for mental illness.)

Sheriffs have decried the practice, saying jails aren't equipped to handle people with severe mental illness. Since 2006, at least 17 people have died after being held in jail during the civil commitment process; nine were suicides.

The bill's sponsors said Mississippi Today and ProPublica's reporting prompted them to act. “The deficiencies have been outlined and they're being corrected,” said state Rep. Kevin Felsher, R-Biloxi, a co-author of the bill.

An affidavit of someone who was committed and held in a Mississippi jail for mental health issues. Credit: Obtained by Mississippi Today and ProPublica. Highlighting by ProPublica.

Under current law, anyone can walk into a county office and fill out an affidavit alleging that someone, often a family member, is so seriously mentally ill that they must be forced into treatment. A judge or special master issues an order directing sheriff's deputies to take the person into custody for evaluations, a court hearing and sometimes inpatient treatment. Those screenings take place after the person is in custody — and often while they are in jail.

The legislation adds several steps to the civil commitment process in order to weed out unnecessary commitments. When someone seeks to file paperwork to commit another person, a county official will direct them to the local community mental health center. There, a mental health professional will try to interview the person alleged to be mentally ill and others who are familiar with their condition. Staff can recommend commitment or other services, including intervention by mental health professionals who will travel to the patient or inpatient treatment at a crisis stabilization unit.

As a chancery clerk in northeastern Mississippi's Lee County, Bill Benson has long dealt with people seeking to file commitment affidavits.

He said first requiring a screening by a mental health professional is a good move. “I'm an accountant. I'm not going to try and make a determination” about whether someone needs to be committed, he said. He generally allows people to file commitment papers so he can “let the judge make that call.”

The bill says that if the community mental health center recommends commitment after the initial screening, someone can't be jailed while awaiting treatment unless all other options have been exhausted and a judge specifically orders the person to be jailed. The legislation also says people can be held in jail for only 24 hours unless the community mental health center requests an additional 24-hour hold and a judge agrees. Roughly two-thirds of the people jailed over four years were held longer than 48 hours, according to Mississippi Today and ProPublica's analysis.

However, the bill does not address the underlying reason that many people are jailed as they await a treatment bed. “I'm not certain there are enough beds and personnel available to take everybody,” Benson said. “I think everyone will attempt to comply, but there are going to be some instances where somebody's going to have to be housed in the jail.”

Nor does the legislation say anything about how the provisions will be enforced. House Public Health Chair Sam Creekmore, R-New Albany, the primary sponsor of the bill, said the Department of Mental Health will “police this.” He also said he hopes the law's new reporting requirements for community mental health centers will encourage county supervisors to monitor compliance.

Moore, at the Department of Mental Health, said the agency won't enforce the law, although it will educate county officials, who are responsible for housing people going through civil commitment until they are transferred to a state hospital. “We sincerely hope all stakeholders will abide by the new processes and restrictions,” Moore said. “But DMH does not have oversight over county courts or law enforcement.”

Several mental health experts and advocates for people with mental illness say the law doesn't go far enough to ban a practice that many contend is unconstitutional. For that reason, representatives of Disability Rights Mississippi have said they're planning to sue the state and several counties.

“The basic flaw remains,” said Dr. Paul Appelbaum, a professor of psychiatry at Columbia University and former president of the American Psychiatric Association. “There is no justification for putting someone who needs hospital-level care in jail, not even for 24 hours.”

Agnel Philip of ProPublica and Isabelle Taft, formerly of Mississippi Today, contributed reporting.

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

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