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MAP: Mississippi makes it uniquely hard for low-income new moms to get health care

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MAP: Mississippi makes it uniquely hard for low-income new moms to get health care

Low-income women in Mississippi have less access to care in the months after giving birth than their counterparts in every except Wyoming.

Mississippi and Wyoming are now the only two states in the country that have neither expanded eligibility to low-income working adults, nor extended postpartum Medicaid coverage for new mothers beyond 60 days after birth, according to data compiled by the health nonprofit KFF.

The other nine states that have not expanded Medicaid eligibility have all sought to extend postpartum coverage in recent years. Seven of them, Alabama, Tennessee, Georgia and South Carolina, have extended coverage to a year after birth. Texas and Wisconsin have sought federal approval to implement shorter extensions of six months and 90 days, respectively.

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“We know infant mortality and maternal health are challenges for our state,” said Tennessee Gov. Bill Lee, a Republican who opposes Medicaid expansion, when he introduced his proposal to extend postpartum coverage in 2020. “One in two Tennessee births are covered through our Medicaid program.”

In Mississippi, that number is higher: about six in 10 births are covered by Medicaid.

During the ongoing federal public health emergency, states are not to kick anyone off Medicaid. As a result, women who have given birth since March 2020 will have coverage until the emergency is lifted, potentially as soon as early 2023.

But ordinarily, a Mississippi woman with two kids and a partner together earning $3,000 a month, for example, would lose her Medicaid coverage two months after her baby is born.

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The same woman living in Alabama, which has not expanded Medicaid eligibility but approved a 12-month postpartum coverage extension earlier this year, would have health insurance until her baby is a year old. And the same woman living in Arkansas, which has expanded Medicaid but not extended postpartum coverage, would have health insurance before and after her pregnancy, because she would be eligible based solely on her income.

In Mississippi, women whose pregnancies are covered by Medicaid lose the ability to go to check-ups, get treatment for postpartum depression, and care for chronic conditions when their babies are just two months old.

(AP /Rogelio V. Solis)

House Speaker Philip Gunn, R-Clinton, has repeatedly rejected postpartum Medicaid extension, which easily passed the Senate last . He has described the proposal as Medicaid expansion, though it would not make more people eligible for Medicaid. Almost every other state that has refused to expand Medicaid has nevertheless extended postpartum coverage.

Last week, some of the state's leading doctors told the Senate Medicaid Committee that extending postpartum Medicaid would not only improve abysmal maternal and infant health outcomes but also save money.

Mississippi has the country's highest infant mortality rate and highest rate of premature births. Dr. Anita Henderson, a pediatrician and president of the Mississippi Chapter of the American Academy of Pediatrics, said the hospital cost of delivering a healthy baby at full term is typically around $5,000 to $6,000. But an extremely preterm baby requires a long stay in a neonatal intensive care unit (NICU), at an average cost of $600,000.

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State Health Officer Dr. Daniel P. Edney mentioned that Mississippi is one of just two states that has neither extended postpartum coverage nor expanded Medicaid eligibility.

“What I would beg us to consider is the fact it makes much more economic sense to let Medicaid pay for this rather than the state having to pay for it – either state agencies such as the health department paying, or hospitals paying for it with uncompensated care,” he said.

Pregnant women in Mississippi qualify for Medicaid as long as their family income is below 194% of the federal poverty level– about $4,600 per month for a family of four.

But after giving birth, a Mississippian with kids qualifies for Medicaid only if she has a very low income, earning $578 or less monthly for a family of four.

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With such a strict income eligibility requirement, it's all but impossible for anyone with a full-time job to qualify for Medicaid coverage. (And healthy adults without kids never qualify for Medicaid in Mississippi.)

In states that have expanded Medicaid, including Louisiana and Arkansas, adults with incomes below 138% of the federal poverty level, or about $3,200 for a family of four, qualify for health insurance.

An analysis by the consulting firm Manatt found that expanding eligibility for Medicaid would cut enrollment in pregnancy Medicaid by about half, because many women would qualify based on income alone.

Wil Ervin, deputy administrator for health policy for Mississippi Medicaid, told the Senate Medicaid Committee last week that extending postpartum coverage to a year would cost the state about $7 million.

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

Mississippi Today

Look for the “why” when engaging in disagreement

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“Bought sense is better than borrowed sense” lives in my memory, rent-. I've always cringed at it because, at every stage of , some lessons have been costly to learn.

At the Alluvial Collective, we show up to the office, on the screen, or in a community with one overarching : to create or deepen the connections that will support collective thriving. That is our “For what.” We get to show up with wisdom purchased over our organization's last 25 years of work and with wisdom borrowed from many generations and traditions. In most traditions, self-reflection and stories reveal the path to where we should go and how we should travel.

As you engage in the National Week of Conversation, here are a couple of stories and a few thoughts to help you show up for each other, our communities, and our country.

What Do You Need

The first story emerges from a book called “Getting To Yes,” about negotiating.

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Two people were arguing over an orange, and after some time, they decided to split it in half, feeling that equal parts were fair, like in elementary school. Before splitting the orange, they never asked each other the reason the other wanted it. As it turns out, one wanted the orange peel to flavor a cake, and the other wanted the orange's “meat” to eat.

In another story, an arriving house guest is deeply offended by their host's demand that they their shoes upon entering their home. The visit goes off the rails and probably off the porch, too.

Each of these stories reminds you of tensions and dilemmas that are all too familiar in our families, towns, and – for me – our leadership discourse.  We have notions about what the other person, or people, want, but at critical points, we need more humanizing insight into what makes it essential to them.

The Cost of Wisdom

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In the second story, the home's foyer had a large rug on its floor that had been in the family for generations. Understanding that, I would have offered to remove my shoes.

We benefit from being curious about the interests, the “for what” the other person engages with, rather than just the “what” or their position. It may seem inefficient, but it pales compared to the value curiosity brings to relationships. Good relationships are win-win; our team leans on telling and hearing stories to build relationships. They are the wellspring of “for whats” and “whys.”

The truthful stories that your neighbor or coworker tells to you and themselves comprise reality as they see it.  Your stories teach your in-laws and teammates history from your the learned or experienced vantage point. Dialogue and stories make our actions and attitudes make sense.  This is where trust begins to form.

Dialogue over Debates and Diatribes.

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As you begin your week, remember that how we engage matters as much as why. Diatribes and speeches don't make us good neighbors, and debates require someone to lose. We like authentic connections and hearing familiar themes in the stories of others. This week, open and honest dialogue is the strategy; to thrive together should always be the goal. We've paid too much for everything else.

Talk more; proclaim less. It's one of our mottos here at The Center for Practical Ethics (TCPE). Put another way, we might say our goal is to foster conversations rather than diatribes. This task is more difficult than most realize. What we know as ethicists is that merely conversations isn't enough. There's a wide variety of skills needed for fruitful dialogue to take place, and some are harder to by than others.

The ideal conversation partner is curious and humble, able to actively listen, knowledgeable about his or her own positions, familiar with basic principles of logical argument, charitable when interpreting claims, and—most importantly—willing to be wrong. Our work centers around equipping students with these skills and helping them navigate the complex ethical issues within our society's most contentious disagreements.

This year, National Week of Conversations (NWoC) coincided with Ethics Week here at the of Mississippi (UM). Many of our events are conversation-based because dialogue is the best way to evaluate the ideas of others and open ourselves up to new information and interpretation of facts, while gaining a better understanding of our own views.

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Two of our events in particular are worth examining more closely to see why NWoC and the work we do at TCPE are critical for sustaining civil society and the myriad public goods we all take for granted. First is our signature Just Conversations event. Students are placed in small groups and given a couple of ethical dilemmas to discuss. Trained student moderators guide the discussion to point out important aspects of the dilemmas, such as logical fallacies, analysis of stakeholders, ethical concepts and assumptions, and varying methods to achieve goals. Students often discover they agree with others—on the dilemma outcome and the details—far more than they expected.

Second, we have invited free speech scholar Sigal Ben-Porath to give a talk about her new book Cancel Wars: How Universities Can Foster Free Speech, Promote Inclusion, and Renew Democracy. Ben-Porath contends that universities are laboratories of democracy where students must learn to engage with disagreement. If the university is to be a place where truth is discovered, it must take seriously its historic social and educational obligation to train students in the skills needed for civil discourse and critical thinking. Her work is especially relevant in our ever more polarized times.

What these events demonstrate is that conversations—that is, engaged and fruitful conversations—must take place at all levels. Students must learn to talk to students just as much as faculty must learn to talk to faculty and administrators to administrators. What's more, these groups must talk to each other because while each of us have a role within academia (faculty, staff, student, dean, vice chancellor, etc.), we are also all citizens who work and live together.

Policies must be made, votes cast, businesses founded, churches attended, friendships established, and life lived. TCPE focuses on the skills of civil discourse by providing opportunities to cultivate those skills through Ethics Week, and highlights conversations that ask us to reflect on the role of universities as part of the NWoC.

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Join us at Noon on Friday, April 19 for a VIRTUAL lunch and learn session exploring tools to make us better listeners, and in turn, better equipped to engage in meaningful conversations across differences.

The session will be led by Dr. Graham Bodie, professor and Interim Chair of the Department of and Communication in the School of Journalism and New Media at the University of Mississippi.

This event is free and open to the public. Register to receive more information.

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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 1977

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mississippitoday.org – Jerry Mitchell – 2024-04-19 07:00:00

April 19, 1977

Alex Haley was awarded a special Pulitzer Prize for “Roots,” which was also adapted for television. 

Network executives worried that the depiction of the brutality of the slave experience might scare away viewers. Instead, 130 Americans watched the epic miniseries, which meant that 85% of U.S. households watched the program. 

The miniseries received 36 Emmy nominations and won nine. In 2016, the History Channel, Lifetime and A&E remade the miniseries, which won critical acclaim and received eight Emmy nominations.

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

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Mississippi Today

Q&A: Explaining the health care coverage gap

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mississippitoday.org – Mississippi Today – 2024-04-18 16:58:45

Lawmakers and advocates regularly refer to without insurance who are in the “coverage gap.” But what is the coverage gap, why does it exist and how does it relate to Medicaid expansion?

What is ?

Medicaid is a federal- program that provides health coverage to millions of people in the U.S., low-income adults, , pregnant women, elderly adults and people with disabilities. States administer the program, which is funded by both states and the federal government. Mississippi participates in the traditional Medicaid program, but the is debating two differing proposals that would expand Medicaid.

What is the coverage gap?

The coverage gap refers to a certain group of uninsured people in states that have not expanded Medicaid under the Affordable Care Act, the federal health reform law enacted in 2010 under the Obama administration. 

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The law sought to make health insurance affordable and accessible to more people and provides subsidies that lower costs for households with incomes between 100% and 400% of the federal poverty level, or between $18,210 and $72,840 in annual income, respectively, for an individual.

The Affordable Care Act also expanded Medicaid eligibility to adults under 64 years of age with income up to 138% of the federal poverty level – or $20,782 annually for an individual in 2024. But a U.S. Supreme Court ruling in 2012 made expansion optional, creating the “coverage gap” in states that did not opt to expand the federal-state program.

Why does it exist?

In Mississippi and the nine other states that have not expanded Medicaid, there is a gap between people whose income is not low enough to qualify for non-expanded Medicaid but less than 100% of the federal poverty level, or about $15,000 a year for an individual, to qualify for subsidized insurance through the federal marketplace. To qualify for Medicaid in Mississippi under current regulations, one's household income must be less than 28% of the federal poverty level, or a mere $7,000 annually for a of three. Non-disabled childless adults are not eligible for Medicaid unless they have another qualifying

How many people fall into the coverage gap?

Roughly 74,000 Mississippians fall into the coverage gap, according to a recent KFF study. Nationally, the number is 1.5 million people.

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What is Mississippi's uninsured population? 

Mississippi had one of the highest uninsured rates among working-age people in the country in 2022 at 16.4%, according to the U.S. Census Bureau's American Community Survey. 

Are people in the coverage gap employed?

In 2019, of the 178,000 uninsured Mississippians making below 138% of the poverty level, the majority – nearly 61% – were either working or looking for work. Many of those not in the labor force are unable to work due to a mental health or medical condition; lack of transportation; caring for a family member or recent incarceration, among other circumstances. More recent years' data has been skewed because of the pandemic and extended Medicaid coverage for people who would not have otherwise been eligible.

Nationally, according to KFF, the most common jobs of people in the coverage gap are cashiers, cooks, waiters-waitresses, construction/laborers retail salespeople and janitors.

What keeps businesses from offering health insurance to its employees or from offering it with reasonable deductibles?, according to Hilltop Institute at the University of Maryland, Baltimore County

Larger employers – those with over 50 employees – are required to offer health insurance to their employees or pay a penalty. For smaller employers, offering health insurance is not mandatory. And because it is often more expensive, smaller employers will offer benefits with higher deductibles and copays in order to reduce their own expenses. So those employed at a small business either may not have the option of health insurance or may choose to opt out because of cost.

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Nearly 69% of private businesses in Mississippi employ fewer than 50 employees, according to the Agency for Healthcare Research and Quality. It's up to 95% when public employees are included, according to Hilltop Institute at the University of Maryland, Baltimore County.

How many people would the House and Senate plans make eligible for Medicaid, and how many of those are in the coverage gap?

The House plan – which is traditional expansion under the Affordable Care Act and would make Mississippi eligible for hundreds of millions of federal dollars – is estimated to cover 200,000 Mississippians. That would include people in the coverage gap and others.

The Senate plan – which is not traditional expansion and does not qualify the state for the federal match – would insure about 40,000 Mississippians. This would include only people in the coverage gap, or only those making up to 99% of the federal poverty level.

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

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