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Mississippi Today

Few Mississippi lawmakers outright oppose Medicaid expansion

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No Republican lawmaker in the Mississippi House or Senate voted in favor of expansion when legislative Democrats forced votes on the issue during the recently completed 2023 .

But those votes do not necessarily mean the state's Republican-controlled Legislature opposes opting into the policy that would provide health coverage for hundreds of thousands of poor, working Mississippians and revive rural hospitals that have been struggling to stay open.

Only a handful of lawmakers in both the House and Senate say they outright oppose Medicaid expansion, according to a survey of legislators conducted during the 2023 legislative session.

Just 21 of the House members surveyed, or 18% of the House, said they outright opposed Medicaid expansion. And just 18 of the Senate members surveyed, or 38% of the Senate, said they outright opposed it.

In the House, 67 members — a majority — said they either supported Medicaid expansion or were undecided. Mississippi Today could not get answers from 32 representatives.

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And in the Senate, 25 members — one vote shy of a voting majority — said they either supported Medicaid expansion or were undecided. Mississippi Today could not get answers from nine senators.

But among the lawmakers who said they opposed expansion or asked to be labeled as “undecided,” several went on to add that they were actually open to some version of expansion.

Several lawmakers who said they opposed expansion said they supported policies similar to those passed in states such as Arkansas, Kentucky or Indiana — all states that have passed versions of Medicaid expansion.

Sen. Kevin Blackwell, a Republican from DeSoto County who chairs the Senate Medicaid Committee, was among those. Other key legislative fell in this camp.

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“I am open to considering something like Indiana has done,” said Rep. Trey Lamar, a Republican from Senatobia, after asking to be labeled “undecided.”

“I'm against it other than I would consider something like in Kentucky or Indiana, where everyone's got skin in the game,” said Rep. Kevin Horan, a Republican from Grenada who asked to be labeled “no.”

Mississippi is one of just 10 states that have resisted Medicaid expansion. Economists say the policy would bring $1.5 in new revenue annually while creating jobs, helping bolster the budgets of struggling hospitals and providing up to 300,000 poor, working Mississippians with health coverage.

The years-long resistance to expansion has most directly from Republican leaders — namely Gov. Tate Reeves and House Speaker Philip Gunn — who have likened the policy to socialism. Republican Lt. Gov. Delbert Hosemann, who presides over the Senate, has in the past indicated support for some version of expansion but hasn't earnestly pushed legislation since he was elected in 2020.

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And as poor Mississippians struggle to afford basic and dozens of the state's rural hospitals struggle to keep their doors open, Mississippi voters appear resolutely behind expansion. An April poll from Mississippi Today/Siena College showed that 66% of Mississippians support Medicaid expansion. An earlier survey in January showed 80% of Mississippians favored expansion.

Several rank-and-file Republican lawmakers polled by Mississippi Today said they were open to expansion, and some shared they believed there was a greater willingness among Republicans to pass expansion than in previous years. All 57 Democratic lawmakers expansion.

Still, there was no serious push by Republicans in the 2023 session to even debate expansion, let alone vote on it.

“I think people are a little more open-minded about it than they were,” said Rep. William Tracy Arnold, a Republican from Booneville who supports Medicaid expansion. “We have a substantial amount of revenue now. We have to help save our struggling hospitals, and this would not only be giving hospitals more funding, it would help the struggling, tax-paying citizen.”

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“Years ago when I first ran, I was totally opposed to Medicaid expansion,” said Rep. Mark Tullos, a Republican from Raleigh. “But I've looked at it further, and looked at what Arkansas did, and I would support something similar to what Arkansas has, with coverage for low income working people. Being from rural Mississippi, hospitals play a large role in our community. For rural Mississippi we are going to have to do something.”

“I'm for giving the working people of Mississippi health coverage,” said Rep. Sam Creekmore, a Republican from New Albany. “I'm for giving the working people health coverage. It would save lives. It would keep people working and prevent medical issues down the road.”

“I am for health insurance for our working people in Mississippi,” said Rep. Jerry Turner, a Republican from Baldwyn. “I'm for a program that would have everybody have skin in the game.”

Dozens of other Republicans asked to be marked as “undecided” in Mississippi Today's expansion database. Some of those indicated they were waiting on leadership to present some options, and others said they wouldn't speak to any theoretical policy change without first seeing a bill.

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“We need to have ,” said Sen. Bart Williams, a Republican from Starkville. “We have a hospital crisis and we need to listen to any and all ideas.”

“Without knowing what a bill looks like, it is hard to say. But we have to do something to help our rural hospitals,” said Rep. Jon Lancaster, a Republican from Houston. “But I am concerned about the federal strings.”

“We need to have discussions about it,” said Rep. Nick Bain, a Republican from Corinth. “There are good parts to it and not so good.”

“The devil is in the details, where the money is coming from,” said Sen. Walter Michel, a Republican from Ridgeland. “I do want to help the hospitals, but I would have to see the bill.”

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Still, several Republicans remain firmly opposed to expansion. And many of those opposed declined to expound on why they are opposed.

But Rep. Dana Criswell, R-Olive Branch, said: “It's bad insurance, so there's no reason to keep expanding it.”

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

Mississippi Today

On this day in 1954

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mississippitoday.org – Jerry Mitchell – 2024-05-17 07:00:00

MAY 17, 1954

Ella J. Rice talks to one of her pupils, all of them white, in a third grade classroom of Draper Elementary School in Washington, D.C., on September 13, 1954. This was the first day of non-segregated schools for teachers and . Rice was the only Black teacher in the school. Credit: AP

In Brown v. Board of Education and Bolling v. Sharpe, the unanimously ruled that the “separate but equal” doctrine in Plessy v. Ferguson was unconstitutional under the 14th Amendment, which guaranteed equal treatment under the

The historic brought an end to federal tolerance of racial segregation, ruling in the case of student Linda Brown, who was denied admission to her local elementary school in Topeka, Kansas, because of the color of her skin. 

In Mississippi, segregationist called the day “Black Monday” and took up the charge of the just-created white Citizens' Council to preserve racial segregation at all costs.

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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

Every university but Delta State to increase tuition this year

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mississippitoday.org – Molly Minta – 2024-05-17 06:30:00

Every in Mississippi is increasing tuition in the fall except for Delta University.

The new rates were approved by the governing board of the eight universities, the Institutions of Higher Learning Board of Trustees, at its regular meeting Thursday. 

The average cost of tuition in Mississippi is now $8,833 a year, a roughly 3% increase from last year. can expect to pay tuition ranging from $7,942 a year at Mississippi Valley State University to $10,052 a year at Mississippi State University. 

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In recent years, universities have cited and rising insurance costs as reasons for the tuition increases. At Thursday's meeting, the board heard a presentation on how property insurance is becoming more expensive for the eight universities as Mississippi sees more tornadoes and storms with severe wind and hail.  

READ MORE: Tuition increases yet again at most public universities

But it's an ongoing trend. Mississippi's public universities have steadily increased tuition since 2000, putting the cost of college increasingly out of reach for the average Mississippi . More than half of Mississippi college students graduated with an average of $29,714 in student debt in 2020, according to the Institution for College Access and .

At Delta State University, the president, Daniel Ennis, announced that he will attempt to avoid tuition increases as the regional college in the Mississippi Delta undergoes drastic budget cuts in an effort to become more financially sustainable. 

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“We will resist tuition increases so that our most economically vulnerable students can continue to have access to the opportunities that a college degree can ,” he wrote in a memo to faculty and staff on Monday. “We will move beyond basic survival and into a place where we have the capacity to take better advantage of our undeniable strengths.” 

Delta State didn't increase tuition last year, either. have been concerned the university is becoming too pricey for the students it serves. 

Tuition for the 2024-25 academic year, by school:

  • Alcorn State University: $8,105
  • Delta State University: $8,435
  • State University: $8,690
  • Mississippi State University: $10,052
  • Mississippi University for Women: $8,392
  • Mississippi Valley State University: $7,492
  • University of Mississippi: $9,612
  • University of Southern Mississippi: $9,888

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

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Federal panel prescribes new mental health strategy to curb maternal deaths

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For help, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) or contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.” Spanish-language services are also available.

BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

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Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

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For Aquino, it wasn't until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force — co-led by the Office on Women's Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

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The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

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Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana's population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

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Twelve states and Washington, D.C., have coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino's recovery. Aquino said she couldn't have imagined going through such a “dark time alone.” With Carrizo's support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

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Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don't want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help recognize mothers' mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage , and offer treatment options.

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But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.

Wendy Ell, executive director of the Maternal Health Access in Missouri, called her service a “lifesaving resource” that is and easy to access for any provider in the state who sees patients in the perinatal period.

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About 50 health care providers have signed up for Ell's program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists' ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study's authors.

Nancy Byatt, a perinatal psychiatrist at the of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

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“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock's reporting is supported by a grant from the National Institute for Health Care Management Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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

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