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Former Gov. Steve Beshear: Medicaid expansion changed course of Kentucky history

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When former Kentucky Gov. Steve Beshear took office in 2007, the Bluegrass State had many challenges — not the least of which was lack of care for working folks — and limited resources to address them.

“Kentucky a number of fundamental weaknesses, not unlike Mississippi and a lot of other Southern states,” Beshear recently told . “We had a lack of educational attainment. We had a workforce that wasn't as trained or agile as the marketplace would demand. We had too many getting a poor start in life. We had an economy that wasn't as diversified as it needed to be. And one of the biggest fundamental weaknesses we had was a population that wasn't healthy.”

“… Governors have a lot of power and a lot of resources at their disposal, but none of us really have the resources locally to make a huge difference in the health of your people,” Beshear said. “We made progress in health care, from 2007 to 2010, but we couldn't really make any huge changes. Then along came the Affordable Care Act.”

Kentucky, starting in 2014, accepted federal to expand Medicaid and has been one of the most successful states in using the ACA to reduce its number of uninsured people. Its creation of a state- health insurance marketplace has been held as a national role model.

Mississippi Today has interviewed governors in the three Southern states that have expanded Medicaid: Arkansas, Louisiana and Kentucky, all of whom report net positives from the move. Despite numerous polls showing public support for expansion, Mississippi remains one of 10 states rejecting federal money for expansion, led now by Gov. Tate Reeves who has remained steadfastly opposed.

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READ MORE‘A no-brainer': Why former Arkansas Gov. Mike Beebe successfully pushed Medicaid expansion

READ MORE: Louisiana Gov. John Bel Edwards: Medicaid expansion ‘easiest big decision I ever made'

Beshear, whose son Andy Beshear is now governor and running for reelection this year, expanded Medicaid by a 2013 executive order. He said Medicaid expansion far exceeded initial projections in number of jobs created, money injected into hospitals, the state's economy and state budget. The number of uninsured Kentuckians dropped from over 20% to 7.5%. The net positive impact on Kentucky's economy was $30 billion over eight years.

“Medicaid expansion was the single-most important decision I made in eight years as governor because we changed the course of Kentucky's history,” Beshear said.

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Beshear's interview with Mississippi Today is below, edited for brevity.

Mississippi Today: Could you give us a quick overview of where things stood in Kentucky in 2013, both health-care wise and politically?

Gov. Steve Beshear: It was estimated that some 640,000 Kentuckians, out of a little over 4 million, had no access to affordable, quality health care. These were folks who would get up every morning and go to work, and just basically roll the dice — just hoping and praying that you don't get sick or get hurt. They were having to choose between food and medicine at times. They would have to ignore checkups that could catch serious conditions early. They just lived every day knowing that bankruptcy was just one bad diagnosis away.

… Fixing this is an expensive proposition, and a state by itself is just simply not in a position to address it … The Affordable Care Act was passed, and of course immediately became embroiled in litigation. My health care people came to me and we sat down and talked through what it allowed. We realized we had two decisions to make. One was, do we create a state-based exchange or do we go into the federal exchange. And two, do we expand Medicaid.

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The first decision was a pretty easy one because basically all of our providers and folks who would be involved felt that we needed to have more flexibility and be able to address Kentucky's particular needs with a state-based exchange … Ours became sort of the national standard, the gold standard for state-based exchanges … called me personally to congratulate us and thank us for showing the world that the Affordable Care Act can work.

… Whether to expand Medicaid was a tougher decision. Morally, I felt that we needed to do it because I believe health care is a basic human right and that Kentuckians needed it. The question came down to can we afford it? The opponents of expanding and of the Affordable Care Act were all saying it would bankrupt us.

I felt like we needed to answer that question. I hired PricewaterhouseCoopers — an internationally renowned accounting firm — to come in and analyze what they felt would happen in Kentucky if we expanded Medicaid.

They took about six months and came back, sat down and looked at me across my desk and said, “Governor, you cannot afford not to do this.” Wow. OK. They said because over the next eight years, you're going to create 17,000 new jobs. You'll inject about $15 billion into Kentucky's economy over the next eight years. You'll protect Kentucky's hospitals from the impact of cuts in indigent care funding and protect rural hospitals. And, you'll have about an $800 million positive budget impact over the next eight years.

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I was thrilled with that analysis, and we publicly announced that we were going to expand Medicaid as well as have our own state-based exchange. I was fortunate from a political standpoint that I did not have to have legislative approval. At that time I had a Democratic House and and Republican Senate and it would have been difficult, if not impossible, because of the surrounding quote-unquote Obamacare. Fortunately, years before, the had delegated the authority to define Medicaid eligibility under the federal law to our cabinet for Health and Services.

Mississippi Today: Did expansion live up to those early projections?

Beshear: The results were a little short of amazing. In the first six months, over 400,000 Kentuckians signed up … most of whom had never had affordable quality health care before. In the first 18 months, our uninsured rate dropped from over 20% to 7.5%. The uncompensated care rate dropped from 25% to less than 5%.

… But the critics would persist, particularly on the affordability of the program. So, after the first year, I went to Deloitte, another internationally known consulting firm, and said, OK, here's the Pricewaterhouse study done before we implemented it. Take this and look at a year of actual results and numbers and tell me where we are. Were they right?

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They did an in-depth study, came back, sat down across my desk, looked me in the eye and said, “Well, governor PricewaterhouseCoopers was wrong. They weren't optimistic enough. They projected that you would create 17,000 new jobs over eight years. Yeah, you've already created 12,000 in the first year, and we project you'll create 40,000 over eight years.” Wow, that was almost $3 billion in new revenue had gone to providers in the first 18 months. Then there's a $30 billion positive impact on Kentucky's economy over eight years … a net impact of $820 million impact on the state general fund over eight years.

Now, we haven't had a totally smooth history since I was governor. After my eight years, I was followed by a Republican governor who had campaigned on repealing Medicaid expansion. During his four years, he did abolish the state-based exchange and pushed us into the federal exchange. He proposed a waiver to the federal government that would place a lot of complicated work requirements on folks on the Medicaid program. But, fortunately, a fellow named Andy Beshear, who happens to be my son, defeated him in the next election and he has reinstituted the state-based exchange and made it even stronger and just recently announced the expansion of Medicaid even further to cover dental and vision and hearing for adults.

Mississippi Today: What is your take on Mississippi and other states struggling with this issue, and any advice on what we should do?

Beshear: Mississippi is one of what, 10 states now that haven't expanded? I would predict that the question is not if it ever will, it's just when will it expand. Because this should not be a political issue. This should not be a partisan argument. Why does anybody want to argue that people shouldn't have good quality health care?

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A lot of the Southern states that are left, that have not expanded Medicaid, tend to fall at the bottom of the list in virtually every ranking that we have now. Sure, Kentucky has also been there, and is still there in some of the rankings, but we're determined that we are going to move out of that category, instead of a state that's continually trying to catch up.

This should be an easy decision, for either political party to make. It's a matter quite honestly of putting people first and partisan politics second. When I was governor and I had to deal with a Republican Senate and Democratic House, I would tell them both, look, our elections are set up on a partisan basis. I understand that. We'll get out there and fight and scratch and carry on in these elections, but once they're over, we're all Kentuckians first … That's exactly the way I think Mississippi ought to approach an issue like this.

Throw out, throw away the partisan bickering and just look at what's best for your people. It's hard to argue that everybody having health care would not make life better for everybody. But there's also sound evidence, that this is not only affordable for a state to do, this is economically beneficial for a state.

Mississippi Today: You've made points very similar to other governors we've talked with. They've said the decision was relatively easy, and believe it was a hallmark of their administrations.

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Beshear: … It was an easy decision to make from the question of whether it was the right thing to do, or whether it would economically benefit Kentucky. It was a hard decision to make politically. In Kentucky at the time, President Obama had a 30% approval rating. Some of my advisors said, governor, do not touch the Affordable Care Act with a 10-foot pole, it will kill you.

But I felt, number one, how many times do you ever get to make a decision that will change the course of, change the history of your state for the good? You know that, and you can't turn your back on that, you have to step up and do the right thing … Medicaid expansion was the single-most important decision I made in eight years as governor because we changed the course of Kentucky's history.

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

Mississippi Today

Pro-Palestinian protest at University of Southern Mississippi ends without confrontation

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mississippitoday.org – Molly Minta – 2024-05-07 16:57:17

HATTIESBURG — A pro-Palestinian protest at the University of Southern Mississippi ended after an hour, with the roughly 50 and faculty who silently held signs facing no counter-protesters or arrests — a sharp contrast to the demonstration five days earlier at the University of Mississippi. 

According to a social media post, the ad hoc group, called USM for Palestine, were calling on the university to divest if it is invested in Israeli companies, echoing demands made by students across the country in the wake of the Israel-Hamas War. A university spokesperson said information about USM's investments would not be available by press time. 

“All members of the University community conducted themselves peacefully and respectfully,” Nicole Ruhnke wrote in an email. 

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It marked the second pro-Palestine protest at a Mississippi university since students at Columbia University set up an encampment about two weeks ago with protests touching over 40 campuses across the country. On May 2, police broke up a similar protest at the University of Mississippi after some 200 of mainly white, male counter-protesters heckled, chased and threw food-related items at pro-Palestinian students. 

Videos of the Ole Miss protest went viral, and the university has said it is investigating the conduct of at least one student. The Phi Delta Theta fraternity expelled from membership a student who was filmed making monkey noises at a Black female student protester. 

At USM, there are significantly less Greek students, but the specter of what could happen seemed to haunt campus . About 20 minutes before the protest was slated to start, the university police chief, Rusty Keyes, was already patrolling Shoemaker Square, the campus -speech zone.

Keyes pulled aside a legal observer from the Mississippi Center for Justice to say the students would only be allowed to protest for an hour because they had not followed university policy.

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“Now, I'm not happy with them,” Keyes told the legal observer. “They have to go by the rules. I have the ability to (approve) time, manner and place, okay? … That's my authority, off the policy.”

“If we're going to do this … it's going to be right there so I can protect them,” he added, gesturing to a patch of grass next to a brick building to the side of the square. “There's a lot things they could've done to make it a lot easier on theirselves (sic). And the policy works with them. But they're doing everything in their power to work against it. If they would just work, they can have everything they want. But they gotta go by the policy. That's why policies and laws are in place. It's to protect everybody. And I'm going to make sure everybody is protected.” 

Rusty Keyes, University of Southern Mississippi's chief of police, issues instructions to pro-Palestine protesters at the University of Southern Mississippi in Hattiesburg, Miss., on Tuesday, May 7, 2024. Credit: Eric Shelton/Mississippi

Then Keyes asked how many people were going to show up, before gesturing at a photographer on the other side of the fountain. 

“They called this photographer, they called that photographer,” he said, “and that shows right there — I mean, what's your intent, you know?” 

“Their intent is just to exercise their free speech,” the legal observer replied. 

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“I hope so,” Keyes said. “I hope so. I want to provide that for them. But they've got to go by my instructions for their safety, okay? And then this ends at 1 o'clock, okay? By 1 o'clock. And they gotta disperse.” 

When Mississippi Today tried to to Keyes, he said he wasn't commenting for the university and asked a reporter to delete her recording. 

A few feet away, Sirena Cantrell, the dean of students, stood with her arms crossed. Student groups aren't typically allowed to hold during finals, she noted, so the protest wasn't fair. And she was concerned that what happened at Ole Miss could happen at USM, especially because the police were stretched thin preparing for graduation. Since the protest was silent, she hoped it would be pointless to counter-protest. 

“We had actually asked the group not to do this, cause of finals weeks,” she said.

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Cantrell added she had tried to talk with a student from USM for Palestine, but it wasn't productive, which was, she added, “unfortunate.” 

“I didn't really have a discussion with her,” Cantrell said. “I just told her the policy, and she said ‘okay,' and then I never heard from her again.” 

By 12 p.m., had stationed themselves at all four corners of the fountain. Police cars blocked off the sidewalks to prevent people from walking too close to the protesters. 

Students wearing keffiyehs began to trickle in, holding signs that said “Save Gaza,” “Nothing Justifies Genocide” and “Humanity Above .” After speaking to Keyes, they shuffled over to the grass. 

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The protest was so silent, chirping birds could be heard over the fountain. So could the laughter of a group of mostly male students who stood to the side. 

University of Southern Mississippi students gather at the university's Shoemaker Square during a pro-Palestine protest at the campus in Hattiesburg, Miss., on Tuesday, May 7, 2024. Credit: Eric Shelton/Mississippi Today

“Because if Israel sees their signs, they'll stop shooting at Palestine,” one of the students said to snickers. He wore a blue ball cap, a gray shirt and gave his name as Tim, then “Binky.” 

Rumors about the protest had been all over social media, “Binky” said, and he had been looking forward to it. But so far, he was disappointed. 

“I kind of wanted it to be wild,” he said. “I was excited to watch them look stupid.” 

“I think there's no sense in yelling at each other, though,” responded his friend, who wouldn't give his name. Cantrell, he added, had told them “we can't raise havoc, just like they (the protesters) couldn't.” 

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“The stuff at Ole Miss got taken too far,” another added. “It was funny but like, some of the shit was way too far.” 

The protest was only supposed to last an hour, someone else said, and they all started laughing again. 

“That's gonna stop what's going on over there,” he said. “An hour of sign holding.” 

The silent protest was an attempt to follow university policy and avoid replicating the confrontational atmosphere of Ole Miss' protest, said Willem Myers, a 22-year-old social work major who was acting as USM for Palestine's spokesperson. 

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A protester holds a pro-Palestine sign during a protest at the University of Southern Mississippi in Hattiesburg, Miss., on Tuesday, May 7, 2024. Credit: Eric Shelton/Mississippi Today

Though they hadn't anticipated the Keyes' restrictions, Myers noted the mood was calmer than at a protest he attended at Tulane University in New Orleans, where police broke up an encampment and arrested 14 people, him. Myers had to get permission to leave the city, where he lives, to be on campus that morning for an exam. 

The goal was to support Palestinians, said Myers, who is Jewish. He disagrees with the idea that Israel “speaks for or is in the best interest of the Jewish people.”  

“What we're seeing overwhelmingly from people who are on the frontlines and who are in Rafah is that they are emboldened by and given hope by the actions of student protesters throughout the world right now,” he said. “The fact is that we don't exist in a vacuum, we're not an island here at USM or in Mississippi. We're part of the larger U.S. imperialist project, and we are firmly standing against it … to have it on record that USM students do not stand with the ongoing genocide and violence against Palestinians.” 

At 1 p.m., the protest was over. Students clapped briefly, then started packing up. 

As police watched, a white student in a blue shirt walked up to them. He asked what “the rules” were and why he wasn't allowed to talk to the protesters, “because it's a public university.” 

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“If you want to communicate with them, wait till they leave,” Keyes responded. “We just want to keep this area safe.” 

Though the student, a 23-year-old finance major who declined to give his name, was friends with the group that was making jokes, he said he actually wanted to have an open dialogue with the protesters. He would've liked to ask what their “end goal” was. 

He said he already knew their answer would be a ceasefire, but he wasn't sure that was possible in the Middle East where, he said, “it's built into their culture not to like each other.” 

But it's like that here, too, he said. In America, political beliefs are becoming more polarized due to “Big Tech” and misinformation. Though he identifies as a conservative, is in a fraternity and plans to vote for Donald Trump, the student said he also opposes the military industrial complex — but where else, except for a protest like this, would he have an opportunity to actually talk with people on the other side? 

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“I guess I do,” he said, when asked if he agreed with the protesters. “I guess I do, in a way. I think I saw a big sign that said ‘‘ceasefire.' Yeah, I do agree with that. I agree with a ceasefire. Of course. Why would I want more people to die?” 

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

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Mississippi Today

State revenue is sluggish, but interest from federal COVID-19 money is buoying budget

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Mississippi is collecting enough money to fund the current year's budget passed by the in 2023 — largely due to interest earnings on federal money — but tax collections remain sluggish.

April's revenue, just released by the staff of the Legislative Budget Committee, was $6.87 million or 0.65% over the estimate. But actual tax collections were $1.3 million below the estimate.

The reason total revenue for April was above the estimate is the interest earnings the is garnering on its surplus money. For the month of April, interest earnings were $8.2 million above the estimate, thanks to the unprecedented amount of surplus money largely from federal COVID-19 spending and because of high interest rates.

Through April, the first 10 months of the fiscal year, interest earnings are $93.4 million above the estimate. Interest earnings are more than half of the total collections above the estimate of $185.8 million for the year.

For the fiscal year to date, revenue is .39% or $24.7 million above the previous year. Without interest earnings, the state would be collecting less revenue that it did the previous year.

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The sluggish collections for April was released just as the Legislature was finalizing a budget for the upcoming fiscal year, which begins July 1.

For the upcoming fiscal year, the budget, all state funds, will be $7.28 or $583.2 million more than was budgeted for the current fiscal year. That number excludes the use of surplus funds to pay for one-time construction projects throughout the state.

Kindergarten through 12th grade education will $246 million or 8% of the increased funds while universities will receive an additional $60.8 million or 7.5% more than they received for the current year. Community colleges will receive an additional 18% or $53 million.

The Legislature is in an unusual position of being able to make record expenditures even as revenue collections appear to be slowing, thanks, in large part to COVID-19 relief funds and other federal funds.

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But many legislative said during the just completed that they will continue to monitor collections that could impact budgeting in future years if the trend continues.

For the year, state income taxes are down $131.2 million or 6.6%. That, according to state Economist Corey Miller, is attributed at least in part to the $525 million income tax cut that currently is being phased in over a four-year period. Sales tax collections are up $71.7 million or 3.2%.

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

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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 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.

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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 , 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.

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

The Mississippi Center for Investigative Reporting at Mississippi and The New York Times highlighted Grassaree in its , “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 of nearly two decades of depositions and a previously undisclosed report by the Mississippi 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 it up when caught.

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Over nearly two decades, as allegations mounted and Noxubee County's insurance company paid to settle lawsuits against Grassaree, 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?”

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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.

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Under Mississippi law, it is a 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.

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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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