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Mississippi Today

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

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

Mississippi's business 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.

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FAQWhat 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 ?

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.

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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.

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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 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.

READ MORE: Gov. Reeves announces 11th hour plan for hospital crisis. Opponents pan it as ‘too little, too Tate'

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.

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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 federal approval.

READ MORE: Senate Medicaid ‘expansion light' would insure fewer than House plan, turn down federal money

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

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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 forward.”

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

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

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“Providing for working Mississippians is vitally important. It remains MEC's stated position that legislative leaders ‘find workable 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.

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“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 , 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 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.

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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.

READ MORE: Senate Medicaid expansion plan shows generosity to the poor — but mostly in other states

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

Mississippi Today

On this day in 1951

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April 28, 1951

Ruby Hurley Credit: Wikipedia

Ruby Hurley opened the first permanent office of the NAACP in the South.

Her introduction to activism began when she helped organize Marian Anderson's 1939 concert at the Lincoln Memorial. Four years later, she became national youth secretary for the NAACP. In 1951, she opened the organization's office in Birmingham to grow memberships in Alabama, Florida, Georgia, Mississippi and Tennessee.

When she arrived in Mississippi, there were only 800 NAACP members. After the governor made remarks she disagreed with, she wrote a letter to the editor that was published in a Mississippi newspaper. After that step in courage, membership grew to 4,000.

“They were surprised and glad to find someone to the governor,” she told the Chicago Defender. “No Negro had ever challenged the governor before.”

She helped Medgar Evers investigate the 1955 murder of Emmett Till and other violence against Black Americans. Despite threats, she pushed on.

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“When you're in the middle of these situations, there's no room for fear,” she said. “If you have fear in your heart or mind, you can't do a good job.”

After an all-white jury acquitted Till's killers, she appeared on the front of Jet magazine with the headline, “Most Militant Negro Woman in the South.”

Months later, she helped Autherine Lucy become the first Black student at the of Alabama.

For her work, she received many threats, a bombing attempt on her home. She opened an NAACP office in Atlanta, where she served as a mentor for civil rights leader Vernon Jordan, with whom she worked extensively and who went on to serve as an adviser to President Bill Clinton.

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After learning of Evers' assassination in 1963, she became overwhelmed with sorrow. “I cried for three hours,” she said. “I shall always remember that pool of blood in which he lay and that spattered blood over the car where he tried to drag himself into the house.”

She died two years after retiring from the NAACP in 1978, and the U.S. Post Office recognized her work in the Civil Rights Pioneers stamp . In 2022, she was portrayed in the ABC miniseries, “Women of the Movement.”

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

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Mississippi Today

Rare open negotiations occur on important Medicaid expansion issue

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mississippitoday.org – Bobby Harrison – 2024-04-28 06:00:00

The curtain was pulled back last for the first time in years on the Mississippi 's often mysterious conferencing .

A conference committee consists of three representatives and three senators appointed to try to reach agreement when the two chambers pass differing versions of the same bill. Last week, a conference committee formed to try to reach agreement on Medicaid expansion caused a stir by meeting in a public setting.

Even though the joint rules of the Mississippi Legislature call for an open conferencing process, the conferees seldom meet in public. They usually meet and negotiate their differences near the end of the behind closed doors.

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That was not always the case.

For a period in the late 1990s and early 2000s, the Legislature, under intense pressure from the Mississippi Press Association, made open conference committees the norm.

Some major issues have been played out in public conference committees. Notable open conferences include:

  • The infamous, excruciatingly long special session in 2002 where businesses received more protection from lawsuits.
  • Budget fights when Haley Barbour was governor when legislators often would reach an impasse in the negotiations process and spend the bulk of their time talking about their cars and eating candy.
  • The major rewrite of the 's economic package under then-Gov. Ronnie Musgrove called Advantage Mississippi.
  • The Mississippi Adequate Education Program, which for decades has provided the state's share for the basic operation of local school districts. It was hammered out in an open conference process in 1997 even before the joint rules mandated the open process.

Then-state Sen. Musgrove and former House Speaker Billy McCoy deserve credit or blame, according to one's perspective, for proving the open conference process could work. When they chaired their respective chamber's education committees, they insisted on an open conference process.

But in more recent years, open conference committees have been few and far between. The joint rule has been largely ignored.

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The fact that the three House and three Senate conferees agreed to meet at least once in public on Medicaid expansion — one of the most pivotal issues facing the Legislature in recent years — drew considerable attention.

If nothing else, the open conference committee provided a raw and unedited view of how far apart the two chambers were at the time on an issue that would provide additional care coverage to primarily the working poor.

The House wanted to provide coverage to those earning up to 138% of the federal poverty level, or about $20,000 annually for an individual, while the Senate had proposed providing coverage to those earning less than 100% of the federal poverty level, or about $15,000 per year.

According to various experts, the House plan would provide coverage to many more working and cost less to the state than would the Senate plan. The reason for the lower cost to the state is that when expanding to 138%, the federal government will pay 90% of the costs and provide the state an additional roughly $700 million over two years as an enticement to expand.

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Under the Senate plan, the federal government will pay 77% of the cost and offer no incentives. It is important to understand that in the expensive world of , the difference in 77% of the cost and 90% means tens of millions to Mississippi state coffers.

The House conferees repeatedly pointed out those numbers — their plan covering more at less cost — during last week's open conference committee.

One of the reasons legislators through the years have not been enamored with an open conference process is that it has often turned into efforts by the negotiators to sell their position to the public.

Once the open conference process starts, the side that feels the most comfortable with its position wants to meet more often in full view of the public to make sure the public understands where each side stands.

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For whatever it is worth, the House conferees were more enthusiastic about continuing the open process after the initial Medicaid expansion conference committee.

And after that initial open conference, the Senate offered a compromise to cover those earning up to 138% of the federal poverty level — just as the House proposed.

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

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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 state's public employee pension program has passed both chambers of the Legislature.

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 help pay for the massive retirement system.

The legislation, which passed both chambers in recent days, was a reaction to the 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 benefits for most public employees on the state and local levels, including staff of local school districts and universities and community colleges.

and county 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 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-Jackson, said the bill failed to address the financial issues facing the system. He said a permanent 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 , 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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