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How Medicaid expansion could have saved Tim’s leg — and changed his life

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How Medicaid expansion could have saved Tim's leg — and changed his life

Note: This article is part of Mississippi Today's ongoing Mississippi Health Care Crisis project. Read more about the project by clicking here.

Tim Floyd has never been one to sit still. 

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After being forced to leave community college to move home to Guntown to help his mom pay the bills, he landed a job driving a truck in his early 20s. But three or four years later, he was diagnosed with sleep apnea, a dangerous condition for professional drivers because it can lead to and slow reactions when driving. Just like that, his truck driving career was over.

The health insurance that job had provided him abruptly disappeared — and his has never been the same since.

“It made me no longer insurable to the truck, and that's what led me down the path of not being able to find a job with health insurance and not being able to afford (private) insurance with the I had,” said Floyd, now 46 years old.

Since then, Floyd has been trapped in what is called the "health insurance gap": he doesn't qualify for Mississippi's strict and limited Medicaid program, and he doesn't have private health insurance from an employer. He can't afford a private plan himself. 

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Meanwhile, over the past five years, Floyd's serious health problems have mounted. He's been diagnosed with diabetes. He's lost part of his leg. He's battled cancer. He told Mississippi Today he's sure he has medical debt, but he tries not to think about it: the past few years have just been about surviving each day.

Floyd's conundrum is not unique in Mississippi. The leads the nation in both rates of poverty and of uninsured people. Mississippi remains one of 12 states – and will likely soon be one of only 10 – not to accept federal dollars and provide health insurance to hundreds of thousands of Mississippians, many of them working poor.

Studies, including one from the state economist, have shown expanding Medicaid would cover up to about 230,000 Mississippians making up to 138% of the federal poverty level, or about $30,000 in annual income for a family of three. Floyd would have been covered under expanded Medicaid during the years he worked as a cashier and other low wage jobs, but because Mississippi never expanded, he wasn't.

The study also showed the state would save anywhere from $186 million to $207 million from 2022 through 2027 and create thousands of jobs. 

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Medicaid expansion has also been associated with reductions in mortality in addition to declines in medical debt, which is highest in the South and in lower-income communities. 

But both Speaker of the House Philip Gunn and Gov. Tate Reeves remain unwaveringly opposed to expansion. 

“Extending Medicaid to people who can't afford health insurance would offer them and their families basic financial security to a healthy life, that includes preventative care. Mississippians shouldn't face financial ruin if they need health care or worry that a lack of preventative health care could cost them their lives,” said Roy Mitchell, executive director of the Mississippi Health Advocacy Program. 

After he lost the trucking job, Floyd then worked many other jobs – including multiple at one time – but never landed another that offered health insurance. 

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The combination of jobs wasn't enough to afford private insurance or pay out-of-pocket medical costs. So he remained uninsured and stopped going to the doctor. 

Six in 10 uninsured adults say they have postponed getting health care they needed due to cost, according to KFF. Uninsured adults are also more likely to report skipping recommended tests or treatment due to cost than adults with insurance. 

In 2012, that practice caught up to Floyd. He was working a construction job when a rock got stuck under his foot inside his boot and created a sore. He put some antibiotic ointment and a Bandaid on it and continued working. But six months later, the sore became infected and his foot swelled up. He used savings to go see a doctor, who referred him to a wound specialist. 

For the next five years, he battled that sore: he would treat it and stay off his feet for a month (which would sometimes cause him to lose whatever job he had at the time), the sore would heal, and he would go back to work. Then the whole cycle repeated again. 

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In 2017, a doctor suggested he have his blood sugar tested. So Floyd, again, dipped into his savings for a basic appointment and test. The results showed he was diabetic, and the sores were diabetic foot ulcers. The infection was now in his bones.   

There was only one option at that point: amputate his leg from the knee down. So again, just like that, his life changed. The charity program at North Mississippi Medical Center where he received his care covered the costs of the surgery, he said. Six months later, he was fitted for a prosthetic and began the process of rebuilding his strength and relearning how to do the things dear to him: basic things like walk, take care of the family's dog, play the drums. 

“It was hard. It was hard not only on me but on the people that cared about me,” he said. “Also, my emotional health wasn't all that great … It took me about another year (after getting the prosthetic) to be able to walk unassisted – no cane or walker or nothing. Then, just building –  going from being pretty active to being very sedentary to trying to get active again took me another year from that before I got my stamina back up to where I could work.”

Tim Floyd, left, listens as his father, Macky Floyd, plays the guitar at their home in Guntown, Miss., Friday, Nov. 4, 2022.

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The hospital – a hub for health care and employment in north Mississippi – offers a financial assistance program for uninsured and underinsured patients like Floyd who need emergency or medically necessary care. The hospital and its subsidiaries spent over $190 million in fiscal year 2021 in charity care and uninsured discounts.

The hospital is situated in the district of Sen. Chad McMahan, a Republican who also lives in Floyd's same small hometown of Guntown. McMahan drew criticism from Republican counterparts in 2021 when he indicated he was willing to discuss Medicaid expansion “and look at what (it) might look like.”

Today, he still maintains he sympathizes with people who work but are uninsured. He says he's not for Medicaid expansion, per se, but does believe it should be discussed and that the health care system in Mississippi needs to be reformed.

“I think everything has to be on the table – whether or not we're going to have Medicaid enhancements or Medicaid expansion or if we're going to have a modernization of the way prices, menu prices, are put out from hospitals,” or how insurance companies operate, he said. 

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McMahan said he regularly speaks with administrators at the hospital that employs nearly 9,000 people. 

“For the hospital system I represent, they have annual salaries of half a billion a year and then an annual income revenue stream of 1 billion-plus. Last year, they gave away 19% in charity,” he said. “… It's unsustainable. In what other business can you give away 19% (and survive)?” 

Beyond the economics of Medicaid expansion and health care reform, McMahan, who grew up without health insurance as the son of a carpenter and a clerk, says he feels for Floyd and identifies with him.

“In the 9th grade I got , and my parents didn't have insurance … I remember seeing the fear in my family's eyes and hearing discussions at the dinner table when my parents would be discussing what we were going to eliminate from the family budget that month to pay for the $20,000 hospital bill I had,” he said. 

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“I'm sympathetic to him (Floyd) because I was like that myself … If we're going to do any type of Medicaid overhaul, there has to be a work requirement. I'm not for anyone getting a public service unless they're in a position to contribute.”

Tim Floyd plays the djembe drum at a festival in Amory, Miss. in 2021.

Finally recovered from losing his leg, Floyd started submitting job applications again in 2020 – right as the U.S. began reporting its first cases and the country subsequently shut down. 

Floyd, still uninsured and ineligible for disability, discovered a knot on his neck. He went to the doctor and was diagnosed with an ear infection and prescribed antibiotics. Floyd said the doctor didn't mention any further testing. 

“You know, actually, most doctors that I've dealt with understand my situation. Because I am uninsured, they don't even bring that stuff (additional testing) up,” he said about. 

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Over the next year, the lump got bigger. He returned to the same doctor, who at that time recommended a biopsy. The biopsy, which the hospital's charity care program again covered, revealed he had stage II Hodgkin's lymphoma.

The oncologist told him if it had been diagnosed earlier, it would've been caught at stage I and required less rigorous treatment, he said.

He went through six weeks each of chemotherapy and radiation, which burned his vocal chords. Until now, his health conditions hadn't kept him from his musical talents: singing and playing the drums in a band called Proximity Rule. But for a while, he couldn't sing, and it was difficult to even speak.

Floyd, who has been in remission since May of 2021, is now on disability, which pays him about $800 a month. The cancer and amputated leg didn't qualify him for the government assistance – but the later addition of a severe carpal tunnel diagnosis did. 

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Looking back, he says, the logic of state leaders who have refused to expand Medicaid is baffling. 

“It would make a lot more sense to find people like me … and (give) them Medicaid for a short period of time to get back healthy so they can continue working and continue providing for their family ….,” he said. “Because if they don't have health insurance, they don't go to the doctor and get seen, eventually they're gonna be just like me, and we're on the hook for them for the rest of their life.”

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

Mississippi Today

Education groups urge lawmakers to keep objective formula in place for school funding

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Several high-powered Mississippi public education groups sent a joint letter to lawmakers this week stressing that any rewrite of the formula providing funds to local schools should be based on objective criteria.

The House leadership has proposed a completely new structure that would it to legislators to annually determine the base student cost. Under the current funding formula called the Mississippi Adequate Education Program, which the Senate is working to tweak but preserve, the base student cost is determined by an objective formula — not by politicians. The base student cost multiplied by enrollment equals the amount of money that school districts are supposed to , though more affluent districts receive less funding than do poorer districts.

READ MOREHouse leaders want lawmakers, not an objective formula, to determine ‘full funding' for public schools

The Feb. 20 letter, addressed to House Speaker Jason White, Lt. Gov. Delbert Hosemann, the House and Senate education chairmen, and every lawmaker, was sent by:

  • The Mississippi Association of Educators.
  • The Mississippi Association of School Administrators.
  • The Mississippi Professional Educators.
  • The Mississippi Association of School Administrators.
  • The ' Campaign.

“We believe that a guiding principle in the of such (school funding formula) should be an understanding that the purpose … is to reflect the true cost of educating Mississippi children to a proficient level in core academic subjects and otherwise preparing them for in college and career,” the letter reads.

To achieve those goals, the letter continues, “essential components” of a formula should include “a base student cost determined by an objective formula. The base cost represents the cost to bring a typical student to academic proficiency as defined by state academic standards.” The formula also should include “an factor to account for increased operational costs to be applied in any year in which there is not a full recalculation of the formula.”

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The Senate Education Committee has passed legislation to make some changes to MAEP, but the Senate bill maintains the objective funding formula and preserves a growth factor, though at a level lower than the current level. Whether a compromise between the two chambers on the funding formula can be achieved could be one of the most contentious issues of the 2024 .

READ MORE: Senate committee passes bill to tweak but preserve MAEP, the public school funding formula

The letter from the education groups went on to say that a rewrite also should include additional funding for students living in poverty, for special education students, for gifted students and for students learning English as a second language. The letter also advocates for more funds for career and technical education and to address teacher shortages in both geographic and in subject areas.

The letter advocated for “an equity provision” providing more state funding in poor districts and less state funding in more affluent districts.

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The bill that the Senate Education Committee passed this week would require more affluent districts to contribute more toward the base student cost, or toward the cost of providing an “adequate” education. The Senate bill would not make any adjustments to the amount of money going to poorer districts. But Senate leaders say they hope to fully fund the formula, pumping an additional $215 million into the program providing more assistance to poorer districts, as it would all districts.

The House plan provides more money for various groups of students who might take more money to educate, such as poor students, special education students and English learners.

MAEP has been fully funded only twice since its implementation in 1997 — the last time in 2007.

READ MORECould this be the year political games end and MAEP is funded and fixed?

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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

Mississippi spends less on college grant aid than nearly every Southern state

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Mississippi spends less money on college financial aid programs than almost every state in the Southern region.

This holds true for both total dollars spent in Mississippi – about $45 million – and the average amount of grant money each college student receives. Other states, deep-red neighbors Arkansas and Louisiana, dole out more money for college on a per-student basis while charging roughly the same or less for tuition. Even West Virginia, with close to half of the population, spends double Mississippi.

Not many lawmakers today know why this is, but several factors may be the cause: Financial aid policy is complex, and the Legislature tries to keep tuition low through funding the colleges and universities. Plus college financial aid is not a core function of , many lawmakers say, such as roads and bridges or paying teachers.

But a change may be underway this legislative . Amid increased interest in workforce — not to mention Mississippi's $700 million surplus — lawmakers are no longer asking the state's financial aid office to make its programs less expensive.

Instead, they want to know: If Mississippi spends more, what will we get for it?

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“If you look at it, that student, their life is an economic development project,” said Sen. Daniel Sparks, R-Belmont. “If we can get them from $26,000 to $66,000 a year (in income), that's the most important economic development project in that person's life.”

Earlier this week, the agency responsible for Mississippi's college financial aid programs presented its new proposal to the Senate Colleges and Universities Committee that would pump $30 million into adult, part-time and many low-income students who, by law, have been ineligible for the Mississippi Resident Tuition Assistance Grant since it was created nearly three decades ago. 

Depending on income, an estimated 37,000 students would get an additional $500 to $1,000 toward the cost of tuition. And, unlike past proposals, this one would be enacted without cuts to the only state grant program that helps low-income students pay for college. It has already passed the House Colleges and Universities Committee.

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The main question posed during the Senate meeting is how will Mississippi benefit from the increased funding. Though Mississippi's overall investment in financial aid would remain low, the proposal's price tag would nearly double what the state spends on helping students afford college, surpassing Alabama.

“Do we have metrics?,” asked Sen. Bart Williams, R-Starkville. “Can we show an ROI (return on investment)? We're talking … about all this including everybody. What are we getting from it?”

There is no data, responded Jennifer Rogers, the director of the Mississippi's Office of Student Financial Aid. Lawmakers have never required performance-based funding for the programs she administers.

But the research on state financial aid spending is clear.

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What research shows on college aid spending

Though not a cure-all, financial aid programs pay off in all the areas lawmakers want to tackle this session: College-going and completion rates, career-readiness and workforce development.

In general, college financial aid of any kind increases graduation rates. In Mississippi, research requested by OSFA found all three grant programs increased college graduation rates.

But exactly how much is typically a function of a student's income.

Because higher education costs money, financial aid that goes to students from families who can't afford to pay for college on their has been shown to yield greater results, said Tom Harnisch, the vice president for government relations at the State Higher Education Executive Officers Association. It can be the difference between these students finding time to be involved on campus or working second jobs to pay for rent.

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“Those are the students that are really going to move the dial,” Harnisch said.

For every $1,000 of grant aid spent on low-income students, research has shown college retention rates increase between 1 and 5%. In Florida, an additional $1,300 in need-based aid increased six-year graduation rates by nearly a quarter. In Texas, a grant program for low-income students was found to have freed 75 to 84 hours they would have spent working their first two years. For first-time students who receive a full federal Pell Grant, each additional $1,000 increase in grant aid is associated with more than $1,000 increase in earnings four years after enrollment.

When states spend more on financial aid, more students pursue higher education. Community colleges in particular see an increase in enrollment.

Sandy Baum, a nonresident senior fellow at the Urban Institute who has studied Mississippi's financial aid programs, said the new proposal would be an improvement on MTAG's current structure because it would direct more dollars to students who can't afford to pay for college on their own.

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“Of course Mississippi needs to spend more,” Baum said.

Other states have dramatically increased financial aid spending, the Urban Institute has found. After Arkansas legalized a lottery in 2008 and used it to fund college scholarships, the state's spending on financial aid increased by $100 million.

So why hasn't Mississippi?

A longstanding preference for less-expensive merit aid programs may be a reason.

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Mississippi's best and brightest

When lawmakers created MTAG in 1995, their goal was to help middle-class students afford college. The legislation was championed at a pivotal time by Eddie Briggs, the first Republican lieutenant governor in Mississippi since the Reconstruction era. To this day, the grant primarily benefits Republicans' traditional constituents: White, middle-class .

“This program will help to keep Mississippi's best and brightest here at home,” Briggs wrote in an op- at the time.

Two years later, lawmakers created the state's Higher Education Legislative Plan for Needy Students. But unlike MTAG, which lawmakers were required to fund from one year to the next, HELP was available only if the money was. In the program's first year, Mississippi budgeted just $500,000 for HELP but spent $900,000, a fraction to MTAG's $12 million.

Today, HELP is the most expensive grant program, because it pays for all four years of college. Of the three, it's also the most effective at what it was created to do. And yet it the fewest Mississippians: Just 4,538 students received HELP last year, less than a third that received MTAG.

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Mississippi's spending on college financial aid is also tied to state revenue, said Sen. Briggs Hopson, R-Vicksburg, the chair of the Senate Appropriations Committee who in 2018 led discussions to change Mississippi's grant programs.

Adequate funding of the colleges and universities, Hopson said, helps keep tuition low.

“It is an overriding theme that we want to keep our colleges affordable, and I think we are,” he said. “It's always a moving target.”

With this latest proposal, lawmakers' tune may be changing on need-based aid as Mississippi's colleges and universities, teetering on the edge of a demographic shift that will mean fewer high school graduates go to college, need more students in seats.

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And, there's an increased push for workforce development programs, which have been called the “message of the day” in Jackson.

Sparks, senator from Belmont, said he would like to see changes to MTAG encourage people to pursue well-paid careers. He liked that last year's proposal offered a bonus for students to major in certain subjects deemed “high-value pathways” by the state's workforce development office. That seemed like a way to ensure the spending has a return-on-investment, Sparks said.

“I don't want to get into choosing what you (students) go take,” Sparks said. “But on the other hand, if I'm looking for someone else to pay the way or pay a portion of the way, they're going to have more input than if I went in and said, ‘I got this myself.'”

Universities v. community colleges?

As with last year's bill, this proposal is likely to down to a tug-of-war between universities and community colleges.

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During the Senate meeting, Hopson asked if the extra dollars might be better spent in direct appropriations to the public institutions considering the new program would also benefit Mississippi's private colleges.

“If we put $31 million into Kell (Smith)'s budget or into Al Rankin's budget, they'd probably say give me the $31 million,” Hopson said. “But the private colleges would probably like this better because they're going to get some part of this.”

Hopson asked if it would be possible to instead ask the public colleges and universities to use the additional funding for institutional scholarships. Rogers replied that money “doesn't always trickle down.”

“I think probably you know exactly what their response is going to be,” Rogers said. “But I guess, from my perspective, someone has got to stand up and fight for the students who are facing a huge affordability puzzle.”

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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 1929

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Feb. 23, 1929

Elston 's plaque in Monument Park at Yankee Stadium Credit: Wikipedia

catcher Elston Howard was born in St. Louis, Missouri. 

In 1955, he became the first Black player to sign with the New York Yankees, signing a $70,000 contract — the highest paid baseball player at the time.

By 1959, the Yankees were often playing Howard at first base so he could remain in the lineup. Despite lacking a regular position, he was selected to the All-Star team in 1957, the first of nine consecutive years through 1965 in which he made the squad.

In 1963, he became the American League's Most Valuable Player, the first Black player to do so, after setting a record in putouts and total chances in a season. He is credited with inventing the doughnut for batting practice, which makes the bat feel heavier so that it will feel lighter when swinging at the plate.

Howard won four World as a player and two more as a coach for the Yankees, becoming the first Black coach in the American League. After coaching, he became an administrative assistant with the Yankees and died in 1980.

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“The Yankees' organization lost more class on the ,” New York Times columnist Red Smith wrote, “than George Steinbrenner could buy in 10 years.”

The Yankees wore a black armband in memory of him in the 1981 season. Three years later, the Yankees retired his number, 32, and dedicated a plaque that honored him as “a man of great gentleness and dignity” — “one of the truly great Yankees.”

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

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