Magnolia Tribune

Mississippi, Medicaid, and Mister Softee

Published

1 week ago

September 14, 2023

Advocates suggest that expansion will be inexpensive, improve poor people's health, and save rural hospitals. Unfortunately, these claims crumble under scrutiny.

In 2009, Oregon's Democratic Senator Ron Wyden told the Wall Street Journal, “Medicaid is a caste system. It is unfair to poor people and it is unfair to taxpayers.” Paraphrasing Wyden, the article said Medicaid, “makes it hard for physicians to take care of the most vulnerable in society.”

Wyden was correct in 2009. His words remain correct today.

However, nine months after that article was published, Congress passed the Affordable Care Act (ACA), which included a massive Medicaid expansion. Since then, 40 states and D.C. have agreed to the expansion, with heavy pressure for the remaining 10–Mississippi included–to fall in line.

Advocates suggest that expansion will be inexpensive, improve poor people's health, and save rural hospitals. Unfortunately, these claims crumble under scrutiny.

Even still, legislators will find it difficult to resist Medicaid expansion for the same reason that people watch Facebook videos while driving and argue ferociously with nasty strangers on Twitter (“X”). It's the same reason a tinkly melody lures me outside to buy ice cream from Mister Softee when my cardiologist has told me to lose weight. (Mississippians can substitute “Blue Bell” for “Mister Softee.”)

Like Facebook, Twitter, and Mister Softee, the ACA's authors crafted the Medicaid expansion to be irresistible to state legislators—even those who agree that the program is unfair to poor people and taxpayers. To understand how, let's start with some history.

The ACA became law in 2010, but from 2007 to 2009, much betting in Washington focused on a different proposal, “Wyden-Bennett” (named for Wyden and Utah's Republican Senator Robert Bennett). Far more radical than the ACA, Wyden-Bennett attracted support from Republicans, including Mississippi's Trent Lott.

Wyden-Bennett would have shifted people from employer-sponsored policies into an individual market, where people would have shopped for health insurance as they do car and homeowner's insurance. Wyden-Bennett would have eliminated Medicaid altogether, with subsidies enabling lower-income Americans to purchase the same health insurance policies as their wealthier neighbors. Then, patients of modest means wouldn't face doctors saying, “Sorry. We don't take Medicaid patients.”

I didn't support Wyden-Bennett, but was impressed by its ambition and intellectual coherence. Despite bipartisan support, it didn't happen. Instead, Washington lobbyists conducted a months-long quilting bee to stitch together the ACA—a messy patchwork comforter to keep interest groups snug and warm while crowding more Americans under the thin blanket of Medicaid.

Medicaid spends piles of money to obtain modest improvements in health. In 2008, Oregon offered researchers a rare opportunity to measure Medicaid's actual impact on enrollees' health. Oregon wanted to expand its Medicaid rolls but didn't have money to cover all potential enrollees. The state held a lottery, with around 40% getting coverage and 60% not. Over several years, a research team observed both groups and found that those who received Medicaid exhibited only a few small and ambiguous health improvements versus those who didn't.

It also isn't clear that rural hospitals fare better in expansion states than in non-expansion states. In the adjacent table, 6 non-expansion states rank fairly high in terms of closure risks but the other five (including North Carolina, which has not yet implemented its expansion) do not. Eight expansion states have a higher percentage of at-risk hospitals than Mississippi, and numerous expansion states have only marginally better percentages than Mississippi. And this table doesn't provide evidence that Medicaid expansion has much impact on these rankings.

Why, then, have 40 states and D.C. followed Oregon's lead in expanding Medicaid? That's where Facebook, Twitter, and Mister Softee come in.

Social media employ pleasure and pain to encourage activity. Facebook “likes” give users dopamine highs similar to those experienced by drug-abusers. Twitter's engineers know exactly how to encourage angry conflict, thereby generating clicks and advertising dollars. Ice cream vendors understand that tinkly music makes you think of frozen confections.

DOPAMINE & DENIAL

The Medicaid expansion was crafted to generate similar effects on politicians, and the strategy was brilliant. A politician who votes “yes” can say, “I gave insurance to thousands of poor people,” or “I brought millions in revenues to rural hospitals.” Voting yes reduces political opponents' capacity to say, “He wants to deny poor people healthcare,” or “She wants rural hospitals to close.”

But the expansion's real magic was its financing formula. Legislators enjoy pleasure and avoid pain while foisting most costs onto other states' taxpayers. If Mississippi expands Medicaid, Mississippians pay only 10% of the cost. Other states' taxpayers cover most of the other 90%. To understand why, here's a simple analogy. It's not precisely how the Medicaid funding works, but it's close enough to give an idea:

Instead of 50 states plus D.C., substitute 51 people at a restaurant. The chef's signature dessert costs $100, and not one of the 51 diners would willingly pay that much out of pocket. However, the deal is that each diner who orders a dessert pays only $10 out of his or her own wallet, with the remaining $90 split with the other 50 diners. Suppose 41 diners have already ordered the dessert, and you're one of the 10 holdouts. If you don't order the dessert, you'll pay $72.35 for those who did (=$90×41÷51). If, instead, you order one, you'll pay $84.12 (=$10 + $90×42÷51). So, for an extra $11.77 (=84.12−$72.35), you can enjoy a $100 dessert.

Ultimately, everyone ends up spending $100 for a dessert no one thought was worth $100. All 51 diners could have said “no thanks,” left the restaurant, and bought a $6 cone from Mister Softee. Of course, we're not talking about a $100 dessert, but hundreds of billions of dollars spread out across taxpayers, including taxpayers in Mississippi.

TEN THOUGHTS FOR FUTURE DISCUSSION:

Medicaid expansion financially favors childless adults with incomes just above the poverty line over traditional Medicaid recipients (e.g., low-income children, pregnant women, senior citizens, and disabled).
Expansion may reduce care for traditional recipients, as the two groups will compete for scarce resources. As of late 2022, per capita Medicaid spending on children in expansion states had grown less than one-third as fast as in non-expansion states.
Expansion enrollees will also compete with non-Medicaid patients for scarce resources.
Rural hospitals face many threats, including declining populations and a shift from inpatient to outpatient care; there's no guarantee that expanding Medicaid can overcome these factors.
In other states, the enrollment and costs of expansion have often been far higher than initially forecast.
With federal budget deficits out of control, reducing Medicaid reimbursements will certainly come under consideration.
Medicaid often pays providers less than the cost of the care provided. One might ask whether “higher revenues” is a winning strategy when accompanied by “even higher costs.”
For those worried about the financial viability of rural hospitals, perhaps rural areas would be better served by more clinics, urgent-care facilities, and ambulatory care facilities.
The field of medicine has become highly politicized, and the federal dollars and oversight in Medicaid will give Washington, DC, greater leverage over states in imposing its political agenda.
Finally, it's good to recall Blahous's Ten Laws of Politics—written by my friend and colleague Chuck Blahous, a veteran Congressional and White House advisor. His Law #5 is, “The more sympathetic the constituency, the worse the policy.” “When Americans are asked whether we should spend more or less on a sympathetic cause or group, they will generally respond with ‘more' before even knowing how much is currently being spent.”

The post Mississippi, Medicaid, and Mister Softee appeared first on Magnolia Tribune.

…

By: Robert Graboyes
Title: Mississippi, Medicaid, and Mister Softee

Published Date: Thu, 14 Sep 2023 11:38:04 +0000

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Magnolia Tribune

MHA parts ways with President & CEO Moore

Published

1 day ago

September 22, 2023

Staff Editor

The Mississippi Hospital Association and its outgoing President Tim Moore have been under scrutiny for months following the terminations of membership by a number of hospital systems. MHA's donation to Democratic gubernatorial candidate Presley has also been a point of contention.

The Mississippi Hospital Association (MHA) has not only lost significant membership this year, but its Board of Governors is now looking for a new President and CEO.

On Friday, it was made known that MHA had parted ways with longtime President and CEO Tim Moore. The decision had been forthcoming for some time.

“I have really enjoyed my time at MHA and tried to represent the hospitals across the state, and I'm sure, in the future, I'll find a way to continue to do that,” Moore told Magnolia Tribune.

As for what led to the decision by the MHA Board, Moore said that would have to come from chairman Lee McCall, the CEO at Neshoba General Hospital. Calls to McCall were not immediately returned.

The Mississippi Hospital Association has been under scrutiny since it was first made known in a series of Magnolia Tribune articles that key hospital systems across the state were leaving the organization over what was described as a loss of confidence in the MHA leadership.

The University of Mississippi Medical Center made their exit first. In a letter noticing MHA of its termination of membership, Vice Chancellor LouAnne Woodward and Associate Vice Chancellor for Clinical Affairs Alan Jones noted the decision came “due to recurring behavior including insufficient transparency around decision making, a misaligned strategic vision and lack of effective communication.”

Within days, George Regional, Memorial in Gulfport, and Singing River Health System followed suit, leaving MHA for similarly stated reasons as voiced by UMMC leadership.

The exit of these hospital systems and others came after the political action committee (PAC) of MHA, Friends of Mississippi Hospitals PAC, made a donation to Democratic gubernatorial candidate Brandon Presley's campaign in the amount of $250,000. It is the largest donation on record for Friends of Mississippi Hospitals PAC.

However, the hospitals that left MHA would not comment as to whether or not the donation impacted their decision to terminate membership.

MHA has been one of the most vocal advocates for Medicaid expansion in the state, going so far as to propose a ballot initiative in 2022. Democratic candidate Presley has made expansion the central theme of his campaign, focusing most of his energy on the state's “health care crisis.” Despite various operational, population, and financial factors impacting the stability of hospitals in Mississippi, Presley has attempted to lay their problems solely at the feet of Governor Tate Reeves' opposition to expanding the welfare program.

The incumbent Republican Governor Reeves has repeatedly voiced concerns about the cost and efficacy of Medicaid expansion over the years, dating back to when he was Lieutenant Governor. Even in announcing plans this week to reform Medicaid reimbursements for hospitals, which could provide roughly $700 million in revenue for the health systems across the state when implemented, Governor Reeves questioned the wisdom of adding more to the welfare rolls.

As for the MHA going forward, a notice sent to members on Friday said outgoing President and CEO Moore “will continue serving as needed” through November 30th. MHA Chief Operating Officer Dr. Kim Hoover will serve as acting President and CEO beginning September 25th and throughout the search process as the Board looks to name Moore's permanent replacement.

MHA will hold a virtual meeting with its members on Tuesday to further discuss the organization's changes and to answer questions.

The post MHA parts ways with President & CEO Moore appeared first on Magnolia Tribune.

…

By: Frank Corder
Title: MHA parts ways with President & CEO Moore

Published Date: Fri, 22 Sep 2023 17:57:36 +0000

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Magnolia Tribune

Why businesses should support a Citizens Police Academy

Published

1 day ago

September 22, 2023

Staff Editor

Columnist Phil Hardwick writes that supporting your local citizens police academy is not only good for public safety but can also benefit businesses in the long run.

Does your business support your local police?

Of course, it does. What a silly question. Or maybe it doesn't.

Across the country, local law enforcement agencies are facing public praise and criticism as never before. Mass shootings, for example, have put law enforcement in the spotlight. Traffic stops and arrests on video show police actions of all types. Recent law enforcement misbehavior, such as that in Rankin County, lead many people to advocate that some police reform is needed.

That leads us to this question: How much do you know about your local police department or sheriff's office? What's their policy on use of force, vehicle pursuits, no-knock searches, and community policing?

Recently, I had the opportunity to attend my local police department's Citizen Police Academy. It's held once a year to familiarize participants with the local department. Sessions meet once a week for several weeks and include a wide variety of subjects, including visits to the jail and emergency operations center. There is even a day at the firing range and a ride-along with an officer evening. In short, it was a behind-the-scenes look at how law enforcement operates, including classroom instruction and hands-on training.

Personally, it was very enlightening to compare today's law enforcement with that when I was a police officer many years ago. None of the other participants in our class had a law enforcement background. They came away with a new appreciation about the local police.

Unfortunately, many businesses fail to recognize the importance of supporting their local Citizens Police Academy if they even have one. They may view it as a government program that doesn't directly benefit their business. However, there are several compelling reasons why businesses should support their local Citizens Police Academy.

First and foremost, a Citizens Police Academy can improve public safety in the local community. By educating citizens about law enforcement practices, participants can become more aware of potential safety threats and how to prevent them. This can lead to a safer and more secure community, which can have a positive impact on local businesses. When people feel safe, they are more likely to go out and support local businesses, which can lead to increased sales and revenue.

Second, a Citizens Police Academy can improve community relations between law enforcement and residents. In recent years, there have been numerous high-profile incidents of police brutality and excessive force. These incidents have eroded public trust in law enforcement and created a divide between police and the communities they serve. By participating in a Citizens Police Academy, community members can gain a better understanding of law enforcement practices and build relationships with police officers. Also, it can show individual officers that the community cares. This can lead to increased trust and cooperation, which can benefit both law enforcement and local businesses.

Third, supporting the local Citizens Police Academy can be a way for businesses to demonstrate their commitment to the community. By sponsoring or donating to the program, businesses can show that they care about the safety and well-being of their customers and employees. This can enhance the reputation of the business and increase customer loyalty.

Finally, supporting the local Citizens Police Academy can be a way for businesses to give back to their community. Law enforcement is an essential public service that relies on the support of the community to function effectively. By supporting the local Citizens Police Academy, businesses can help ensure that law enforcement has the resources and support it needs to keep the community safe.

In conclusion, supporting the local citizens police academy is not only good for public safety but can also benefit businesses in the long run. By promoting community safety and building relationships with law enforcement, businesses can enhance their reputation and increase customer loyalty. Furthermore, by supporting law enforcement, businesses can give back to the community and ensure that it remains a safe and prosperous place to live and work.

If your community does not have a Citizens Police Academy and you would like to learn more, contact me at phil@philhardwick.com and I'll share more specific information.

The post Why businesses should support a Citizens Police Academy appeared first on Magnolia Tribune.

…

By: Phil Hardwick
Title: Why businesses should support a Citizens Police Academy

Published Date: Fri, 22 Sep 2023 15:00:00 +0000

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Magnolia Tribune

Long Beach Middle’s house system gives students unique life lessons

Published

1 day ago

September 22, 2023

Staff Editor

Community, purpose and responsibility are just some of the lessons for students.

To make the transition from elementary to secondary easier, a Mississippi school district's middle school is utilizing a unique system to give students a sense of purpose, community and responsibility.

Long Beach Middle School's administration got the idea to implement the Ron Clark Academy House System after touring a private school where its successes were on display, said Principal Johanna Hughey.

Similar house systems have been implemented in other Mississippi school districts, with many of them at the elementary level.

In 2019, the RCA House System became part of the Long Beach Middle School. It works kind of like the house system in the fictional Harry Potter series, but instead of a talking hat choosing the house, students pick a wrist band from a box. About 90 students are in each of the school's five houses.

“We want to create experiences for the students to look back on and think it was fun,” said Hughey.

Students are placed in their houses at the beginning of their 7th grade year and then participate in monthly meetings and house rallies each nine weeks.

Teachers and administrators are also assigned to a house for the duration of their career, establishing a sense of belonging for the children who are in the same house. As students walk the halls, they can identify a teacher's house by the small flags that adorn the door to each classroom.

Each house features a crest that defines that house's animal, color and words of pride.

English Language Arts Interventionist Mary Woodruff said most of the house names are Latin in origin, but some come from other languages. House names include Paratum, Quantum, Mutunci, Fidum and Nitimini.

Similar to how houses work in the Harry Potter series, students earn points for their house through challenges, grades, events and behavior. Points can be earned for being on the honor roll, not being referred to the office for bad behavior and not having any unexcused absences, Guidance Counselor Lisa Starita said. The points system also allows the students see how their actions affect others, giving them a sense of community.

Houses also engage with the larger community through fundraisers or gathering donations for a cause. By giving them a sense of connection, students behave better and work harder.

“Students don't want to disappoint teachers they like,” Starita said.

Since the implementation of the house system student misbehavior has declined. In the first year it was implemented, office referrals dropped drastically.

Being in a house also allows every student to take on a leadership role. Woodruff said most house leaders she has seen are not the popular kids in school.

Even though the students only attend the middle school for 7th and 8th grades, they carry the connection built by the house system into high school.

“We say five houses, one family, and that's what we mean,” said Starita.

While the high school does not officially participate in the house system, Woodruff said the graduating class that attended the middle school in 2019 will walk the halls of Long Beach Middle School wearing the house pins they were assigned years ago.

Initially, some parents expressed concern about the system. But through a modified open house called “Crash The House,” the parents were presented with the opportunity to see how the houses work, and how participation in the system can help their child succeed in the school. “Crash The House” lasts longer than a regular open house, because the event puts parents in the same houses as their children before sending them on a tour of the school. During the tour parents visit stations where they meet teachers and learn about each house from the school's students.

Today, it's been accepted by the adults so well that they buy multiple house shirts for their children and themselves, Starita said.

The post Long Beach Middle's house system gives students unique life lessons appeared first on Magnolia Tribune.

…

By: Jeremy Pittari
Title: Long Beach Middle's house system gives students unique life lessons

Published Date: Fri, 22 Sep 2023 14:35:23 +0000

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