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Democrats finalize hospital crisis plan, blast Republicans for inaction

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Democrats finalize hospital crisis plan, blast Republicans for inaction

Note: This article was first published in Mississippi Today’s weekly legislative newsletter. Subscribe to our free newsletter for exclusive early access to legislative analyses and up-to-date information about what’s happening under the Capitol dome.

Democratic legislative leaders will propose a plan this week to address a problem they say most of their Republican counterparts won’t even fully acknowledge: the Mississippi hospital crisis.

health officials have warned lawmakers that 38 rural hospitals across the state are in danger of imminent closure because of budget problems. Some of those hospitals are larger regional care centers, such as Greenwood Leflore Hospital.

Even the large metro hospitals are understaffed and struggling to provide adequate care due to rising costs. Physicians and other leaders are sounding the alarm about the entire state’s ability to maintain a reliable system of care.

Given the growing urgency of the crisis, Democratic leaders under the dome say they can’t wait around for their Republican counterparts to propose solutions.

“I feel silly trying to explain to (Republicans) why we need to do something about this quickly when the need is right there smacking them in the face every single day,” said Rep. Robert Johnson, the House Democratic leader. “These people have the best possible access to the best possible information about the state, and they’re ignoring it. They’re running away from the problem. The house is fully on fire right now, but it’s fine because Republicans say it’s not really burning.

“I don’t know what they’re waiting on, but this crisis needs to be addressed right now,” Johnson continued. “I don’t know where their plan is, but we have one.”

That plan, shared with Mississippi Today before legislation is filed in coming days, has two key components:

  • A bill that would appropriate $150 million as a “lifeline” to rural hospitals. The state would send cash directly to the hospitals to help temporarily balance their budgets and fund health care services. Public hospitals that can demonstrate financial hardship would apply for grants from the new fund, which would be administered by the Department of Finance and Administration. This proposal would flow from several funding sources: $135 million from funds lawmakers haven’t yet spent; $13 million from the state’s Health Care Expendable Fund; and $2 million from the BP settlement fund.
  • Several bills that would expand under the Affordable Care Act, as 39 other states have done. Numerous economists say Medicaid expansion would provide $1 billion in new revenue to the state and help hospitals better cover the rising costs of providing care to poor, working . Many Democrats have filed bills to expand Medicaid for more than 10 years, but GOP leaders at the Capitol have deeply dug their heels in opposition to it, claiming without proof that the state cannot afford it and writing it off as a liberal policy of former President Barack Obama.

READ MORE: Mississippi leaving more than $1 billion per year on table by rejecting Medicaid expansion

Rep. John Hines, who authored the rural hospital lifeline bill, said the first bill is intended to help hospitals temporarily until Medicaid expansion, the more long-term solution, is passed. Johnson, who has fought for Medicaid expansion for several years, panned the legislative Republicans who have blocked it.

“The Black man who was president is far enough now for Republicans to wake up and realize that every single Mississippian — white, Black, Democrat, Republican — is losing money and might lose out on critical care because of this crisis,” Johnson said. “We’re leaving $1 billion on the table every year while our hospitals close and people die. It’s as simple as that.”

The Republican leaders at the Capitol, House Speaker Philip Gunn and Lt. Gov. Delbert Hosemann, are at odds about how to meet the moment. And in the early days of the session, no Republican appears eager to move quickly to pass a hospital crisis fix.

Gunn, who along with Gov. Tate Reeves is directly responsible for the state’s resistance to Medicaid expansion, proposed in December a one-time, $50-$70 million appropriation for hospitals this year. That was panned by critics and even inspired a statewide newspaper column that bluntly asked: “Will closed hospitals be Gunn’s legacy, too?”

READ MORE: ‘What’s your plan, watch Rome burn?’: Politicians continue to reject solution to growing hospital crisis

Hosemann, to his credit, has been the one Republican leader who has directly acknowledged the hospital crisis. In December, he said he sought solutions to the crisis “not just for next year, but for the next generation.” He floated several ideas, including expanding a Medicaid program for new mothers — an effort he successfully led in the Senate last year but was killed by Gunn and the House — and increasing Medicaid reimbursements to struggling hospitals.

Hosemann has long been one of few Republican leaders open to discussion of Medicaid expansion, but he said last month it’s not likely lawmakers will tackle that issue this year. He also said it’s not a cure-all.

“I don’t think that’s the answer,” Hosemann said in December. “Even if we had that expansion, (Greenwood Leflore) would not make it, it would still be short.”

After just the first week of the legislative session, key lawmakers and legislative observers are already repeating the refrain: “Don’t expect anything major to gain steam this year because it’s an election year.” Indeed, all 174 legislative seats and all eight statewide offices are up for grabs this November.

But that logic isn’t sitting well with Johnson and other Democratic leaders, particularly as the Mississippi hospital crisis worsens by the day.

“This is quite literally a matter of life and , and we seem to be the only people in this building united behind providing relief for hospitals and health care for all Mississippians,” said Sen. Derrick Simmons, the Democratic leader of the Senate. “We’re going to push Republicans hard on this. We aren’t elected for three years and a vacation to Jackson during election years.”

Simmons continued: “We’ve got a plan. Here it is. ‘No’ is no longer an acceptable answer from the Republicans standing in the way of addressing this issue. If you don’t like it, and you have a better idea, then let’s hear what the plan is.”

READ MORE: Mississippi Today’s full coverage of the 2023 legislative session

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

Louisianans on Medicaid expansion can get care across river at Natchez hospital

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Louisianans on Medicaid expansion can get care across river at Natchez hospital

Just across the Mississippi River bridge from Natchez are the Louisiana towns of Vidalia, Ferriday and other communities where there are people who have coverage through the expansion of .

Those Louisianans, if they are in the correct Medicaid health care network, can obtain medical services across the bridge in Mississippi at Merit Natchez hospital. People in Mississippi, of course, also can receive health care at Merit, one of the largest health care providers in southwest Mississippi.

But those cannot take advantage of Medicaid expansion to help pay their medical bills because Mississippi, unlike Louisiana, does not have Medicaid expansion.

“Expanding Medicaid was Gov. (John Bell) Edwards’ first official act when he took office in 2016,” Laura Leist, a spokeswoman for the Democratic governor, told Mississippi Today via email. “He often says it’s the easiest big decision he’s made as governor.”

Kay Ketchings, a spokesperson for the Natchez hospital, said Merit will work with Louisianans who are not in network to provide them medical care as it will with Mississippians who have no access to Medicaid expansion. But Merit Natchez, like other Mississippi hospitals, have a difficult time collecting payment from many poor people who are not covered by Medicaid expansion. They often do not have the money to pay, leaving hospitals to eat those costs or pass the costs on to other patients.

“Medicaid covers the most vulnerable residents in Mississippi …,” Ketchings said. “It is an important step toward advancing the overall health of Mississippians because it provides sustainable coverage for continued access to preventive care and physician assistance with chronic conditions. Like others in , we are supportive of efforts to expand coverage for vulnerable Mississippians.”

Louisiana is one of the few Southern states to expand Medicaid. Medicaid provides health care coverage for primarily the working poor who earn up to 138% of the federal poverty level or about $18,750 for an individual. The federal government pays 90% of the cost plus substantial incentives for the states that have not expanded Medicaid to do so.

South Dakota voters earlier this month voted to expand Medicaid. Now 11 states, mostly in the Southeast, have not taken advantage of the expansion as is offered as part of the Patient Protection and Affordable Care Act, also known as Obamacare.

A map of the states that have not expanded Medicaid looks much the same as a footprint of the NCAA’s Southeastern Conference with four notable exceptions – Arkansas, Louisiana, Kentucky and Missouri. Those four states, including two contiguous to Mississippi, have expanded Medicaid.

Of the 11 states that have not expanded Medicaid, seven have schools in the Southeastern Conference, and all seven have higher percentages of their population uninsured or lacking health care coverage than does the nation at a whole.

The four SEC states that have expanded Medicaid have higher percentages of their population with health insurance coverage than those that have not expanded Medicaid.

“Today, more than 747,000 of Louisiana’s working poor have access to health care, including mammograms and other preventive heath screenings, mental health resources and substance abuse services,” said Leist. “Louisiana’s uninsured rate has dropped from 22.7% in 2015 prior to expansion to just 9.4%, and rural hospitals that were on the verge of closing before expansion have been able to stay open and continue serving their communities.”

In Mississippi, the Hospital Association, with many of its member medical centers in financial straits, is one of the most vocal supporters of Medicaid expansion. Mississippi's Health Officer Daniel Edney has said that 38, or 54%, of the state’ rural hospitals are in danger of closing. Hospital Association officials say Medicaid expansion would provide a boost to those struggling hospitals by decreasing the amount of uncompensated care they deliver.

But Mississippi political leaders have blocked efforts to expand Medicaid. They have provided a litany of reasons for opposing the expansion, ranging from the state cannot afford it to not wanting to expand welfare programs in the state.

Susan Dunlap, a spokesperson for Kentucky Gov. Andy Beshear, a Democrat, said Medicaid expansion has been a positive in the Bluegrass state.

“Costs to the state have what was anticipated,” she said. “Expansion of this program resulted in economic growth through increased state and local tax revenue, the creation of new jobs and additional (health care) provider revenue.”

She said the expansion has resulted in people being able to get medical care, including important but non-life threatening procedures, such as knee replacements, shoulder surgeries and tonsillectomies.

In three Southern states, Louisiana, Arkansas and Kentucky, Medicaid was expanded under Democratic governors. But in those states, the expansion has been largely supported by Republican-controlled legislatures that have not tried to repeal the program. And in Arkansas, it has been continued under a Republican governor. And Arkansas-Gov. elect Sarah Huckabee Sanders, former spokesperson for , has not advocated for the repeal of that state’s version of Medicaid expansion. In Arkansas, the state uses the federal Medicaid expansion matching funds to purchase private insurance for those who otherwise would be eligible for the Medicaid expansion program.

“Out of the 38 (states that have expanded Medicaid), none have stopped,” Tim Moore, chief executive with the Mississippi Hospital Association, recently told the Senate Public Health Committee during a hearing on the financial difficulties facing Mississippi hospitals.

“They continue to use it. They continue to take down federal dollars. It has been a good thing for everybody, including the state, the patients and the providers.”

The states with the highest uninsured rates in the nation are primarily Southern states that have not expanded Medicaid. Texas is the highest at 18.4%, while Georgia and Florida are at 13.2% followed by Mississippi at 13%, according to a recent report by the Health Foundation.

The national uninsured rate is 9.2%, according to the same study. The Southern states that have expanded Medicaid all have uninsured rates near or below the national average. Kentucky's uninsured rate is 6.4%.

Uninsured rates across the national have declined significantly since the 2010 passage of the Affordable Care Act that also includes the health care exchange that allows people to buy insurance coverage in most cases with the help of a government subsidy.

But there are people who do not qualify for health insurance policies through the health care exchange because their income is below a certain level. The architects of the Affordable Care Act envisioned they would be covered through Medicaid expansion, not contemplating there would be states like Mississippi that opted not to participate in the program.

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

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