Connect with us

Mississippi Today

Reddit AMA recap: Medicaid expansion in Mississippi with Senior Political Reporter Geoff Pender

Published

on

Reddit AMA recap: Medicaid expansion in Mississippi with Senior Political Reporter Geoff Pender

Mississippi's growing health crisis threatens to close at least a dozen hospitals across the state and puts Mississippi in the lead nationally for rates of uninsured people.

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

Studies have shown and advocates have long touted the benefits of Medicaid expansion, but state leaders remain steadfast in their opposition. As such, Mississippi remains one of only 11 states in the country not to expand the federal-state program.

Mississippi Today launched an ongoing series looking at the impact of the health care crisis on the people and institutions of the state.

As part of that project, Senior Political Reporter Geoff Pender answered readers' questions on Reddit about Medicaid expansion (or the lack thereof) in the state. Here's a recap:

Click to jump to a specific question

Q: Thank you for doing this and continuing to push on this topic.

As I sit here seeing the Greenwood hospital closing while the governor touts tax breaks for companies and the state government refuses this aid… I just do not get it.

Unless I think of all of the non-rational reasons for it.

A: Unfortunately, we are hearing from many corners that Greenwood may be the canary in the coal mine right now. We have heard some dire predictions of late from state hospital and other officials. State Health Officer Dr. Edney recently warned that we're looking at at least half a dozen hospitals on the brink, and others are saying our entire system is troubled. I don't know that Medicaid expansion would be the panacea for all that, but most experts are saying the influx of billions of federal dollars for health care would stave off many of these problems.

Q: As the Q&A article describes, there are political and economic arguments against expansion, but what in your opinion are the underlying motives for the stance? Are the politicians perhaps more driven by financial incentive from opposition groups in addition to maintaining their political platforms for the sake of the party? And as for general people, do you think it’s related to a mentality of being against handouts and of “pulling yourself up by your bootstraps”? What do you think are the underlying feelings and motivations to these stances?

And lastly, how do you think these underlying reasons can be negotiated with to make progress towards achieving expansion?

A: As far as the current drivers of opposition to expansion, I would say they are now more political than economic, and have been so for quite a while. For one thing, we have empirical evidence from other states, including now Louisiana and Arkansas, that show expansion isn’t the budget-buster our leaders once feared.

We also have reams of studies and evidence from other states showing we would see net positive benefits – thousands of jobs created, savings of double-digit percentages in uncompensated care for hospitals, more workforce participation (ours is typically lowest in the country), net GDP growth and even projected growth in population. Also, we’ve seen firsthand over the last two years that Mississippi, with our economy so heavily dependent on federal spending, sees booming state budget growth when there is an influx of billions of federal dollars. We’re sitting on more than $2 billion in basically surplus state money right now, largely the result of the influx of federal pandemic spending.

And again, this expansion is aimed primarily at the “working poor,” people in the gap between being poor enough for other help or being able to afford private insurance or pay medical bills out of pocket. As many have pointed out, a lot of the folks we’re talking about with this are working more than one job. As for pulling one’s self up by bootstraps, too many folks are one ER visit away from not having any bootstraps, and once someone gets a chronic illness because of lack of preventive care, it costs taxpayers anyway (and more).

No, the opposition now would appear to be more purely political (partisan) and philosophical – not wanting expansion of “Obamacare,” and opposition to expansion of a government program, even if in the long run it’s projected to benefit the workforce and private sector.

That opposition to government programs, however, appears to be selective among state leaders. One recent anecdote struck me in particular. Gov. Reeves recently held a press conference to trumpet the state’s work on expanding broadband internet across rural Mississippi. This is being funded with federal tax dollars. Instead of lamenting such government largesse, Reeves vowed to see that “we not only get our fare share, but that we get more than our fair share.” It would appear it’s OK to take hundreds of millions of federal dollars for internet service to areas where the private sector won’t do it, but not OK to take federal money to help keep people alive and well and working.

As for how this opposition might be overcome – I don’t know that anyone has a simple answer to that. One thing I hear all the time, though, even from some who have opposed expansion, is time. I have heard over and again in recent years that it’s probably just a matter of time before Mississippi expands Medicaid. Polling in recent years would indicate the populace may already be a bit ahead of our politicians on this policy … and, of course, look at other states relenting, such as Arkansas, Louisiana.

We attempted to delve into some of this opposition, past and present, here.

READ MORE: Who’s opposed to Mississippi Medicaid expansion and why?

Q: Can Medicaid expansion prevent local hospitals from closing?

A: It's unclear if it definitely would — rural hospitals in particular are facing major headwinds with personnel shortages and costs, supplies, inflation, uncompensated care. But most projections by experts have shown net benefits, and we've seen in other states that expansion helped. Particularly, in Louisiana, rural hospitals saw reductions in uncompensated care costs in the 55% range. This alone could give struggling rural hospitals some breathing room.

This study indicates hospitals in expansion states are less likely to close.

Q: With Medicaid expansion costing far more than initially predicted in other states, it delivering consistently poor health outcomes for those on the program, and it failing to ultimately help save rural providers as seen in Colorado and Indiana…why advocate so intensely for expanding a program that’s heading toward insolvency besides the fact that it will pad the pockets of and expand profits for big hospitals?

A: As for costing more than predicted, as I understand, this has not truly been the case at least on the state level. Some states have seen more people than initially predicted, but that has also been offset by people shifting from their traditional Medicaid to that with the higher match rate from the feds, and other non-direct economic benefits.

As for Colorado, I just recently read a report that rural hospitals there are "about 6 times less likely to close than hospitals in non-expansion states, according to a study by researchers at the University of Colorado Anschutz Medical Campus." I'm not sure what you are looking at, but would like to see it if you can forward a link.

As for poor health outcomes, I'm not sure Mississippi would have anywhere to go but up. Mississippi Medicaid has had poor health outcomes, but that has been primarily because only the sickest of the sick, so to speak, are on its adult population. Proponents say that the working-poor expansion population would receive more preventive care and improve outcomes — but you are right, that has been one major argument against expansion in Mississippi.

I don't know that expansion would pad the pockets and profits of big hospitals. It would help ameliorate the $600 million or so in uncompensated care that is hammering, in particular, smaller rural hospitals.

READ MORE:
The Mississippi Health Care Crisis
Mississippi moms and babies suffer disproportionately. Medicaid expansion could help.
How Medicaid expansion could have saved Tim’s leg — and changed his life
Q&A: What is Medicaid expansion, really?

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

Mississippi Today

IHL deletes the word ‘diversity’ from its policies

Published

on

mississippitoday.org – Molly Minta – 2024-11-21 14:32:00

The governing board of Mississippi’s public universities voted Thursday to delete the word “diversity” from several policies, including a requirement that the board evaluate university presidents on campus diversity outcomes.

Though the Legislature has not passed a bill targeting diversity, equity and inclusion initiatives in higher education, the Institutions of Higher Learning Board of Trustees approved the changes “in order to ensure continued compliance with state and federal law,” according to the board book

The move comes on the heels of the re-election of former President Donald Trump and after several universities in Mississippi have renamed their diversity offices. Earlier this year, the IHL board approved changes to the University of Southern Mississippi’s mission and vision statements that removed the words “diverse” and “inclusiveness.”

In an email, John Sewell, IHL’s communications director, did not respond to several questions about the policy changes but wrote that the board’s goal was to “reinforce our commitment to ensuring students have access to the best education possible, supported by world-class faculty and staff.”

“The end goal is to support all students, and to make sure they graduate fully prepared to enter the workforce, hopefully in Mississippi,” Sewell added.

On Thursday, trustees approved the changes without discussion after a first reading by Harold Pizzetta, the associate commissioner for legal affairs and risk management. But Sewell wrote in an email that the board discussed the policy amendments in open session two months ago during its retreat in Meridian, more than an hour away from the board’s normal meeting location in Jackson.

IHL often uses these retreats, which unlike its regular board meetings aren’t livestreamed and are rarely attended by members of the public outside of the occasional reporter, to discuss potentially controversial policy changes.

Last year, the board had a spirited discussion about a policy change that would have increased its oversight of off-campus programs during its retreat at the White House Hotel in Biloxi. In 2022, during a retreat that also took place in Meridian, trustees discussed changing the board’s tenure policies. At both retreats, a Mississippi Today reporter was the only member of the public to witness the discussions.

The changes to IHL’s diversity policy echo a shift, particularly at colleges and universities in conservative states, from concepts like diversity in favor of “access” and “opportunity.” In higher education, the term “diversity, equity and inclusion” has traditionally referred to a range of efforts to comply with civil rights laws and foster a sense of on-campus belonging among minority populations.

But in recent years, conservative politicians have contended that DEI programs are wasteful spending and racist. A bill to ban state funding for DEI in Mississippi died earlier this year, but at least 10 other states have passed laws seeking to end or restrict such initiatives at state agencies, including publicly funded universities, according to ABC News.

In Mississippi, the word “diversity” first appeared in IHL’s policies in 1998. The diversity statement was adopted in 2005 and amended in 2013. 

The board’s vote on Thursday turned the diversity statement, which was deleted in its entirety, into a “statement on higher education access and success” according to the board book. 

“One of the strengths of Mississippi is the diversity of its people,” the diversity statement read. “This diversity enriches higher education and contributes to the capacity that our students develop for living in a multicultural and interdependent world.”

Significantly, the diversity statement required the IHL board to evaluate the university presidents and the higher learning commissioner on diversity outcomes. 

The statement also included system-wide goals — some of which it is unclear if the board has achieved — to increase the enrollment and graduation rates of minority students, employ more underrepresented faculty, staff and administrators, and increase the use of minority-owned contractors and vendors. 

Sewell did not respond to questions about if IHL has met those goals or if the board will continue to evaluate presidents on diversity outcomes.

In the new policy, those requirements were replaced with two paragraphs about the importance of respectful dialogue on campus and access to higher education for all Mississippians. 

“We encourage all members of the academic community to engage in respectful, meaningful discourse with the aim of promoting critical thinking in the pursuit of knowledge, a deeper understanding of the human condition, and the development of character,” the new policy reads. “All students should be supported in their educational journey through programming and services designed to have a positive effect on their individual academic performance, retention, and graduation.” 

Also excised was a policy that listed common characteristics of universities in Mississippi, including “a commitment to ethnic and gender diversity,” among others. Another policy on institutional scholarships was also edited to remove a clause that required such programs to “promote diversity.” 

“IHL is committed to higher education access and success among all populations to assist the state of Mississippi in meeting its enrollment and degree completion goals, as well as building a highly-skilled workforce,” the institutional scholarship policy now reads. 

The board also approved a change that requires the universities to review their institutional mission statements on an annual basis.

A policy on “planning principles” will continue to include the word “diverse,” and a policy that states the presidential search advisory committees will “be representative in terms of diversity” was left unchanged.

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

Continue Reading

Mississippi Today

Closed St. Dominic’s mental health beds to reopen in December under new management

Published

on

mississippitoday.org – Gwen Dilworth – 2024-11-21 13:54:00

The shuttered St. Dominic’s mental health unit will reopen under the management of a for-profit, Texas-based company next month. 

Oceans Behavioral Hospital Jackson, a 77-bed facility, will provide inpatient behavioral health services to adults and seniors and add intensive outpatient treatment services next year. 

“Jackson continuously ranks as one of the cities for our company that shows one of the greatest needs in terms of behavioral health,” Oceans Healthcare CEO Stuart Archer told Mississippi Today at a ribbon cutting ceremony at its location on St. Dominic’s campus Thursday. “…There’s been an outcry for high quality care.” 

St. Dominic’s 83-bed mental health unit closed suddenly in June 2023, citing “substantial financial challenges.”

Merit Health Central, which operates a 71-bed psychiatric health hospital unit in Jackson, sued Oceans in March, arguing that the new hospital violated the law by using a workaround to avoid a State Health Department requirement that the hospital spend at least 17% of its gross patient revenue on indigent and charity care.

Without a required threshold for this care, Merit Health Central will shoulder the burden of treating more non-paying patients, the hospital in South Jackson argued. 

The suit, which also names St. Dominic’s Hospital and the Mississippi Department of Health as defendants, awaits a ruling from Hinds County Chancery Court Judge Tametrice Hodges-Linzey next year. 

The complaint does not bar Oceans from moving forward with its plans to reopen, said Archer.

A hallway inside Oceans Behavioral Hospital in Jackson, Miss., is seen on Thursday, Nov. 21, 2024, during the facility’s grand opening. Credit: Eric Shelton/Mississippi Today

Oceans operates two other mental health facilities in Mississippi and over 30 other locations in Louisiana, Oklahoma and Texas. 

“Oceans is very important to the Coast, to Tupelo, and it’s important right here in this building. It’s part of the state of Mississippi’s response to making sure people receive adequate mental health care in Mississippi,” said Lt. Governor Delbert Hosemann at the Nov. 21 ribbon cutting.

Some community leaders have been critical of the facility. 

“Oceans plans to duplicate existing services available to insured patients while ignoring the underserved and indigent population in need,” wrote Hinds County Sheriff Tyree Jones in an Oct. 1 letter provided to Mississippi Today by Merit Health. 

Massachusetts-based Webster Equity Partners, a private-equity firm with a number of investments in health care, bought Oceans in 2022. St. Dominic’s is owned by Louisiana-based Catholic nonprofit Franciscan Missionaries of Our Lady Health System.

Oceans first filed a “certificate of need” application to reopen the St. Dominic’s mental health unit in October 2023. 

Mississippi’s certificate of need law requires medical facilities to receive approval from the state before opening a new health care center to demonstrate there is a need for its services. 

The Department of Health approved the application under the condition that the hospital spend at least 17% of its patient revenue on free or low-cost medical care for low-income individuals – far more than the two percent it proposed. 

Stuart Archer, CEO of Oceans Healthcare, speaks during the grand opening of Oceans Behavioral Hospital in Jackson, Miss., on Thursday, Nov. 21, 2024. Credit: Eric Shelton/Mississippi Today

Oceans projected in its application that the hospital’s profit would equal $2.6 million in its third year, and it would spend $341,103 on charity care.

Merit Health contested the conditional approval, arguing that because its mental health unit provides 22% charity care, Oceans providing less would have a “significant adverse effect” on Merit by diverting more patients without insurance or unable to pay for care to its beds. 

Oceans and St. Dominic’s also opposed the state’s charity care condition, arguing that 17% was an unreasonable figure. 

But before a public hearing could be held on the matter, Oceans and St. Dominic’s filed for a “change of ownership,” bypassing the certificate of need process entirely. The state approved the application 11 days later

Merit Health Central then sued Oceans, St. Dominic and the State Department of Health, seeking to nullify the change of ownership. 

“The (change of ownership) filing and DOH approval … are nothing more than an ‘end run’ around CON law,” wrote Merit Health in the complaint. 

Oceans, St. Dominic’s and the Mississippi Department of Health have filed motions to dismiss the case. 

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

Continue Reading

Mississippi Today

How Mississippi’s Supreme Court Runoff Election Could Impact Criminal Cases

Published

on

mississippitoday.org – Caleb Bedillion, The Marshall Project and Daja E. Henry, The Marshall Project – 2024-11-21 11:00:00

Mississippi voters have dealt defeat to one conservative state Supreme Court justice and forced a moderate justice into a Nov. 26 runoff, with the final outcome possibly making the court more open to considering the rights of criminal defendants.

The nine-member court is largely conservative but justices have recently split in high-profile decisions that sharply affected state politics, including a ruling that shut down citizen-led ballot initiatives in Mississippi and allowed some state control over local criminal cases in its majority-Black capital. The court has also rendered rulings that have made the state increasingly unfavorable to defendants appealing their cases. 

“The ability of death row inmates in particular, and inmates in general, to access the courts has been recently curtailed significantly,” Matthew Steffey, a professor at Mississippi College School of Law, told The Marshall Project – Jackson and Bolts following the Nov. 5 election.  

Justice Dawn H. Beam joined the majority in those decisions, acquiring a reputation of being hostile to appeals by criminal defendants, and she ran for reelection this fall as the Republican Party’s favored candidate. However, she lost in the state’s 2nd District on Nov. 5 to David P. Sullivan, a defense attorney who has worked as a public defender.

Judicial races in Mississippi are nonpartisan and Sullivan has given few explicit signals about his judicial outlook. He has supported at least some criminal justice reforms and would be the third justice with experience as a defense attorney on this court. Some reformers nationwide have pushed for more professional diversity on the bench.

Even if Sullivan turns out to be more centrist or independent than Beam on criminal law, any overall shift in power on the court depends on the outcome of a runoff election next week. 

Two-term Justice Jim Kitchens and challenger Jenifer B. Branning will face each other in the Nov. 26 runoff election after neither won more than 50% of the vote on Nov. 5. The runoff will take place across the 22 counties that make up the Supreme Court’s central district, including Hinds County, home to Jackson. Throughout the campaign, the state GOP targeted Kitchens with attacks, while Branning, a Republican state senator with a conservative voting record, is endorsed by the party.

Kitchens is one of two reliably moderate-to-liberal high court justices. Justices from among an additional group of four sometimes veer away from the majority, as well, but can be more unpredictable, and this group does not vote as a bloc. 

Quinn Yeargain, a Michigan State University law professor who closely watches state courts, recently analyzed the court’s voting patterns and found Beam was consistently more conservative than Kitchens in recent cases. Yeargain told The Marshall Project – Jackson and Bolts that conservative and liberal voters often have few signals about how to select a candidate in judicial races. “It’s very hard to label the justices,” they said.


Sullivan — whose father was a Mississippi Supreme Court justice from 1984 to 2000 — called himself a “conservative” throughout his campaign. But he has also touted the value of judicial independence and criticized Beam for campaigning on her endorsement by the state Republican Party. 

“I think that rubbed a lot of people the wrong way,” Sullivan told the Sun Herald newspaper, speaking of Beam’s use of the endorsement. “Judicial races are nonpartisan for a reason. A judge’s impartiality could be called into question.”

Sullivan has broad legal experience, but much of his career has focused on private criminal defense while also doing some public defense work. He told The Marshall Project – Jackson and Mississippi Today that he supported a new administrative rule handed down in 2023 by the state Supreme Court to require continuous legal representation for poor criminal defendants from the beginning of their cases. An investigation by The Marshall Project, ProPublica and the Northeast Mississippi Daily Journal last year found, however, that many courts were unready at the time to implement the new representation rules.

During the campaign, Sullivan told The Marshall Project – Jackson and Mississippi Today that more work is needed to improve public defense.

Kitchens has also advocated for public defense reforms during his two terms on the court. He told a committee of legislators last year that the “playing field is far from level” between prosecutors and poor defendants.

On other criminal justice issues, he has sometimes dissented from opinions upholding death sentences. His decisions have scrutinized prosecutorial conduct and inadequate legal representation. 

Branning, the Republican senator, has a voting record on criminal justice issues that suggests a harsher approach toward criminal defendants. She has supported higher mandatory minimum sentences and reclassifying misdemeanors as felonies, has opposed expansion of parole and was among only a few lawmakers who voted against legalizing medical marijuana. 

She also supported increasing the jurisdiction of a controversial, state-run police force inside the majority-Black city of Jackson as well as increasing state control over many felony cases in Jackson. The Supreme Court unanimously curtailed much state power over these felony cases, but a majority left some control intact, with Kitchens and another judge dissenting.

Branning did not respond to questions from The Marshall Project – Jackson and Mississippi Today during the Nov. 5 campaign about her possible judicial outlook.

Kitchens was a prosecutor and then in private practice before joining the bench. Branning is a practicing attorney who typically handles civil cases. 

The winner of the Nov. 26 runoff will join Sullivan on a court that in recent years has been restricting the ability of people who say the legal system has wronged them to seek relief, legal experts told The Marshall Project – Jackson and Bolts this month. 

Krissy Nobile, director of the state’s Office of Capital Post-Conviction Counsel, said it’s become “increasingly more difficult to correct a wrongful conviction.” Her office provides legal counsel for indigent people on death row. 

She said a number of recent cases showed the barriers the high court has erected for criminal defendants appealing their convictions, and demonstrated indifference to civil rights violations. Kitchens disagreed with the majority, in full or in part, in all but one of the appeals, which the court unanimously denied.

In a case earlier this year, the Court ruled to monetarily fine an incarcerated person for filing any future post-conviction relief petitions that lacked merit. Kitchens joined a dissenting opinion condemning the fine. In another, the court denied a man who argued that his lawyers were ineffective and that they did not challenge prosecutorial misconduct or false forensic evidence presented by a medical examiner with a checkered past. The court’s majority denied the motion, and in the process, overturned a precedent that allowed ineffective counsel as an adequate reason to give a case another look in some types of appeals. Kitchens dissented, along with two other justices. 

“For decades in Mississippi, the Court held that it would correct errors if there was a violation (of) a person’s fundamental rights,” Nobile said. But she added this has changed considerably. Now, if you land a terrible lawyer who rushes your case, “You are out of luck,” she said, “even if your core constitutional rights have been clearly violated.” 

For the court’s majority, Nobile added, “The legal technicalities now trump a person’s constitutional rights.” 

Branning, left, and Kitchens at the Neshoba County Fair in August 2024. Credit: Eric Shelton, Mississippi Today

The runoff is the nation’s final supreme court race of the year. Thirty-two states held elections for their high courts earlier this year, resulting in a muddled picture, with liberals and conservatives each gaining ground in different places, Bolts reports

Mississippi’s runoff outcome will heavily depend on turnout and the composition of the electorate. In the Supreme Court’s central district, voters split narrowly between Democrat Kamala Harris and Republican Donald Trump in the presidential election on Nov. 5, but the runoff is just two days before Thanksgiving and will likely see a large dropoff in turnout. Branning received 42% of the vote in the first round, and Kitchens received 36%, with three other candidates making up the rest. 

There will also be a runoff the same day in the Gulf Coast area between Amy Lassiter St. Pé and Jennifer Schloegel for an open seat on the state Court of Appeals. The Court of Appeals hears both criminal and civil cases that have been appealed from lower courts. The Mississippi Supreme Court can hear cases directly on appeal or can assign cases to the Court of Appeals.

Observers agreed that against the national legal backdrop, neither a Kitchens victory nor a Branning victory would lead to a seismic change since neither outcome would flip the court’s conservative lean. Still, a modest shift could impact some of the most controversial cases, such as a rare 5-4 decision that upheld the death sentence in Willie Manning’s case

A Kitchens win, coupled with Sullivan’s upset earlier this month, would deal the Republican Party rare setbacks in a state where it has been dominant and could put moderate forces in a position to grow their numbers further in future elections. 

“You might end up with a normal conservative court,” law professor Yeargain said, “instead of one of the most conservative courts in the country.”

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

Continue Reading

Trending