Mississippi Today

‘The life and breath of communities’: Hospital leaders say Medicaid expansion still needed

Published

8 months ago

February 1, 2024

Gov. Tate Reeves’ Medicaid payment changes, pitched during the eleventh-hour of a heated reelection campaign and his only major health plan during his first four years as governor, delivered $658.2 million to hospitals in January.

Hospital leaders say the influx of federal money is a lifeline, but it’s not enough to forgo Medicaid expansion – a long-term solution that would insure hundreds of thousands of working poor people in one of the country’s sickest states.

Quentin Whitwell owns four hospitals in rural Mississippi. He knows intimately the struggles they face. While the extra federal money Reeves secured is helpful, he said, expansion would go further.

“There is no reason to leave funding on the table to assist rural hospitals that are the life and breath of communities,” he said.

As Mississippi hospitals continue to struggle, expanding Medicaid to cover the working poor has been hotly contested over the last decade, most openly during the last two gubernatorial elections. Reeves, as did two of his GOP predecessors, has remained steadfastly opposed, saying it would make Mississippians more reliant on “welfare.”

Medicaid expansion would increase the income threshold needed to qualify for Medicaid to 138% of the federal poverty level, meaning many more Mississippians would qualify for coverage. For a family of four, that would be an annual income of $43,056.

As it stands, low-income, working-class Mississippians who make just above the poverty level don’t qualify for Medicaid but also can’t afford insurance. Nearly one in five Mississippians is uninsured, contributing to the state’s abysmal public health metrics – such as the lowest life expectancy in the country.

Extensive research underlines the policy’s financial and health benefits, and a majority of Mississippians say they want Medicaid eligibility expanded, as it has been in 40 other states. Researchers estimate the policy would insure between 200,000 and 300,000 Mississippians, generate thousands of jobs, help struggling hospitals and bring billions of dollars into the state.

The money’s needed — one report estimates nearly half of the state’s rural hospitals are at risk of closure, largely due to losses related to caring for uninsured patients.

However, the governor and some other Republican leaders have remained staunchly against the policy.

Weeks before the November election, in which Reeves narrowly defeated Democrat Brandon Presley, the governor announced that the state had requested federal approval of changes to its Medicaid payment policies. The changes, Reeves claimed, would bring in nearly $700 million in total to the state’s hospitals.

Reeves’ plan relies on increased extra payments hospitals get for treating patients on Medicaid. It increases a “bed tax” on Mississippi hospitals, in exchange for them drawing down more in federal Medicaid payments. Hospitals and GOP leaders in the Legislature had pitched roughly the same plan the year before, but Reeves’ own Medicaid administration had told them it wouldn’t work.

At the September press conference announcing his plan, Reeves touted the reforms as an alternative to Medicaid expansion, which he referred to as increasing the state’s “welfare rolls.” He was flanked by various hospital leaders from across the state. Most were from hospitals that had recently left the state hospital association under political pressure after the association’s political action committee made a largee donation to Reeves’ pro-expansion opponent Presley.

Months after his announcement, half of Reeves’ plan has been approved and the bulk of the money has gone out.

And while hospital executives say the money will allow Mississippi hospitals that have been struggling for years to stay above water, the program does nothing to address the egregiously high number of uninsured, working-class Mississippians.

Lee McCall, chief executive officer of Neshoba General Hospital in Philadelphia, said his hospital loses more than $4 million a year on uncompensated care.

“These proceeds are going to help offset that … but it hasn’t done anything to expand access to coverage for Mississippians that are uninsured,” he said. “So yes, we’re still proponents of expansion, in whatever form it could come in, really to help out Mississippians, so that they can seek the care that they need.”

McCall said while he was thankful for the extra money, he acknowledged the governor’s plan gave more money to the state’s larger hospitals, rather than the ones struggling the most in rural parts of the state.

While the reimbursement plan helps hospitals recoup losses they face when caring for uninsured people, Baptist Memorial Health Care’s vice president of government affairs Keith Norman said it doesn’t replace the need for Medicaid expansion, which would insure more people.

“We have never seen the (payment increases) and Medicaid expansion as being exclusive of one another,” Norman said. “We’ve always seen the both-and approach, not either-or. Because when we start talking about Medicaid expansion, we’re talking about covering working Mississippians … and we’re looking to adopt both.”

From a strictly financial perspective, the reimbursement plan is seen by some hospital executives as comparable to the benefits of expansion.

“It is injecting close to $40 million in additional funding for Singing River Health System, which we really needed after the lingering effects of COVID,” said Singing River chief financial officer Jason McNeil. “From our perspective, it’s really doing about the same as if Medicaid were expanded.”

But in order for the two programs to have comparable financial benefits, the reimbursement plan would need to recur annually. And while hospital executives are expecting that to be the case the plan doesn’t automatically renew. The current payment arrangement applies through June 30, 2024.

“If we lose access to the program, it’s going to destabilize our operations,” said Greenwood Leflore Hospital’s interim chief executive officer Gary Marchand.

Greenwood Leflore’s financial struggles have been well-documented — the hospital, once poised to close, has managed to hold on until through the end of its fiscal year.

McCall said that while the expectation is that the money from the reforms will continue to arrive annually, “we won’t know until it’s submitted.”

Even assuming it is a permanent change, the plan only benefits hospitals, explained Marchand, and not other forms of care – such as outpatient care and preventative care patients receive at clinics. One of the consequences of the current system of coverage is that the indigent population does not have access to preventative care – leading to tragedies such as widespread amputations among diabetics whose condition went unchecked and untreated.

In addition to the devastating consequences a lack of coverage has for patients, it’s also not cost effective for hospitals. The population not currently covered by Medicaid tends to only have access to health care in the context of an emergency room, which can’t turn anyone away – regardless of insurance coverage. But it’s also the most expensive place to receive health care.

The hospital reimbursement plan helps offset some of the money hospitals lose when caring for uninsured patients. But it’s throwing money at a problem that wouldn’t exist under Medicaid expansion.

“I haven’t spoken to anyone in health care or hospital administration that says we’re no longer interested in expansion,” McCall said.

Hospital leaders from Merit Health System, Delta Health System in Greenville, North Mississippi Health System in Tupelo and Forrest General Hospital in Hattiesburg declined interviews.

Leaders from the University of Mississippi Medical Center and Gulfport’s Memorial Hospital System also refused an interview. South Central Regional Medical Center’s chief executive officer Greg Gibbes did not respond to multiple requests for comment. Representatives from all three were part of a cohort of medical leaders that flanked the governor at his September election-time press conference.

A second, smaller part of Reeves’ plan is still pending approval from the federal government. Medicaid expansion will likely be a major policy discussion during the Legislature’s 2024 session, and several Republican legislative leaders have said they’ll devote attention to the topic.

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 1955

Published

18 hours ago

September 21, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-09-21 07:00:00

Sept. 21, 1955

Moses Wright points at J.W. Milam as one of the kidnappers of his great-nephew, Emmett Till. Ernest Withers defied a judge’s orders and took this photo. Credit: Wikipedia

Moses Wright took the witness stand and identified the men who kidnapped and killed his great-nephew, Emmett Till.

“It was the first time in my life I had the courage to accuse a white man of a crime, let alone something terrible as killing a boy,” Wright said later. “I just wanted to see justice done.”

He worked as a sharecropper and was also a minister, whom the locals called “Preacher.” The two white men who abducted Till — J.W. Milam and his half-brother, Roy Bryant — threatened to kill Wright if he said anything.

“How old are you, Preacher?” Milam asked. Wright replied 64. “If you make any trouble, you’ll never live to be 65,” Milam said. When the teen’s body was recovered from the Tallahatchie River, Wright identified Till. Despite threats, Wright still took the witness stand. When the prosecutor asked him to point out Till’s abductors, he stood up, pointed his weathered finger at Milam and said, “There he is. That’s the man.”

He testified that Bryant identified himself as “Mr. Bryant.” It may have been the first murder trial in Mississippi where a Black man testified against a white man. Even after the trial, the threats continued, and Wright left to join his family in Chicago, where he had already sent them.

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

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Mississippi Today

Mississippi River mayors agree to unify ports from the Corn Belt to the coast

Published

1 day ago

September 20, 2024

Staff Editor

mississippitoday.org – Delaney Dryfoos, The Lens and Elise Plunk, Louisiana Illuminator – 2024-09-20 16:19:36

BATON ROUGE, La. — Mayors from 10 states along the Mississippi River convened in Louisiana’s capital this week to announce a cooperative agreement between the working river’s ports.

In town for the annual Mississippi River Cities & Towns Initiative meeting, the mayors also called upon the next U.S. president to prioritize several federal policy changes to support the 105 cities represented by the initiative.

On Wednesday, mayors from the Midwestern Corn Belt joined mayors from Louisiana to sign the Mississippi River Ports Cooperative Endeavor Agreement. The agreement is the first to ensure cooperation between the inland ports in the heart of the corn belt and the coastal ports of Louisiana that export 60% of the nation’s agricultural products.

Vicksburg, Mississippi, Mayor George Flaggs praised the move in a statement on Friday, adding that he and the other mayors there were paying particular attention to environmental issues along the river such as the ongoing drought.

“This agreement ensures that ports from St. Louis to St. Paul will receive federal designation, a significant step that will bolster commerce and strengthen the economic impact of the entire Mississippi River region,” Flaggs said.

The inland ports between St. Louis and St. Paul were not federally recognized until 2022, said Robert Sinkler, executive coordinating director of the Corn Belt Ports. With the support of the Mississippi River cities initiative, the Corn Belt Ports initiative launched in 2019 to advocate for federal recognition of those ports.

Now, the corn belt and coastal ports will take on commerce-related policy actions together, for the first time in Mississippi River history, said Sinkler. The river moves nearly one trillion dollars in product through its ports annually, according to MRCTI. Maintaining the navigation capability on the river is a key part of the agreement.

Drought disrupts commerce and drinking water along the Mississippi River corridor

For the third year in a row, the Midwest is under extreme drought conditions, which have led to low water levels that threaten to disrupt barge transports carrying fuel and grain. The 16-month drought spanning from 2022 to 2023 cost the nation $26 billion. The drought of 2012 cost the Mississippi River corridor $35 billion.

Belinda Constant, mayor of Gretna, Louisiana, said that droughts often cost more than floods, but do not qualify as “major disasters” worthy of relief from the Federal Emergency Management Agency.

“We still are not able to capture federal disaster declarations for drought or intense heat,” Constant said.

While drought is not considered a “major disaster” by FEMA, the president can declare one. President Joe Biden declared a federal emergency last September in Louisiana when the effects of drought caused salt water to intrude up the Mississippi River and threaten drinking water.

FEMA is not set up to provide relief for intense droughts or extreme heat, which are expected to become more extreme, according to the Fifth National Climate Assessment. The federal government does offer support through other agencies, such as farm losses through the U.S. Department of Agriculture.

Constant asked the next U.S. president to update FEMA regulations to include droughts and extreme heat. Earlier this summer, dozens of labor and environmental groups filed a petition to push FEMA to declare extreme heat and wildfire smoke as “major disasters,” on par with other natural disasters such as floods and tornadoes.

Constant said the next administration should also create a mechanism to incentivize or compensate manufacturers and farmers who recycle water or reduce water usage during dry periods.

Louisiana is again dealing with drought. As of Sept. 13, 2024, the saltwater wedge had reached river mile 45, corroding drinking water infrastructure below Port Sulphur and inching toward Pointe a la Hache, Louisiana. Earlier this week, the U.S. Army Corps of Engineers began construction on an underwater sill near Myrtle Grove to help slow the creep of saltwater intrusion for the third summer in a row.

But the drought impacts all communities along the Mississippi River, not just those in southern Louisiana. And 50 cities with a total population of 20 million people depend on the Mississippi River for their drinking water.

“Memphis depends on the health of the corridor to power our international port and fuel our multi-billion-dollar outdoor recreation and tourism industry,” said Paul Young, mayor of Memphis, Tennessee. The tournament fishing industry is worth billions in revenue.

“It is vital we work to safeguard the Mississippi River together,” he added.

Tugboats maneuver barges south along the Mississippi River in Vicksburg, Thursday, Oct. 27, 2022. Near record low water levels are affecting shipping and tourism. Credit: Vickie D. King/Mississippi Today

Advocating for the Mississippi River corridor as a whole

The 105 cities represented by inititiuave also called on the next U.S. president to advocate for the corridor both at home and internationally. “We are asking the next president to please work with us to enact a federal Mississippi River program through which we can deploy infrastructure spending at a multi-state scale,” said Hollies J. Winston, mayor of Brooklyn Park, Minnesota.

On the global stage, the initiative has advocated for the Mississippi River corridor at five United Nations climate meetings. Bob Gallagher, mayor of Bettendorf, Iowa, called on the next President to ensure that the nation remains a part of the Paris Agreement to sustain the corridor’s $500 billion in revenue.

“Serving as a past co-chair of MRCTI along with being from an agricultural state, I know firsthand that U.S. participation in the Paris Accord helps us compete and move our commodities and goods across the world to other markets,” said Gallagher.

Pulling out of the Paris Agreement could trigger tariffs for goods coming from a non-signatory nation. Leaving the international climate accord would place farmers and manufacturers at a potential disadvantage in the global market, said Gallagher.

In 2017, President Donald Trump announced that the U.S. would withdraw from the Paris Climate Accord. In 2021, on President Biden‘s first day in office, the U.S. rejoined the international agreement to limit temperature increases.

“We can’t afford to make any policy decisions that will jeopardize the $164 billion in agricultural commodities the Mississippi River makes possible every year,” said Gallagher.

Mitch Reynolds, mayor of La Crosse, Wisconsin, and the initiative’s co-chair, said that the advocacy work of the initiative is paramount to defending the health of the river and its communities.

The Mississippi River Ports Cooperative Endeavor Agreement unites the communities along the corridor in a shared commitment to protect, restore and manage the river’s resources sustainably, said Sharon Weston Broome, mayor of Baton Rouge, Louisiana, and host of the initiative’s 13th annual meeting.

“We urge the next administration to increase its focus on the river, its impact on the national economy and its continued need for stewardship,” said Broome.

This story is a product of the Mississippi River Basin Ag & Water Desk, an independent reporting network based at the University of Missouri in partnership with Report for America, with major funding from the Walton Family Foundation. MRCTI is also a Walton grantee.

Mississippi Today environmental reporter Alex Rozier contributed to this report.

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

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Mississippi Today

Jerry Mitchell: Why Medgar Evers should represent Mississippi in U.S. Capitol Statuary Hall

Published

2 days ago

September 20, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-09-20 11:32:07

Editor’s note: Mississippi Today and the Mississippi Humanities Council cosponsored an event – “Reimagining Statuary Hall” – on Sept. 18 at The Station in Fondren. Several speakers suggested accomplished Mississippians to represent the state in Statuary Hall at the U.S. Capitol. Currently, statues of staunch segregationists Jefferson Davis and J..Z. George represent Mississippi. What follows is Mississippi Today investigative reporter Jerry Mitchell’s pitch from the event.

Medgar Evers Credit: National Park Service

Medgar Evers dove onto the sand at Normandy. In the weeks following the D-Day invasion of June 6, 1944. He joined a million soldiers fighting to expand the beachhead. The Luftwaffe strafed and bombed them, hoping to push them back into the sea.

He was also part of the Red Ball Express, which provided fuel, food and other critical supplies as Allied troops pushed back the German forces.

As Allied forces freed more of France from Nazi occupation, Evers enjoyed life without the color line. He could eat in any restaurant he desired. He even fell in love with a French girl.

After battling the Nazis, he returned to Mississippi and fought racism all over again in the form of Jim Crow, which barred Black Americans from restaurants, restrooms and voting booths. When he tried to vote in his hometown of Decatur, Mississippi, he and other Black war veterans were turned away by an armed white mob.

After graduating from Alcorn College, he worked for his mentor, Dr. T.R.M. Howard, and was involved in passing out bumper stickers across the Delta that read, “Don’t Buy Gas Where You Can’t Use the Restroom.”

In January 1954, he tried to enroll at the University of Mississippi School of Law — only to be turned away. NAACP officials considered taking up his case but were so impressed with him they decided instead to hire him as the first field secretary for the Mississippi NAACP.

He investigated violence against African Americans, including the 1955 assassinations of the Rev. George Lee and Lamar Smith, who were killed because they helped Black Mississippians register to vote.

He worked with Dr. Howard on the lynching of Emmett Till and helped find new witnesses.

The economic threats and violence became so great that Dr. Howard and others left Mississippi, but Medgar Evers stayed.

He helped James Meredith enroll at Ole Miss, and he logged 40,000 miles a year traveling the roads, sometimes flooring it past 100 to escape those hell-bent on harming him.

His telephone rang at all hours with threats. Some were short and emphatic: “We’re going to kill you, N-word.” Others described how they planned to torture him.

Evers told a CBS reporter, “They say I’m going to be dead soon, that they’re going to blow up my house, that they’re going to blow my head off. If I die, it will be a good cause. I’m fighting for America just as much as the soldiers in Vietnam.”

After the white mayor of Jackson chastised the civil rights movement in Mississippi in spring 1963, Evers won his FCC bid for “equal time” to respond. He talked on television about the mistreatment of Black Mississippians and in so doing he became even more of a target. The Evers’ home was firebombed.

Hours after President Kennedy told the nation that the grandchildren of those enslaved are “not yet freed from the bonds of injustice,” Evers was shot in the back as he stepped onto his own driveway in Jackson, Mississippi. His wife, Myrlie Evers, heard the shot, ran outside, saw the blood and screamed. When the children heard the scream, they ran outside and saw their father.

“Daddy, get up,” his 8-year-old daughter, Reena, said. “Daddy, get up.”

He never did.

On Evers’ birthday in 1964, Congress passed the Civil Rights Act

Three decades later, his family finally saw his assassin convicted.

“All I want to say is, ‘Yay, Medgar, yay!’” Myrlie Evers declared as she wiped away tears. “My God, I don’t have to say accused assassin anymore. … what he failed to realize was that Medgar was still alive in spirit and through each and every one of us who wanted to see justice done.”

That justice inspired others. To date, 24 men have been convicted in civil rights cold cases.

A year after Evers’ killer went to prison, Myrlie Evers became chairman of the national NAACP and helped rescue the civil rights organization from the brink of bankruptcy.

She continues to break boundaries. She became the first lay person to deliver the inaugural invocation at Barack Obama’s second inauguration.

She cheered when Mississippi removed the Confederate emblem from the state flag, and she told me the reason we keep repeating its history is we don’t know our history.

Putting Medgar Evers in Statuary Hall would honor a fallen soldier in the war against hate and would help ensure that we know our history so that we don’t repeat it.