Mississippi Today

A coverage gap Catch-22: To work, Selinda Walker needs health care. To get health care, she needs work.

Published

7 months ago

April 18, 2024

A coverage gap Catch-22: To work, Selinda Walker needs health care. To get health care, she needs work.

Forty-seven-year-old Selinda Walker had to move back in with her elderly mother after an untreated and severe case of Graves’ disease left her unable to work and live independently.

As a single, low-income individual with no children, Walker has no path toward health care in the state of Mississippi, which remains one of 10 states in the country not to expand Medicaid. And as lawmakers advocate for work requirements in Medicaid expansion bills, Walker faces a Catch-22: she needs health insurance first to get healthy enough to be able to return to work.

The progression of her disease made it impossible for her to continue working at her jobs in retail and car sales. The worst of her symptoms cause her to suffer dizzy spells and temporarily-paralyzing falls throughout the day, among a slew of other problems.

“I feel like I’m a burden to my mother,” Walker, who lives in Columbus, said. “She has to do so much because I can do so little. There are days where I am just useless, the pain is so bad.”

Selinda Walker, 47, takes one of several medications at her mom’s home in Columbus, Miss., on Thursday, April 18, 2024. Selinda has an autoimmune disease called Graves’ Disease. Credit: Eric Shelton/Mississippi Today

Since she inherited the gene from both her parents, Walker has a textbook case of the autoimmune disease with all of its worst symptoms. The condition, which causes the immune system to mistakenly attack healthy tissue, gets progressively worse if left untreated.

Without health insurance, Walker’s only recourse is a free clinic in Tupelo, about an hour and a half away from where she lives in Columbus. The clinic is able to prescribe her thyroid medications to varying degrees of success, but it’s nothing compared to the quality of life improvement she might experience if she were able to get the proper tests done and potentially undergo a more permanent solution like thyroid surgery.

One of the 10 medications she’s currently on helps treat the insomnia associated with Graves’ disease, but it sometimes causes her to sleep through the day. None of the medications help alleviate her back pain or the gut issues, chills or tremors she lives with.

“It’s very scary to think I don’t have anybody to check me out every month … every day I’m wondering if I’ll wake up,” she mused.

As a childless adult, Walker doesn’t qualify for Medicaid – period. She says the last two times she applied for disability Medicaid, case workers told her they could only help her if she got pregnant.

“I was shocked,” Walker said. “I couldn’t believe what I was hearing. Mississippi is one of the strangest states ever. The only way to help me is if I have children?”

Even if she had children, or if that rule didn’t exist, Walker was at that time making more than 28% of the federal poverty level, a mere $7,000 annually for a family of three – the maximum salary a Mississippi family can make and still qualify for Medicaid – working full-time at her jobs in retail and car sales.

And she’s far from the only one. Anyone making at least minimum wage working full-time makes more than 28% of the federal poverty level, which then counts against them and disqualifies them from Medicaid.

Walker is one of tens of thousands of Mississippians who fall into the “coverage gap.” These individuals don’t qualify for Medicaid under the state’s current restrictions but make less than the 100% of the federal poverty level, about $15,000 a year for an individual, that would qualify them for subsidies that make marketplace insurance affordable.

The coverage gap exists in states that have not expanded Medicaid under the Affordable Care Act, which presumed all states would automatically expand Medicaid. However, a 2012 Supreme Court ruling made expansion optional for states.

New proposals in the Mississippi Legislature would expand Medicaid, as 40 other states have done, covering families and adults with a household income of up to 138% of the federal poverty level, under the House plan, or 99%, under the Senate plan.

Both plans would cover more Mississippians than are currently covered. But under both plans, the threat of a work requirement could leave individuals like Walker behind.

Policing and enforcing the work requirement costs more than it would cost to insure the population of unemployed people who would become eligible for Medicaid under expansion. Experts say developing new administrative systems would burden an already precarious system and could cost up to tens of millions of dollars. What’s more is the paperwork can be confusing to enrollees, causing legitimately employed and income-eligible individuals to be denied coverage.

The House plan would expand Medicaid regardless of whether the federal government approved a special waiver necessary to implement a work requirement. But the Senate plan is entirely contingent on the approval of the work requirement – unlikely to happen under the Biden administration, which has rescinded work requirements previously granted under the Trump administration and not approved new ones.

Dr. Dustin Gentry, a family physician at Winston Medical Center in Louisville, is a self-described Republican who says he can’t abide by his party’s long-standing belief that Medicaid expansion isn’t the most financially responsible decision for Mississippi.

“I want Mississippi to have coverage for uninsured patients in the coverage gap, and I want us to do it in a way that makes most sense financially, which is the House plan,” Gentry said. “It doesn’t make sense for us to not take the (federal) money, when everybody else is taking it. It puts us further behind.”

A plan like the Senate’s would leave $1 billion federal dollars on the table. An expansion plan that doesn’t cover people making up to 138% of the federal poverty level, about $20,000 annually for an individual, isn’t considered “expansion” under the Affordable Care Act, and therefore doesn’t qualify for the increased federal match rate, nor the additional two-year financial incentive the ACA gives to newly-expanded states.

Mississippians are already paying for Medicaid to cover hundreds of thousands of poor, working people – in other states.

“It’s important to note that the residents of Mississippi and the other holdout states have not been spared from paying for Medicaid expansion,” Dr. Joe Thompson, the Arkansas surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe told Mississippi Today. “They have been helping to fund it for over a decade through their federal tax dollars, but the money has been flowing into states like Arkansas and Louisiana instead of benefiting the working poor, hospitals, and economies of their home states.”

And hospitals are dying because uninsured individuals’ only recourse for medical care is the emergency room – the most expensive place to receive care. One report estimates that nearly half of all Mississippi’s rural hospitals are at risk of closure due to uncompensated care costs hospitals must front to cover these individuals each year.

Selinda Walker’s medications for Graves’ Disease and other illnesses are seen placed at her mother’s home in Columbus, Miss., on Thursday, April 18, 2024. Credit: Eric Shelton/Mississippi Today

“Everybody’s got heartburn over people ‘getting something they don’t deserve,’” Gentry said. “But these people get free care anyways. They’re getting it from the emergency room, and it’s uncompensated care, and it’s the most expensive way to get care possible. So they’re getting it for free, we’re just bickering over who is going to pay for it.”

And while emergency rooms cannot turn down individuals who require immediate life-saving care, they do nothing to provide the necessary preventative care to improve the quality of life for people like Walker.

Walker believes if she could get the proper tests and treatment plan, she could go back to work and live independently. But with Gov. Tate Reeves promising to veto any expansion bill and the Senate hung up on a stringer work requirement, the chances Walker will get the care she needs look slim.

The six lawmakers tasked with hammering out a conference report on Medicaid expansion currently have until April 27 to file the bill and until April 29 to adopt it.

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

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Mississippi Today

Senate panel weighs how much — or whether — to cut state taxes

Published

9 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Taylor Vance – 2024-11-04 15:42:00

A group of state senators on Monday grappled with how much to slash state taxes or if they should cut them at all, portending a major policy debate at the Capitol for next year’s legislative session.

The Senate Fiscal Policy Study Group solicited testimony from the state government’s leading experts on budget, economic and tax policies to prepare for an almost certain intense debate in January over how much they should trim state taxes while balancing the need to fund government services.

Senate Finance Chairman Josh Harkins, a Republican from Flowood whose committee has jurisdiction over tax policy, told Mississippi Today that he wanted senators to have basic facts in front of them before they help decide next year if Mississippi should cut taxes.

“We’re getting a tax cut the next two years whether we do anything or not,” Harkins said. “I just want to make sure we have all the facts in front of people to understand we have a clear picture of how much revenue we’re bringing in.”

Mississippi is already phasing in a major tax cut. After a raucous debate in 2022, lawmakers agreed to phase in an income tax cut. In two years it will leave Mississippi with a flat 4% tax on income over $10,000, one of the lowest rates in the nation.

However, the top two legislative leaders, Lt. Gov. Delbert Hosemann who oversees the Senate and House Speaker Jason White, have both recently said they want legislators to consider new tax cut policies.

Hosemann, the Republican leader of the Senate, has publicly said he would like to see the state’s grocery tax, the highest of its kind in the nation, reduced, though he hasn’t specified how much of a reduction or how long it would take for the cut to be implemented.

White, a Republican from West, said last week that he would like to see the state’s 4% income tax phased out and have the state’s 7% grocery tax cut in half over time.

“We are hoping to construct a tax system that, yes, prioritizes certain needs in our state, but it also protects and rewards taxpayers,” White said last week.

But it’s difficult to collect accurate data on the state’s grocery tax, and state lawmakers must grapple with a laundry list of spending needs and obligations based on testimony from state agency leaders on Monday.

Mississippi currently has a 7% sales tax, which is applied to groceries. The state collects the tax but remits 18.5% back to cities. For many municipalities, the sales tax is a significant source of revenue.

If state lawmakers want to reduce the grocery tax without impacting cities, they could pass a new law to change the diversion amounts or appropriate enough money to make the municipalities whole.

State Revenue Commissioner Chris Graham said the Mississippi Department of Revenue, the agency in charge of collecting state taxes, does not have a mechanism in place for accurately capturing how much money cities collect in grocery taxes. This is because the tax on groceries is the same as non-grocery items.

However, Graham estimates that the state collects roughly $540 million in taxes from grocery items.

The other problem lawmakers would have in implementing significant tax cuts is a growing list of spending needs in Mississippi, a state with abject poverty, water and sewer and other infrastructure woes and some of the worst health metrics in the nation.

Representatives from the Legislative Budget Office, the group that advises lawmakers on tax and spending policy, told senators that lawmakers will also be faced with rising costs in the public employee retirement system, the Medicaid budget, public education, state employee health insurance, and state infrastructure projects.

State agencies, including the employee retirement system, also requested $751 million more for the coming budget year.

“That’s the billion dollar question, I guess,” Senate Appropriations Chairman Briggs Hopson, a Republican from Vicksburg, said. “How we’re able to fund basic government services?”

Harkins and Hopson said the committee would likely meet again before the Legislature convenes for its 2025 session on January 7.

A House committee on tax cuts has also been holding hearings, and White in September held a summit on tax policy.

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

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Mississippi Today

Already dire lack of affordable housing for low-income Mississippians on verge of worsening

Published

13 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Simeon Gates – 2024-11-04 11:00:00

In Mississippi, where there’s already a dearth of 50,000 or more affordable homes for extremely low-income residents, that number could grow in the next five years.

Housing units available under the federal Low Income Tax Credit program could lose their affordability by 2030 –a number estimated nationwide to be 350,000 with 2,917 in Mississippi, alone; 496 in the state already have.

The federal program responsible for most of the nation’s affordable housing is expiring.

The Low Income Housing Tax Credit, introduced as part of the Tax Reform Act of 1986, provides for developers to buy, build and restore low-income housing units. Under the deal, the housing only needs to stay low-rent for 30 years. Construction began in the early 1990s.

Some LIHTC housing will remain affordable due to other subsidies, nonprofits, state law and individual landlords.

“I think the low-income housing tax credit has done everything that it can to address the need for affordable housing around the state,” said Scott Spivey, executive director of the Mississippi Housing Corporation, a state office that administers the program and works with the state government and those in the affordable housing industry to create and support affordable housing

Spivey supports the proposed Affordable Housing Credit and Improvement Act, a federal bill that would expand upon the low-income housing tax credit in several ways, including giving developers more credit for certain projects for low-income households and changing tenant eligibility rules.

The bill was introduced in the House and the Senate last session, and is co-sponsored by Mississippi Sens. Cindy Hyde-Smith and Roger Wicker and in the House by Reps. Mike Ezell, and Michael Guest. As of this spring, both bills are in committee.

While housing has become a major issue for Americans, getting legislation passed has been challenging. “Everybody knows that housing is an issue, but it gets caught up with everything else…and it kind of gets lost in the shuffle,” said Spivey.

This issue is especially important in Mississippi, where demand for housing is high across all incomes.

“All the market studies that we see that come with the applications tell us that there’s a huge need for affordable housing across the state at all the income bands” said Spivey.

According to the National Low Income Housing Coalition, almost a third of Mississippi renters are extremely low income; 65% of them are severely cost burdened, meaning they spent more than half their income on rent. The majority of these households are seniors, disabled people, single caregivers of young children, people enrolled in school, or other.

Director of Housing Law at the Mississippi Center for Justice, Ashley Richardson said housing problems worsened after Mississippi stopped participating in the federal rental assistance program in 2022.

MCJ’s work on housing includes a statewide eviction hotline, investigating instances of housing discrimination, and more.

Richardson praised the LIHTC program, but echoed Spivey’s concerns. “Even with the affordable housing we do have in Mississippi, we are still at a lack,” she said.

The National Housing Preservation Database estimates Mississippi is short 52,421 affordable and available rental homes for low-income people. The National Low Income Housing Coalition puts the figure at 49,478.

Richardson wants the state to deal with issues like providing more tenant protections and rental assistance. There’s also a need to improve homes that are rundown or in poor condition, and many housing nonprofits are running out of funding.

Spivey said people should talk to their property managers and learn about their rights. MHC’s website has resources for homebuyers and renters.

As the housing crisis goes on, there are options for people struggling to find and keep affordable housing and an effort to take action at the federal and state levels.

Some aspiring low-income homeowners may qualify for Habitat for Humanity, a program that builds homes for families in need. Families who qualify work on the homes alongside volunteers, pay an affordable mortgage and receive financial literacy education.

New applicants must meet the qualifications, including a good debt-income ratio, 125 hours of sweat equity and taking classes on financial literacy, home repairs, and being a good neighbor.

Merrill McKewen, executive director for Habitat for Humanity Mississippi Capital Area, emphasized the importance of housing to individuals and communities.

“There are untold studies that have been done that, you’ve gotta have a safe, decent, affordable place to live. The children are better students, the parents are better employees…it grounds you to a community that you can contribute to and be a part of. It is the American dream, to own a home, which is what we’re all about,” she said.

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

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Mississippi Today

Mississippi Election 2024: What will be on Tuesday’s ballot?

Published

14 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Bobby Harrison – 2024-11-04 10:00:00

Mississippians will go to the polls on Tuesday, Nov. 5, to elect federal and state judicial posts and some local offices, such as for election commissioners and school board members.

Polls will be open from 7 a.m. to 7 p.m. on Tuesday. To find your polling place, use the secretary of state’s locator, or call your local county circuit clerk.

The following is a list of the candidates for federal and judicial posts with brief bios:

President

Kamala Harris, current vice president and Democratic nominee for president. Her running mate is Tim Walz.
Donald Trump, former president and current Republican nominee. His running mate is J.D. Vance.
Robert Kennedy Jr. remains on the ballot in Mississippi even though he has endorsed Trump. His running mate is Nicole Shanahan.
Jill Stein is the Green Party candidate. Her running mate is Rudolph Ware.
Five other candidates will be on the Mississippi ballot for president. For a complete list of presidential candidates, see the sample ballot.

U.S. Senate

Ty Pinkins is the Democratic nominee. He is a Rolling Fork native and attorney, representing, among other clients, those alleging unfair working conditions. He served 21 years in the U.S. Army, including combat stints, other overseas deployment and posts in the White House,
Roger Wicker is the Republican incumbent senator. He resides in Tupelo and has served in the U.S. Senate since late 2007 after first being appointed to fill a vacancy by then-Gov. Haley Barbour. He was elected to the post in 2008. He previously served in the U.S. House and as a state senator. He is an attorney and served in the United States Air Force.

House District 1

Dianne Black is the Democratic nominee. She is a small business owner in Olive Branch in DeSoto County.
Trent Kelly is the Republican incumbent. He was elected to the post in a special election in 2015. He previously served as a district attorney and before then as a prosecuting attorney for the city of Tupelo. He is a major general in the Mississippi Army National Guard.

House District 2

Bennie Thompson is the Democratic incumbent. He was first elected to the post in 1993. Before then, he served as a Hinds County supervisor and as alderman and then as mayor of Bolton.
Ronald Eller is the Republican nominee. He grew up in West Virginia and moved to central Mississippi after retiring from the military. He is a physician assistant and business owner.

House District 3

Michael Guest is the Republican incumbent and is unopposed.

House District 4

Mike Ezell is the Republican incumbent first being elected in 2022. He previously served as Jackson County sheriff.
Craig Raybon is the Democratic nominee. Raybon is from Gulfport and began a nonprofit “focused on helping out the community as a whole.”

Central District Supreme Court

Jenifer Branning currently serves as a member of the state Senate from Neshoba County.
Byron Carter is a Hinds County attorney and previously served as a law clerk for Supreme Court Justice Armis Hawkins.
James Kitchens is the incumbent. He has served on the state’s highest court since 2008.
Ceola James previously served on the Court of Appeals.
Abby Gale Robinson is a Jackson attorney. She previously was a commercial builder.

Southern District Supreme Court

Dawn Beam is the incumbent, having been first appointed in 2016 by then-Gov. Phil Bryant and later winning election to the post. She is a former chancellor for the Hattiesburg area.
David Sullivan is an attorney in Harrison County and has been a municipal judge in D’Iberville since 2019. His father, Michael, previously served on the state Supreme Court.

Northern District Supreme Court seats

Robert Chamberlin of DeSoto County is unopposed.
James Maxwell of Lafayette County is unopposed.

Court of Appeals 5^th District seat

Ian Baker is an assistant district attorney in Harrison County.
Jennifer Schloegel is a Chancery Court judge for Harrison, Hancock and Stone counties.
Amy St. Pe is a Municipal Court judge in Gautier.