Mississippi Today
Blue Cross, UMMC reach contract agreement after months of negotiation
Blue Cross, UMMC reach contract agreement after months of negotiation
After months of negotiations during which tens of thousands of Mississippians were unable to access services at the state’s largest hospital, Blue Cross and the University of Mississippi Medical Center have reached a contract agreement. The terms of the agreement are confidential.
“Effective December 15, 2022, all UMMC facilities, physicians and other individual Professional Providers are fully participating Network Providers for all Blue Cross commercial health plans,” the parties wrote in a press release Friday afternoon.
The state’s largest hospital had been out of network with its largest commercial insurer since April 1, meaning patients with Blue Cross insurance couldn’t see their doctors at UMMC unless they were prepared to pay significantly more out of pocket. Some patients – including people in the middle of chemotherapy or late in their pregnancies – benefitted from continuity of care provisions until July 1.
UMMC offers the state’s only Level I trauma center, Level IV neonatal intensive care unit, and children’s hospital. About 30 to 40 patients are transferred from other Mississippi hospitals to UMMC every day.
The two parties disagreed over reimbursement rates and the insurance company’s quality care plan. UMMC, the state’s only academic medical center, has maintained it was being underpaid relative to other such centers in the Southeast. It sought a 30% increase in overall reimbursement rates from the insurer, and in some areas an increase of 50%. Blue Cross said that would force it to raise customers’ premiums.
The hospital also wanted changes to the insurer’s quality care plan, which measures hospital performance across metrics like readmission rates and blood clots after surgery. It claimed the complexity of some services it offers means it should have its own individualized plan, while Blue Cross said it should be evaluated the same as other hospitals.
The contract dispute forced thousands of patients to miss appointments with specialists or fine new doctors farther away. Heather Tanner, who suffers from multiple sclerosis, which requires regular appointments, tests and infusions, said the resolution can’t undo the months of frustration, expense and delayed appointments she’s dealt with.
“During this mediation my past neurologist was available to continue prescribing my medications but, after waiting for months on an agreement to be reached, I had no choice but to seek a neurologist elsewhere to obtain the tests that have been delayed,” she said in an email to Mississippi Today. “At this point I do not know if I will go back to see the doctors at UMMC because it is already hassle enough to switch everything over. I am very disappointed that the dollar to both the hospital network and insurance companies is more important thanmy health and wellbeing.”
Blue Cross is by far the biggest private insurer in the state, with market share of 55%. The next-biggest, United, holds just 17%.
That gives hospitals little leverage to negotiate with the insurer to get more payment, because if Blue Cross kicks them out of their network, they’ll have very few other patients with commercial insurance. And the hospitals can’t negotiate with Medicaid and Medicare, because reimbursement rates for those programs are set by the federal government. With labor and supply costs rising, Mississippi hospitals have few opportunities to increase their income.
Blue Cross in July sued Dr. LouAnn Woodward, UMMC’s CEO, and several other top administrators for defamation and civil conspiracy over the hospital’s public relations campaign. The campaign featured billboards and signs that said the insurance company “excluded” UMMC from its network, which it believed was misleading since UMMC was the one to end the relationship between the two.
After encouraging the two parties to enter into mediation to resolve the dispute, Insurance Commissioner Mike Chaney called off mediation in October. He said he had not received communication about any progress for six weeks.
Chaney would go on to publicly accuse both UMMC and Blue Cross of wrongdoing and took a strong stance against the nearly yearlong dispute: “It’s deplorable that the citizens of our state are being used as pawns to settle this dispute,” he said.
Earlier Friday, Chaney told Mississippi Today that one option he had to increase pressure to settle was threatening to prevent Blue Cross from issuing new policies unless it expanded its network for policyholders– meaning reinstating UMMC.
“Blue Cross and UMMC remain focused on their missions of serving Mississippians’ health care needs,” the release said.
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 1997
Dec. 22, 1997
The Mississippi Supreme Court upheld the conviction of white supremacist Byron De La Beckwith for the 1963 murder of Medgar Evers.
In the court’s 4–2 decision, Justice Mike Mills praised efforts “to squeeze justice out of the harm caused by a furtive explosion which erupted from dark bushes on a June night in Jackson, Mississippi.”
He wrote that Beckwith’s constitutional right to a speedy trial had not been denied. His “complicity with the Sovereignty Commission’s involvement in the prior trials contributed to the delay.”
The decision did more than ensure that Beckwith would stay behind bars. The conviction helped clear the way for other prosecutions of unpunished killings from the Civil Rights Era.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Medicaid expansion tracker approaches $1 billion loss for Mississippi
About the time people ring in the new year next week, the digital tracker on Mississippi Today’s homepage tabulating the amount of money the state is losing by not expanding Medicaid will hit $1 billion.
The state has lost $1 billion not since the start of the quickly departing 2024 but since the beginning of the state’s fiscal year on July 1.
Some who oppose Medicaid expansion say the digital tracker is flawed.
During an October news conference, when state Auditor Shad White unveiled details of his $2 million study seeking ways to cut state government spending, he said he did not look at Medicaid expansion as a method to save money or grow state revenue.
“I think that (Mississippi Today) calculator is wrong,” White said. “… I don’t think that takes into account how many people are going to be moved off the federal health care exchange where their health care is paid for fully by the federal government and moved onto Medicaid.”
White is not the only Mississippi politician who has expressed concern that if Medicaid expansion were enacted, thousands of people would lose their insurance on the exchange and be forced to enroll in Medicaid for health care coverage.
Mississippi Today’s projections used for the tracker are based on studies conducted by the Institutions of Higher Learning University Research Center. Granted, there are a lot of variables in the study that are inexact. It is impossible to say, for example, how many people will get sick and need health care, thus increasing the cost of Medicaid expansion. But is reasonable that the projections of the University Research Center are in the ballpark of being accurate and close to other studies conducted by health care experts.
White and others are correct that Mississippi Today’s calculator does not take into account money flowing into the state for people covered on the health care exchange. But that money does not go to the state; it goes to insurance companies that, granted, use that money to reimburse Mississippians for providing health care. But at least a portion of the money goes to out-of-state insurance companies as profits.
Both Medicaid expansion and the health care exchange are part of the Affordable Care Act. Under Medicaid expansion people earning up to $20,120 annually can sign up for Medicaid and the federal government will pay the bulk of the cost. Mississippi is one of 10 states that have not opted into Medicaid expansion.
People making more than $14,580 annually can garner private insurance through the health insurance exchanges, and people below certain income levels can receive help from the federal government in paying for that coverage.
During the COVID-19 pandemic, legislation championed and signed into law by President Joe Biden significantly increased the federal subsidies provided to people receiving insurance on the exchange. Those increased subsidies led to many Mississippians — desperate for health care — turning to the exchange for help.
White, state Insurance Commissioner Mike Chaney, Gov. Tate Reeves and others have expressed concern that those people would lose their private health insurance and be forced to sign up for Medicaid if lawmakers vote to expand Medicaid.
They are correct.
But they do not mention that the enhanced benefits authored by the Biden administration are scheduled to expire in December 2025 unless they are reenacted by Congress. The incoming Donald Trump administration has given no indication it will continue the enhanced subsidies.
As a matter of fact, the Trump administration, led by billionaire Elon Musk, is looking for ways to cut federal spending.
Some have speculated that Medicaid expansion also could be on Musk’s chopping block.
That is possible. But remember congressional action is required to continue the enhanced subsidies. On the flip side, congressional action would most likely be required to end or cut Medicaid expansion.
Would the multiple U.S. senators and House members in the red states that have expanded Medicaid vote to end a program that is providing health care to thousands of their constituents?
If Congress does not continue Biden’s enhanced subsidies, the rates for Mississippians on the exchange will increase on average about $500 per year, according to a study by KFF, a national health advocacy nonprofit. If that occurs, it is likely that many of the 280,000 Mississippians on the exchange will drop their coverage.
The result will be that Mississippi’s rate of uninsured — already one of the highest in the nation – will rise further, putting additional pressure on hospitals and other providers who will be treating patients who have no ability to pay.
In the meantime, the Mississippi Today counter that tracks the amount of money Mississippi is losing by not expanding Medicaid keeps ticking up.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1911
Dec. 21, 1911
Josh Gibson, the Negro League’s “Home Run King,” was born in Buena Vista, Georgia.
When the family’s farm suffered, they moved to Pittsburgh, and Gibson tried baseball at age 16. He eventually played for a semi-pro team in Pittsburgh and became known for his towering home runs.
He was watching the Homestead Grays play on July 25, 1930, when the catcher injured his hand. Team members called for Gibson, sitting in the stands, to join them. He was such a talented catcher that base runners were more reluctant to steal. He hit the baseball so hard and so far (580 feet once at Yankee Stadium) that he became the second-highest paid player in the Negro Leagues behind Satchel Paige, with both of them entering the National Baseball Hame of Fame.
The Hall estimated that Gibson hit nearly 800 homers in his 17-year career and had a lifetime batting average of .359. Gibson was portrayed in the 1996 TV movie, “Soul of the Game,” by Mykelti Williamson. Blair Underwood played Jackie Robinson, Delroy Lindo portrayed Satchel Paige, and Harvey Williams played “Cat” Mays, the father of the legendary Willie Mays.
Gibson has now been honored with a statue outside the Washington Nationals’ ballpark.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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