Mississippi Today
Former Gov. Steve Beshear: Medicaid expansion changed course of Kentucky history
When former Kentucky Gov. Steve Beshear took office in 2007, the Bluegrass State had many challenges — not the least of which was lack of health care for working folks — and limited resources to address them.
“Kentucky faced a number of fundamental weaknesses, not unlike Mississippi and a lot of other Southern states,” Beshear recently told Mississippi Today. “We had a lack of educational attainment. We had a workforce that wasn’t as trained or agile as the marketplace would demand. We had too many children getting a poor start in life. We had an economy that wasn’t as diversified as it needed to be. And one of the biggest fundamental weaknesses we had was a population that wasn’t healthy.”
“… Governors have a lot of power and a lot of resources at their disposal, but none of us really have the resources locally to make a huge difference in the health of your people,” Beshear said. “We made progress in health care, from 2007 to 2010, but we couldn’t really make any huge changes. Then along came the Affordable Care Act.”
Kentucky, starting in 2014, accepted federal funding to expand Medicaid and has been one of the most successful states in using the ACA to reduce its number of uninsured people. Its creation of a state-run health insurance marketplace has been held as a national role model.
Mississippi Today has interviewed governors in the three Southern states that have expanded Medicaid: Arkansas, Louisiana and Kentucky, all of whom report net positives from the move. Despite numerous polls showing public support for expansion, Mississippi remains one of 10 states rejecting federal money for expansion, led now by Gov. Tate Reeves who has remained steadfastly opposed.
READ MORE: ‘A no-brainer’: Why former Arkansas Gov. Mike Beebe successfully pushed Medicaid expansion
READ MORE: Louisiana Gov. John Bel Edwards: Medicaid expansion ‘easiest big decision I ever made’
Beshear, whose son Andy Beshear is now governor and running for reelection this year, expanded Medicaid by a 2013 executive order. He said Medicaid expansion far exceeded initial projections in number of jobs created, money injected into hospitals, the state’s economy and state budget. The number of uninsured Kentuckians dropped from over 20% to 7.5%. The net positive impact on Kentucky’s economy was $30 billion over eight years.
“Medicaid expansion was the single-most important decision I made in eight years as governor because we changed the course of Kentucky’s history,” Beshear said.
Beshear’s interview with Mississippi Today is below, edited for brevity.
Mississippi Today: Could you give us a quick overview of where things stood in Kentucky in 2013, both health-care wise and politically?
Gov. Steve Beshear: It was estimated that some 640,000 Kentuckians, out of a little over 4 million, had no access to affordable, quality health care. These were folks who would get up every morning and go to work, and just basically roll the dice — just hoping and praying that you don’t get sick or get hurt. They were having to choose between food and medicine at times. They would have to ignore checkups that could catch serious conditions early. They just lived every day knowing that bankruptcy was just one bad diagnosis away.
… Fixing this is an expensive proposition, and a state by itself is just simply not in a position to address it … The Affordable Care Act was passed, and of course immediately became embroiled in litigation. My health care people came to me and we sat down and talked through what it allowed. We realized we had two decisions to make. One was, do we create a state-based exchange or do we go into the federal exchange. And two, do we expand Medicaid.
The first decision was a pretty easy one because basically all of our providers and folks who would be involved felt that we needed to have more flexibility and be able to address Kentucky’s particular needs with a state-based exchange … Ours became sort of the national standard, the gold standard for state-based exchanges … President Obama called me personally to congratulate us and thank us for showing the world that the Affordable Care Act can work.
… Whether to expand Medicaid was a tougher decision. Morally, I felt that we needed to do it because I believe health care is a basic human right and that Kentuckians needed it. The question came down to can we afford it? The opponents of expanding and of the Affordable Care Act were all saying it would bankrupt us.
I felt like we needed to answer that question. I hired PricewaterhouseCoopers — an internationally renowned accounting firm — to come in and analyze what they felt would happen in Kentucky if we expanded Medicaid.
They took about six months and came back, sat down and looked at me across my desk and said, “Governor, you cannot afford not to do this.” Wow. OK. They said because over the next eight years, you’re going to create 17,000 new jobs. You’ll inject about $15 billion into Kentucky’s economy over the next eight years. You’ll protect Kentucky’s hospitals from the impact of cuts in indigent care funding and protect rural hospitals. And, you’ll have about an $800 million positive budget impact over the next eight years.
I was thrilled with that analysis, and we publicly announced that we were going to expand Medicaid as well as have our own state-based exchange. I was fortunate from a political standpoint that I did not have to have legislative approval. At that time I had a Democratic House and and Republican Senate and it would have been difficult, if not impossible, because of the politics surrounding quote-unquote Obamacare. Fortunately, years before, the Legislature had delegated the authority to define Medicaid eligibility under the federal law to our cabinet for Health and Family Services.
Mississippi Today: Did expansion live up to those early projections?
Beshear: The results were a little short of amazing. In the first six months, over 400,000 Kentuckians signed up … most of whom had never had affordable quality health care before. In the first 18 months, our uninsured rate dropped from over 20% to 7.5%. The uncompensated care rate dropped from 25% to less than 5%.
… But the critics would persist, particularly on the affordability of the program. So, after the first year, I went to Deloitte, another internationally known consulting firm, and said, OK, here’s the Pricewaterhouse study done before we implemented it. Take this and look at a year of actual results and numbers and tell me where we are. Were they right?
They did an in-depth study, came back, sat down across my desk, looked me in the eye and said, “Well, governor PricewaterhouseCoopers was wrong. They weren’t optimistic enough. They projected that you would create 17,000 new jobs over eight years. Yeah, you’ve already created 12,000 in the first year, and we project you’ll create 40,000 over eight years.” Wow, that was almost $3 billion in new revenue had gone to providers in the first 18 months. Then there’s a $30 billion positive impact on Kentucky’s economy over eight years … a net impact of $820 million impact on the state general fund over eight years.
Now, we haven’t had a totally smooth history since I was governor. After my eight years, I was followed by a Republican governor who had campaigned on repealing Medicaid expansion. During his four years, he did abolish the state-based exchange and pushed us into the federal exchange. He proposed a waiver to the federal government that would place a lot of complicated work requirements on folks on the Medicaid program. But, fortunately, a fellow named Andy Beshear, who happens to be my son, defeated him in the next election and he has reinstituted the state-based exchange and made it even stronger and just recently announced the expansion of Medicaid even further to cover dental and vision and hearing for adults.
Mississippi Today: What is your take on Mississippi and other states struggling with this issue, and any advice on what we should do?
Beshear: Mississippi is one of what, 10 states now that haven’t expanded? I would predict that the question is not if it ever will, it’s just when will it expand. Because this should not be a political issue. This should not be a partisan argument. Why does anybody want to argue that people shouldn’t have good quality health care?
A lot of the Southern states that are left, that have not expanded Medicaid, tend to fall at the bottom of the list in virtually every ranking that we have now. Sure, Kentucky has also been there, and is still there in some of the rankings, but we’re determined that we are going to move out of that category, instead of a state that’s continually trying to catch up.
This should be an easy decision, for either political party to make. It’s a matter quite honestly of putting people first and partisan politics second. When I was governor and I had to deal with a Republican Senate and Democratic House, I would tell them both, look, our elections are set up on a partisan basis. I understand that. We’ll get out there and fight and scratch and carry on in these elections, but once they’re over, we’re all Kentuckians first … That’s exactly the way I think Mississippi ought to approach an issue like this.
Throw out, throw away the partisan bickering and just look at what’s best for your people. It’s hard to argue that everybody having health care would not make life better for everybody. But there’s also sound evidence, that this is not only affordable for a state to do, this is economically beneficial for a state.
Mississippi Today: You’ve made points very similar to other governors we’ve talked with. They’ve said the decision was relatively easy, and believe it was a hallmark of their administrations.
Beshear: … It was an easy decision to make from the question of whether it was the right thing to do, or whether it would economically benefit Kentucky. It was a hard decision to make politically. In Kentucky at the time, President Obama had a 30% approval rating. Some of my advisors said, governor, do not touch the Affordable Care Act with a 10-foot pole, it will kill you.
But I felt, number one, how many times do you ever get to make a decision that will change the course of, change the history of your state for the good? You know that, and you can’t turn your back on that, you have to step up and do the right thing … Medicaid expansion was the single-most important decision I made in eight years as governor because we changed the course of Kentucky’s history.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Cutting fat in state government: Everything old is new again
Years ago, some state elected leaders lamented that Mississippi has far too much bureaucracy for such a poor, small state, and vowed — for starters — to eliminate or consolidate state government’s roughly 200 agencies, boards and commissions.
More than a decade later, the number of state agencies, boards and commissions has been whittled down to … roughly 200.
There was one monumental victory in the war on bureaucracy in Mississippi: After years of bitter political debate, the Legislature this year combined the separate cosmetology and barber licensure boards into one. Saa-lute!
That’s not much ROI for Mississippi’s war on big government. But as a comedian once said, hope springs in turtles.
State Auditor Shad White, eyeing the open governor seat for 2027, has paid a Boston consultant $2 million in taxpayer dollars to determine how to cut spending of taxpayer dollars.
The resultant report is a spectacular, novel blueprint for lawmakers on how to starve the beast, run the state more like a bid-ness — and it’s chock full of hitherto unheard of ideas to put the Magnolia State’s government on a diet.
Actually, no. It’s not.
It’s mostly a rehash, amalgam of long-discussed, never enacted ideas to cut government spending. Someone could have cobbled it together after spending a day or two on Google, going through Mississippi press clippings and perusing old legislative watchdog reports and recommendations and bills.
It’s mostly a greatest hits compilation of Mississippi government spending cutting ideas. And it has many Mississippi politicos surmising it’s mostly a taxpayer-funded gubernatorial campaign stunt by White. It produced a 59-page report destined to sit atop a pile of dusty Joint Legislative Committee on Performance Evaluation and Expenditure Review reports and others espousing many of the same findings and recommendations.
White says his report shows how state government could cut $335 million in spending without breaking a sweat. That’s debatable. But it does clearly show how $2 million could have been saved.
There’s been some banter around the Capitol of folks saying they would have created a similar report for a mere $1 million, or $100,000, or for a nice lunch and a couple of beers. Others noted the 59-page report cost taxpayers $33,898 per page.
None of this is to say the report’s findings are bad ideas for belt-tightening. Many would make sense. That’s why they’ve been proposed before, some over and again. They’ve just proved nearly impossible to enact in the realpolitik of the Legislature and government. Some of the cost savings have been enacted, but then government backslid, un-enacted or ignored them.
Perhaps now is the time to dust off some of these ideas. If, as legislative leaders and Gov. Tate Reeves avow, they are going to continue slashing taxes, it might be a good idea to cut some spending as well.
White’s consultant report includes recommendations such as reducing government officials’ travel spending. This was a hot topic for several years, after a 2013 investigation by the Clarion-Ledger showed that even during lean budget years, government officials still spent tens of millions of dollars on travel, domestic and abroad, and had a massive fleet of government vehicles with dubious need for them. The Legislature clamped down on travel and agencies enacted fleet rules and promoted mileage reimbursement for personal vehicles. But according to White’s report, travel spending has been growing and again needs a major haircut.
The report found that, compared to other states, Mississippi government is spending too much on office space and insurance for state buildings and leased property, and on advertising and public relations for state agencies. Again, these are issues that have been pointed out multiple times over the last couple of decades, by lawmakers, media and PEER reports.
Ditto for the state spending millions on incentives for motion pictures to be shot here. There was a knock-down, drag-out battle over that years ago, with then-Lt. Gov. Tate Reeves and others pointing out the state was receiving little to nothing in return for doling out taxpayer funded incentives.
White’s report recommends the state consolidate and reform its purchasing and look for better deals when it buys goods and services. That should sound familiar. Two lawmakers in particular, Sen. John Polk and Rep. Jerry Turner, led a serious crusade on purchasing reform for several years, and managed to push through some meaningful changes. But many of those have been undone or are now ignored.
White pointed out potential savings from state agencies consolidating back-office functions, such as accounting and purchasing. Nothing new under the sun here. Others, notably former Sen. Buck Clarke, championed this years ago, to little avail.
White says there is a dog’s breakfast of savings to be had with state IT purchasing — for computer software and hardware and such. Some major restructuring of the admin side of state government years ago was supposed to address this issue.
White said Mississippi could sell the state’s airplane, make officials use commercial or charter flights, and save more than $1 million a year. The state airplane, travel on it by governors and related issues have been scrutinized and debated off and on for decades. Then-Gov. Phil Bryant made a big issue out of selling one of the state’s planes (a jet) when it had two and vowed to take commercial flights.
White notes state agencies’ misuse of emergency contracts — declaring an emergency so bidding requirements can be waived — costs the state millions. This was pointed out as a major issue in the Mississippi prisons bribery and kickback scandal that sent former Corrections Commissioner Chris Epps to prison and tainted around $1 billion of state contracts. There were vows then, about a decade ago, to reform this. But White says that emergency contracts now constitute more than 30% of all active state-funded contracts by value.
One would assume that Boston Consulting Group provided White with more than what’s in the 59 pages he released to the public as his “Project Momentum” report. But if it did, it’s a secret. Mississippi Today requested all the backing documents the consultant submitted to White’s agency to complete the project.
White denied the public records request, claiming exemption of any such documents as the work product of an audit. But if the work was an actual audit, it was an unusual one. In his contract with the company, White gave it the directive to find at least $250 million in wasteful spending among the 13 agencies it examined. Typically, hired auditors are not told upfront specifically what they should find.
Perhaps not to be outdone, Lt. Gov. Delbert Hosemann, who himself has eyes on the 2027 governor’s race, wants to reorganize state government. He’s calling for lawmakers to create a committee to … wait for it … figure out how to consolidate or eliminate many of the more than 200 agencies, boards and commissions.
Hosemann years ago, when he was secretary of state, called for such consolidation and famously opined of the state’s sprawling bureacracy, “You wouldn’t run a lemonade stand like this, much less state government.”
Hosemann was joined in this call to cut bureaucracy and spending by then-Gov. Phil Bryant. But those efforts fizzled, with Bryant and Hosemann back then lamenting there was little will among lawmakers to whittle down state government. Hosemann more recently said there were bigger fish to fry, including tax cuts, but now he wants to focus on government efficiency and cutting the number of agencies, boards and commissions.
Once again, everything old is new again.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1871
Nov. 17, 1871
Edward Crosby stood before the congressional hearing and swore to tell the truth. By raising his right hand, Crosby put himself and his family at risk. He could be killed for daring to tell about the terrorism he and other Black Mississippians had faced.
Days earlier, he had attempted to vote in Aberdeen, Mississippi, asking for a Republican ballot. The clerk at the polling place said none was available. He waited. Dozens more Black men came to vote, and they were all told the same thing. Then he tried another polling place. Same result.
That day, white men, backed by a cannon, drove about 700 Black voters from the polls in Aberdeen. After nightfall, Crosby stepped out to retrieve water for his child when he saw 30 or so Klansmen galloping up on horses. He hid in a smokehouse, and when Klansmen confronted his wife, she replied that he was away. They left, and from that moment on, “I didn’t sleep more than an hour,” Crosby recalled. “If there had been a stick cracked very light, I would have sprung up in the bed.”
In response, Mississippi, which was under federal rule at the time, pursued an anti-Klan campaign. In less than a year, grand juries returned 678 indictments with less than a third of them leading to convictions.
That number, however, was misleading, because in almost all the cases, Klansmen pleaded no contest in exchange for small fines or suspended sentences. Whatever protection that federal troops offered had vanished by the time they left the state a few years later.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Supporters of public funds to private schools dealt a major blow after recent election results
Mississippians who are dead set on enacting private school vouchers could do like their counterparts in Kentucky and attempt to change the state constitution to allow public funds to be spent on private schools.
The courts have ruled in Kentucky that the state constitution prevents private schools from receiving public funds, commonly known as vouchers. In response to that court ruling, an issue was placed on the ballot to change the Kentucky Constitution and allow private schools to receive public funds.
But voters threw a monkey wrench into the voucher supporters’ plans to bypass the courts. The amendment was overwhelmingly defeated this month, with 65% of Kentuckians voting against the proposal.
Kentucky, generally speaking, is at least as conservative or more conservative than Mississippi. In unofficial returns, 65% of Kentuckians voted for Republican Donald Trump on Nov. 5 compared to 62% of Mississippians.
In Mississippi, like Kentucky, there has been a hue and cry to enact a widespread voucher program.
Mississippi House Speaker Jason White, R-West, has voiced support for vouchers, though he has conceded he does not believe there are the votes to get such a proposal through the House Republican caucus that claims a two-thirds supermajority.
And, like in Kentucky, there is the question of whether a voucher proposal could withstand legal muster under a plain reading of the Mississippi Constitution.
In Mississippi, like Kentucky, the state constitution appears to explicitly prohibit the spending of public funds on private schools. The Mississippi Constitution states that public funds should not be spent on a school that “is not conducted as a free school.”
The Mississippi Supreme Court has never rendered a specific ruling on the issue. The Legislature did provide $10 million in federal COVID-19 relief funds to private schools. That expenditure was challenged and appealed to the Mississippi Supreme Court. But in a ruling earlier this year, the state’s high court did not directly address the issue of public funds being spent on private schools. It instead ruled that the group challenging the expenditure did not have standing to file the lawsuit.
In addition, a majority of the court ruled that the case was not directly applicable to the Mississippi Constitution’s language since the money directed to private schools was not state funds but one-time federal funds earmarked for COVID-19 relief efforts.
To clear up the issue in Mississippi, those supporting vouchers could do like their counterparts did in Kentucky and try to change the constitution.
Since Mississippi’s ballot initiative process was struck down in an unrelated Supreme Court ruling, the only way to change the state constitution is to pass a proposal by a two-thirds majority of the Mississippi House and Senate and then by a majority of the those voting in a November general election.
Those touting public funds for private schools point to a poll commissioned by House Speaker White that shows 72% support for “policies that enable parents to take a more active role in deciding the best path for their children’s education.” But what does that actually mean? Many have critiqued the phrasing of the question, wondering why the pollster did not ask specifically about spending public funds on private schools.
Regardless, Mississippi voucher supporters have made no attempt to change the constitution. Instead, they argue that for some vague reason the language in the Mississippi Constitution should be ignored.
Nationwide efforts to put vouchers before the voters have not been too successful. In addition to voters in Kentucky rejecting vouchers, so did voters in ruby-red Nebraska and true-blue Colorado in this year’s election.
With those election setbacks, voucher supporters in Mississippi might believe their best bet is to get the courts to ignore the plain reading of the state constitution instead of getting voters to change that language themselves.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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