Mississippi Today
Inside Mississippi’s coverage gap, workers say health care is a ‘pipe dream’ or ‘whimsical idea’
When Brandon Allred woke up in the hospital after suffering heat stroke and a series of seizures at work, all he could think about was how much it was going to cost.
It was a legitimate concern: Seven years later, he’s still paying off the medical debt.
“It’s not just anxiety,” the 35-year-old father said, “but also the conscious, embarrassing fact that I’m living in one of the richest countries in the world and I am a natural born citizen and I have to sit here day by day and think ‘I dream of healthcare.’ I dream of a day where I can get all my teeth fixed and not have to worry about that. Or maybe I can figure out what was going on with me with those seizures.”
Allred, a prep cook and the primary provider for his six young daughters, works full-time but falls into Mississippi’s coverage gap, where he says health care is but a “pipe dream” and a “whimsical idea.”
The coverage gap is made up of low-income workers who make more than 28% of the federal poverty level — the maximum income allowed to currently qualify for Medicaid in the state — but less than the 100% of the federal poverty level needed to get subsidies that would make private insurance plans affordable. And it’s surprisingly big, comprising roughly 74,000 Mississippians, according to a recent KFF study.
If Medicaid were expanded in Mississippi – one of only 10 states that has not done so – Allred and tens of thousands of other working Mississippians like him would be covered. Income-eligible adults without children would also be covered.
It’s estimated that 123,000 uninsured Mississippians would gain coverage under expansion – that includes the 74,000 people under the poverty level and an additional 49,000 uninsured adults whose income is between 100% and 138% of the FPL. That means that under expansion, a family of four could make up to $43,056 and qualify for Medicaid.
Critics of expansion argue that anyone, even if they’re not offered health insurance through their employer, can purchase it through the marketplace. Those plans exist, but are so expensive that for those in the coverage gap, they practically do not exist.
Other critics of expansion argue that because there is a chance that some privately-insured Mississippians would switch to Medicaid under expansion, that’s reason to keep the 123,000 uninsured Mississippians uninsured — and turn down at least $1 billion a year in federal money to cover most of the cost.
Private insurance plans, especially ones with low premiums, have high deductibles that can easily run $5,000 a year. A plan with a deductible on the higher end of that spectrum would equate to about $400 a month – on top of premiums and copays – that an individual would need to pay in order for insurance companies to start picking up the slack.
A majority of uninsured adults make slightly too much to qualify for Medicaid under the present eligibility criteria, and so have no path toward health care.
As it stands, Medicaid eligibility for adults in Mississippi is very limited.
Firstly, Medicaid in Mississippi doesn’t currently cover childless adults – period. And even adults who have children would need to be making less than 28% of the federal poverty level to be eligible for Medicaid. For a family of two, such as a single mother and her child, 28% of the federal poverty level would be about $5,700 a year, or $475 a month.
That means that a working mother making incrementally more, such as 29% of the federal poverty level, would not qualify for Medicaid but would have to use nearly her entire salary if she were to pay out of pocket for a private insurance plan through the marketplace. This is an obvious impossibility for someone paying for rent and food and other basic necessities.
Nobody knows that better than Lakeisha Preston, a single working mother who couldn’t afford the deductibles on her insurance plan, and therefore was stuck paying out of pocket for a bout of pneumonia that put her in the hospital in 2019.
Over four years later she’s still paying off that medical bill – which forced her to move back in with her parents and take out personal loans.
“I had health insurance, it’s just that the deductibles were so high,” Preston explained. “I don’t go to the doctor all the time, and of course you have to meet the deductible first before the insurance covers you. So I was in that predicament.”
Ironically, Preston works at a federal Medicaid call center. She helps thousands of people, with incomes similar to hers, enroll in Medicaid in states with Medicaid expansion. As a Mississippian, she cannot get that coverage.
Preston said: “As a call center worker, I expect more from the state of Mississippi.”
Mississippi lawmakers have debated the need for expansion — mostly over partisan political reasons — for over a decade, despite the state’s abysmal public health metrics and pleas from doctors, hospital leaders and other health providers.
On Thursday, the deadline day for bills to pass their original chambers, Care4Mississippi, a coalition of 36 organizations whose goal is health care for all Mississippians, held a press conference at the Capitol. Doctors and health officials shared experiences from the frontline and urged lawmakers to pass expansion bills.
“As a pediatrician, I have seen firsthand the impact of parents’ health on their children,” Dr. Anita Henderson said during the press conference. “Children need their parents, and their parents need to act healthy, mentally, physically, and able to engage with their children. I have seen patients whose parents worked, sometimes two jobs, and lacked health insurance … The men and women in Mississippi are living almost a decade less than the people of Hawaii.”
This is the first year since Medicaid expansion was offered to states under the Affordable Care Act in 2014 that Mississippi Republican legislative leadership is considering it seriously. A House Republican bill overwhelmingly passed the full House and now sits in the Senate – which just killed its own expansion bill, according to Medicaid Chair Kevin Blackwell, R-Southaven.
But Allred said that after a decade, lawmakers aren’t moving fast enough or treating the situation for the health care crisis that it is.
“If there was a state that needed to have a red flag pinned on it to say ‘you have a medical emergency to take care of,’ it would be Mississippi,” he said. “And we need a rethinking of what health care is for our citizens in the state.”
Allred saw his father lose all his money as he battled cancer in the last six months of his life – despite the fact he’d worked hard at one company for 30 years. Growing up, his mother warned him not to let a medical debt go to collections, and said it always felt like “the medical industry was there to be feared.”
The father of six said he hopes that by the time his daughters are grown, they won’t have to choose between paying rent or paying a medical bill. Right now, his children are covered by Medicaid. But he worries if legislation isn’t passed, they’ll be in the same predicament he’s in once they turn 18.
“I don’t want them to follow in the same footsteps as me when they shouldn’t have to,” Allred reflected. “When they’re being told their whole life they’re being raised in the greatest country in the world but they’re also being told the greatest country in the world can not take care of you.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
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In a time when trusted journalists and media sources are disappearing, we believe the stakes couldn’t be higher. Without on-the-ground, trustworthy reporting, civic engagement suffers, accountability falters and corruption often goes unaddressed. But it doesn’t have to be this way.
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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Hinds County loses fight over control of jail
The Hinds County sheriff and Board of Supervisors have lost an appeal to prevent control of its jail by a court-appointed receiver and an injunction that orders the county to address unconstitutional conditions in the facility.
Two members from a three-judge panel of the 5th U.S. Circuit Court of Appeals agreed with decisions by U.S. District Judge Carlton Reeves to appoint a receiver to oversee day-to-day jail operations and keep parts of a previous consent decree in place to fix constitutional violations, including a failure to protect detainees from harm.
However, the appeals court called the new injunction “overly broad” in one area and is asking Reeves to reevaluate the scope of the receivership.
The injunction retained provisions relating to sexual assault, but the appeals court found the provisions were tied to general risk of violence at the jail, rather than specific concerns about the Prison Rape Elimination Act. The court reversed those points of the injunction and remanded them to the district court so the provisions can be removed.
The court also found that the receiver should not have authority over budgeting and staff salaries for the Raymond Detention Center, which could be seen as “federal intrusion into RDC’s budget” – especially if the receivership has no end date.
Hinds County Board of Supervisors President Robert Graham was not immediately available for comment Friday. Sheriff Tyree Jones declined to comment because he has not yet read the entire court opinion.
In 2016, the Department of Justice sued Hinds County alleging a pattern or practice of unconstitutional conditions in four of its detention facilities. The county and DOJ entered a consent decree with stipulated changes to make for the jail system, which holds people facing trial.
“But the decree did not resolve the dispute; to the contrary, a yearslong battle ensued in the district court as to whether and to what extent the County was complying with the consent decree,” the appeals court wrote.
This prompted Reeves to hold the county in contempt of court twice in 2022.
The county argued it was doing its best to comply with the consent decree and spending millions to fix the jail. One of the solutions they offered was building a new jail, which is now under construction in Jackson.
The county had a chance to further prove itself during three weeks of hearings held in February 2022. Focuses included the death of seven detainees in 2021 from assaults and suicide and issues with staffing, contraband, old infrastructure and use of force.
Seeing partial compliance by the county, in April 2022 Reeves dismissed the consent decree and issued a new, shorter injunction focused on the jail and removed some provisions from the decree.
But Reeves didn’t see improvement from there. In July 2022, he ordered receivership and wrote that it was needed because of an ongoing risk of unconstitutional harm to jail detainees and staff.
The county pushed back against federal oversight and filed an appeal, arguing that there isn’t sufficient evidence to show that there are current and ongoing constitutional violations at the jail and that the county has acted with deliberate indifference.
Days before the appointed receiver was set to take control of the jail at the beginning of 2023, the 5th Circuit Court ordered a stay to halt that receiver’s work. The new injunction ordered by Reeves was also stayed, and a three-person jail monitoring team that had been in place for years also was ordered to stop work.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
2 out of 5 child care teachers make so little they need public assistance tosupport their families
This story about child care wages was produced by The Hechinger Report, a nonprofit,
independent news organization focused on inequality and innovation in education. Sign up for the Hechinger’s early childhood newsletter.
Caring for children during their first few years is a complex and critical job: A child’s
brain develops more in the first five years than at any other point in life. Yet in America,
individuals engaged in this crucial role are paid less than animal caretakers and
dressing room attendants.
That’s a major finding of one of two new reports on the dismal treatment of child care
workers. Together, the reports offer a distressing picture of how child care staff are
faring economically, including the troubling changes low wages have caused to the
workforce.
Early childhood workers nationally earn a median wage of $13.07 per hour, resulting in
poverty-level earnings for 13 percent of such educators, according to the first report, the
Early Childhood Workforce Index 2024. Released earlier this month by the Center for
the Study of Child Care Employment at the University of California, Berkeley, the annual
report also found:
? 43 percent of families of early educators rely on public assistance like
food stamps and Medicaid.
? Pay inequity exists within these low wages: Black early childhood
educators earn about $8,000 less per year than their white peers. The
same pay gap exists between early educators who work with infants and
toddlers and those who work with preschoolers, who have more
opportunities to work in school districts that pay higher wages.
? Wages for early educators are rising more slowly than wages in other
industries, including fast food and retail.
In part due to these conditions, the industry is losing some of its highest-educated
workers, according to a second new report, by Chris M. Herbst, a professor at Arizona
State University’s School of Public Affairs. That study compares the pay of child care
workers with that of workers in other lower-income professions, including cooks and
retail workers; it finds child care workers are the tenth lowest-paid occupation out of
around 750 in the economy. The report also looks at the ‘relative quality’ of child care
staff, as defined by math and literacy scores and education level. Higher-educated
workers, Herbst suggests, are being siphoned off by higher-paying jobs.
That’s led to a “bit of a death spiral” in terms of how child care work is perceived, and
contributes to the persistent low wages, he said in an interview. Some additional
findings from Herbst’s study:
? Higher-educated women increasingly find employment in the child care
industry to be less attractive. The share of workers in the child care
industry with a bachelor’s degree barely budged over the past few
decades, increasing by only 0.3 percent. In contrast, the share of those in
the industry who have 12 years of schooling but no high school degree,
quadrupled.
? Median numeracy and literacy scores for female child care workers
(who are the majority of the industry staff) fall at the 35 th and 36 th
percentiles respectively, compared to all female workers. Improving these
scores is important, Herbst says, considering the importance of education
in the early years, when children experience rapid brain development.
This doesn’t mean child care staff with lower education levels can’t be good early
educators. Patience, communication skills and a commitment to working with young
children also matter greatly, Herbst writes. However, higher education levels may mean
staff have a stronger background not only in English and math but also in topics like
behavior modification and special education, which are sometimes left out of
certification programs for child care teachers.
You can read Herbst’s full report here, and the 2024 workforce index here.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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