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Q&A: Why Arkansas could be a model for Mississippi Medicaid expansion

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As leaders from the House and Senate will soon begin meeting to find common ground on their dueling Medicaid expansion proposals, some people have pointed to Arkansas as a model that could prove successful in Mississippi.

Arkansas, a red state that shares many demographic similarities with Mississippi, implemented its expansion plan, now called Arkansas Health and Opportunity for Me (ARHOME), in 2014. The program provides health coverage to about 250,000 Arkansans. It has cut the state’s uninsured rate in half, and it has helped struggling hospitals stay open.

The expansion program in Arkansas has been so successful that it’s been renewed each year since 2014 by a supermajority of the state’s Republican-controlled legislature.

READ MORE: ‘A no-brainer’: Why former Arkansas Gov. Mike Beebe successfully pushed Medicaid expansion

Mississippi Today invited Dr. Joe Thompson, who was Arkansas’ surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe, to explain how Arkansas’ expansion program has worked. Thompson now serves as president and CEO of the Arkansas Center for Health Improvement.

Mississippi Today: Arkansas implemented a pretty unique Medicaid expansion model. How does your state’s program work?

Dr. Joe Thompson: Instead of enrolling uninsured people in the state-run Medicaid program, Arkansas obtained permission from the federal government to use federal Medicaid funds for “premium assistance” — an historically available but rarely used strategy by states. Arkansas purchases private health insurance plans offered on the health insurance marketplace to provide adult Arkansans earning up to 138% of the federal poverty level insurance coverage — with 90% of the costs coming from the federal government.

Newly covered individuals effectively get private coverage and the healthcare access they need; providers get paid commercial insurance rates far higher than Medicaid rates; and insurers benefit because the state is a large, guaranteed purchaser in an otherwise risky individual insurance market.

Governors and legislators have made changes to the program over the years, including a work requirement that was implemented in 2018 and blocked by a federal judge the following year, but the basic structure has remained the same.

MT: How has the program impacted Arkansas?

Thompson: For starters, it cut our adult uninsured rate, which had been among the highest in the nation, by half. Newly insured Arkansans gained access to treatment for chronic conditions that had gone untreated for years, as well as preventive care that allowed them to avoid other health problems and associated costs.

The newly insured also became able to pay for hospital visits, reducing uncompensated care costs at Arkansas hospitals by more than half. Since 2012, no rural Arkansas hospital has closed without being reopened or replaced, while 59 rural hospitals have closed in the six states surrounding Arkansas, including five hospitals in Mississippi.

MT: Some Mississippians are concerned about being able to afford the state match to draw down federal dollars. How has that gone in Arkansas?

Thompson: The federal government pays 90% of expansion costs, but even so, opponents of Medicaid expansion warned that Arkansas’ obligation to pay the remaining 10% would break the budget. In 2016, however, a consultant hired by the Republican legislative leadership analyzed the economic impact of Medicaid expansion and found it would have a net positive impact of $757 million on the state budget between 2017 and 2021 through reduced state expenditures and increased tax revenues.

It’s important to note that the residents of Mississippi and the other holdout states have not been spared from paying for Medicaid expansion. 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.

MT: There’s been some concern expressed about how expansion would affect insurers in Mississippi. How has the Arkansas model addressed similar concerns there?

Thompson: Some benefits Arkansas has received from Medicaid expansion are tied to unique aspects of the state’s program. Medicaid expansion is a huge decision for states — they can focus on the expansion decision alone or, as Arkansas did, use expansion to shape both the private and public health insurance systems.

Prior to our expansion, insurance carriers could cherry-pick the counties in which they would offer coverage. Arkansas now requires insurers participating in the exchange to offer coverage statewide, creating competition and consumer choice in all areas of the state. Arkansas also enrolled people deemed “medically frail” in traditional Medicaid, creating an expansion population that was relatively young, healthy and low-risk for insurers to cover. In 2014, average marketplace premiums in Arkansas were among the highest in the region, but since 2017 they have been lower than in any of the surrounding states, including Mississippi.

Arkansas’ decision to provide private health coverage has also been advantageous for enrollees. Private coverage does not carry the stigma of Medicaid, and because payment rates are higher for commercially insured patients than for Medicaid patients, Medicaid expansion enrollees in Arkansas have been less likely to encounter barriers to care than traditional Medicaid enrollees.

MT: How many people are actually enrolled in Arkansas, and should Mississippians worry about costs if more people enroll as time goes on?

Thompson: Some opponents of Medicaid expansion have accused Arkansas’ program of out-of-control growth, pointing out that enrollment was projected at the program’s inception to be about 250,000 but grew to more than 340,000 in 2022. In fact, enrollment only reached that level because of a now-defunct rule that required states to keep people continuously enrolled in Medicaid programs during the COVID-19 public health emergency. Arkansas resumed eligibility checks for Medicaid programs last April, and by the end of 2023, total enrollment in ARHOME was just under 252,000 — very close to original projections.

Medicaid expansion’s slow journey toward nationwide adoption is reminiscent of the original federal-state Medicaid partnership, which was enacted by Congress in 1965 but not adopted by every state until 1982, when the last holdout, Arizona, came on board. Change can be hard, but polls show that voters, including Mississippi voters, favor Medicaid expansion. It’s no wonder that the number of holdout states keeps dwindling.

READ MORE: Negotiations begin: Where do House, Senate, governor stand on Medicaid expansion? Is there room for compromise?

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

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On this day in 1903, W.E.B. Du Bois urged active resistance to racist policies

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April 27, 2025

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mississippitoday.org – @MSTODAYnews – 2025-04-27 07:00:00

by Jerry Mitchell, Mississippi Today
April 27, 2025

April 27, 1903

W.E.B. Du Bois by James E. Purdy in 1907 from the National Portrait Gallery.

W.E.B. Du Bois, in his book, “The Souls of Black Folk,” called for active resistance to racist policies: “We have no right to sit silently by while the inevitable seeds are sown for a harvest of disaster to our children, black and white.” 

He described the tension between being Black and being an American: “One ever feels his twoness, — an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose strength alone keeps it from being torn asunder.” 

He criticized Washington’s “Atlanta Compromise” speech. Six years later, Du Bois helped found the NAACP and became the editor of its monthly magazine, The Crisis. He waged protests against the racist silent film “The Birth of a Nation” and against lynchings of Black Americans, detailing the 2,732 lynchings between 1884 and 1914. 

In 1921, he decried Harvard University’s decisions to ban Black students from the dormitories as an attempt to renew “the Anglo-Saxon cult, the worship of the Nordic totem, the disenfranchisement of Negro, Jew, Irishman, Italian, Hungarian, Asiatic and South Sea Islander — the world rule of Nordic white through brute force.” 

In 1929, he debated Lothrop Stoddard, a proponent of scientific racism, who also happened to belong to the Ku Klux Klan. The Chicago Defender’s front page headline read, “5,000 Cheer W.E.B. DuBois, Laugh at Lothrup Stoddard.” 

In 1949, the FBI began to investigate Du Bois as a “suspected Communist,” and he was indicted on trumped-up charges that he had acted as an agent of a foreign state and had failed to register. The government dropped the case after Albert Einstein volunteered to testify as a character witness. 

Despite the lack of conviction, the government confiscated his passport for eight years. In 1960, he recovered his passport and traveled to the newly created Republic of Ghana. Three years later, the U.S. government refused to renew his passport, so Du Bois became a citizen of Ghana. He died on Aug. 27, 1963, the eve of the March on Washington.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Jim Hood’s opinion provides a roadmap if lawmakers do the unthinkable and can’t pass a budget

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6 hours ago

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April 27, 2025

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mississippitoday.org – @BobbyHarrison9 – 2025-04-27 06:00:00

by Bobby Harrison, Mississippi Today
April 27, 2025

On June 30, 2009, Sam Cameron, the then-executive director of the Mississippi Hospital Association, held a news conference in the Capitol rotunda to publicly take his whipping and accept his defeat.

Cameron urged House Democrats, who had sided with the Hospital Association, to accept the demands of Republican Gov. Haley Barbour to place an additional $90 million tax on the state’s hospitals to help fund Medicaid and prevent the very real possibility of the program and indeed much of state government being shut down when the new budget year began in a few hours. The impasse over Medicaid and the hospital tax had stopped all budget negotiations.

Barbour watched from a floor above as Cameron publicly admitted defeat. Cameron’s decision to swallow his pride was based on a simple equation. He told news reporters, scores of lobbyists and health care advocates who had set up camp in the Capitol as midnight on July 1 approached that, while he believed the tax would hurt Mississippi hospitals, not having a Medicaid budget would be much more harmful.

Just as in 2009, the Legislature ended the 2025 regular session earlier this month without a budget agreement and will have to come back in special session to adopt a budget before the new fiscal year begins on July 1. It is unlikely that the current budget rift between the House and Senate will be as dramatic as the 2009 standoff when it appeared only hours before the July 1 deadline that there would be no budget. But who knows what will result from the current standoff? After all, the current standoff in many ways seems to be more about political egos than policy differences on the budget.

The fight centers around multiple factors, including:

  • Whether legislation will be passed to allow sports betting outside of casinos.
  • Whether the Senate will agree to a massive projects bill to fund local projects throughout the state.
  • Whether leaders will overcome hard feelings between the two chambers caused by the House’s hasty final passage of a Senate tax cut bill filled with typos that altered the intent of the bill without giving the Senate an opportunity to fix the mistakes.
  • Whether members would work on a weekend at the end of the session. The Senate wanted to, the House did not.

It is difficult to think any of those issues will rise to the ultimate level of preventing the final passage of a budget when push comes to shove.

But who knows? What we do know is that the impasse in 2009 created a guideline of what could happen if a budget is not passed.

It is likely that parts, though not all, of state government will shut down if the Legislature does the unthinkable and does not pass a budget for the new fiscal year beginning July 1.

An official opinion of the office of Attorney General Jim Hood issued in 2009 said if there is no budget passed by the Legislature, those services mandated in the Mississippi Constitution, such as a public education system, will continue.

According to the Hood opinion, other entities, such as the state’s debt, and court and federal mandates, also would be funded. But it is likely that there will not be funds for Medicaid and many other programs, such as transportation and aspects of public safety that are not specifically listed in the Mississippi Constitution.

The Hood opinion reasoned that the Mississippi Constitution is the ultimate law of the state and must be adhered to even in the absence of legislative action. Other states have reached similar conclusions when their legislatures have failed to act, the AG’s opinion said.

As is often pointed out, the opinion of the attorney general does not carry the weight of law. It serves only as a guideline, though Gov. Tate Reeves has relied on the 2009 opinion even though it was written by the staff of Hood, who was Reeves’ opponent in the contentious 2019 gubernatorial campaign.

But if the unthinkable ever occurs and the Legislature goes too far into a new fiscal year without adopting a budget, it most likely will be the courts — moreso than an AG’s opinion — that ultimately determine if and how state government operates.

In 2009 Sam Cameron did not want to see what would happen if a budget was not adopted. It also is likely that current political leaders do not want to see the results of not having a budget passed before July 1 of this year.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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1964: Mississippi Freedom Democratic Party was formed

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April 26, 2025

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mississippitoday.org – @MSTODAYnews – 2025-04-26 07:00:00

by Jerry Mitchell, Mississippi Today
April 26, 2025

April 26, 1964

Aaron Henry testifies before the Credentials Committee at the 1964 Democratic National Convention.

Civil rights activists started the Mississippi Freedom Democratic Party to challenge the state’s all-white regular delegation to the Democratic National Convention. 

The regulars had already adopted this resolution: “We oppose, condemn and deplore the Civil Rights Act of 1964 … We believe in separation of the races in all phases of our society. It is our belief that the separation of the races is necessary for the peace and tranquility of all the people of Mississippi, and the continuing good relationship which has existed over the years.” 

In reality, Black Mississippians had been victims of intimidation, harassment and violence for daring to try and vote as well as laws passed to disenfranchise them. As a result, by 1964, only 6% of Black Mississippians were permitted to vote. A year earlier, activists had run a mock election in which thousands of Black Mississippians showed they would vote if given an opportunity. 

In August 1964, the Freedom Party decided to challenge the all-white delegation, saying they had been illegally elected in a segregated process and had no intention of supporting President Lyndon B. Johnson in the November election. 

The prediction proved true, with white Mississippi Democrats overwhelmingly supporting Republican candidate Barry Goldwater, who opposed the Civil Rights Act. While the activists fell short of replacing the regulars, their courageous stand led to changes in both parties.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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