Reddit AMA recap: Medicaid expansion in Mississippi with Senior Political Reporter Geoff Pender

by Mississippi Today, Mississippi Today
November 21, 2022

Mississippi's growing health crisis threatens to close at least a dozen hospitals across the state and puts Mississippi in the lead nationally for rates of uninsured people.

READ MORE: ‘What’s your plan, watch Rome burn?’: Politicians continue to reject solution to growing hospital crisis

Studies have shown and advocates have long touted the benefits of Medicaid expansion, but state leaders remain steadfast in their opposition. As such, Mississippi remains one of only 11 states in the country not to expand the federal-state program.

Mississippi Today launched an ongoing series looking at the impact of the health care crisis on the people and institutions of the state.

As part of that project, Senior Political Reporter Geoff Pender answered readers' questions on Reddit about Medicaid expansion (or the lack thereof) in the state. Here's a recap:

Click to jump to a specific question

Q: Thank you for doing this and continuing to push on this topic.

As I sit here seeing the Greenwood hospital closing while the governor touts tax breaks for companies and the state government refuses this aid… I just do not get it.

Unless I think of all of the non-rational reasons for it.

A: Unfortunately, we are hearing from many corners that Greenwood may be the canary in the coal mine right now. We have heard some dire predictions of late from state hospital and other officials. State Health Officer Dr. Edney recently warned that we're looking at at least half a dozen hospitals on the brink, and others are saying our entire system is troubled. I don't know that Medicaid expansion would be the panacea for all that, but most experts are saying the influx of billions of federal dollars for health care would stave off many of these problems.

Q: As the Q&A article describes, there are political and economic arguments against expansion, but what in your opinion are the underlying motives for the stance? Are the politicians perhaps more driven by financial incentive from opposition groups in addition to maintaining their political platforms for the sake of the party? And as for general people, do you think it’s related to a mentality of being against handouts and of “pulling yourself up by your bootstraps”? What do you think are the underlying feelings and motivations to these stances?

And lastly, how do you think these underlying reasons can be negotiated with to make progress towards achieving expansion?

A: As far as the current drivers of opposition to expansion, I would say they are now more political than economic, and have been so for quite a while. For one thing, we have empirical evidence from other states, including now Louisiana and Arkansas, that show expansion isn’t the budget-buster our leaders once feared.

We also have reams of studies and evidence from other states showing we would see net positive benefits – thousands of jobs created, savings of double-digit percentages in uncompensated care for hospitals, more workforce participation (ours is typically lowest in the country), net GDP growth and even projected growth in population. Also, we’ve seen firsthand over the last two years that Mississippi, with our economy so heavily dependent on federal spending, sees booming state budget growth when there is an influx of billions of federal dollars. We’re sitting on more than $2 billion in basically surplus state money right now, largely the result of the influx of federal pandemic spending.

And again, this expansion is aimed primarily at the “working poor,” people in the gap between being poor enough for other help or being able to afford private insurance or pay medical bills out of pocket. As many have pointed out, a lot of the folks we’re talking about with this are working more than one job. As for pulling one’s self up by bootstraps, too many folks are one ER visit away from not having any bootstraps, and once someone gets a chronic illness because of lack of preventive care, it costs taxpayers anyway (and more).

No, the opposition now would appear to be more purely political (partisan) and philosophical – not wanting expansion of “Obamacare,” and opposition to expansion of a government program, even if in the long run it’s projected to benefit the workforce and private sector.

That opposition to government programs, however, appears to be selective among state leaders. One recent anecdote struck me in particular. Gov. Reeves recently held a press conference to trumpet the state’s work on expanding broadband internet across rural Mississippi. This is being funded with federal tax dollars. Instead of lamenting such government largesse, Reeves vowed to see that “we not only get our fare share, but that we get more than our fair share.” It would appear it’s OK to take hundreds of millions of federal dollars for internet service to areas where the private sector won’t do it, but not OK to take federal money to help keep people alive and well and working.

As for how this opposition might be overcome – I don’t know that anyone has a simple answer to that. One thing I hear all the time, though, even from some who have opposed expansion, is time. I have heard over and again in recent years that it’s probably just a matter of time before Mississippi expands Medicaid. Polling in recent years would indicate the populace may already be a bit ahead of our politicians on this policy … and, of course, look at other states relenting, such as Arkansas, Louisiana.

We attempted to delve into some of this opposition, past and present, here.

READ MORE: Who’s opposed to Mississippi Medicaid expansion and why?

Q: Can Medicaid expansion prevent local hospitals from closing?

A: It's unclear if it definitely would — rural hospitals in particular are facing major headwinds with personnel shortages and costs, supplies, inflation, uncompensated care. But most projections by experts have shown net benefits, and we've seen in other states that expansion helped. Particularly, in Louisiana, rural hospitals saw reductions in uncompensated care costs in the 55% range. This alone could give struggling rural hospitals some breathing room.

This study indicates hospitals in expansion states are less likely to close.

Q: With Medicaid expansion costing far more than initially predicted in other states, it delivering consistently poor health outcomes for those on the program, and it failing to ultimately help save rural providers as seen in Colorado and Indiana…why advocate so intensely for expanding a program that’s heading toward insolvency besides the fact that it will pad the pockets of and expand profits for big hospitals?

A: As for costing more than predicted, as I understand, this has not truly been the case at least on the state level. Some states have seen more people than initially predicted, but that has also been offset by people shifting from their traditional Medicaid to that with the higher match rate from the feds, and other non-direct economic benefits.

As for Colorado, I just recently read a report that rural hospitals there are "about 6 times less likely to close than hospitals in non-expansion states, according to a study by researchers at the University of Colorado Anschutz Medical Campus." I'm not sure what you are looking at, but would like to see it if you can forward a link.

As for poor health outcomes, I'm not sure Mississippi would have anywhere to go but up. Mississippi Medicaid has had poor health outcomes, but that has been primarily because only the sickest of the sick, so to speak, are on its adult population. Proponents say that the working-poor expansion population would receive more preventive care and improve outcomes — but you are right, that has been one major argument against expansion in Mississippi.

I don't know that expansion would pad the pockets and profits of big hospitals. It would help ameliorate the $600 million or so in uncompensated care that is hammering, in particular, smaller rural hospitals.

READ MORE:
• The Mississippi Health Care Crisis
• Mississippi moms and babies suffer disproportionately. Medicaid expansion could help.
• How Medicaid expansion could have saved Tim’s leg — and changed his life
• Q&A: What is Medicaid expansion, really?

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