Mississippi Today
Senate passes bill to regulate how health insurance companies decide what procedures, drugs to cover
The Mississippi Senate this week unanimously passed a bill to regulate how insurance companies decide which medical procedures or prescription drugs to cover for a consumer — a process called “prior authorization.”
Senate Insurance Committee Chairman Walter Michel said the legislation grew out of complaints he received from both physicians and insurance companies about how the authorization process currently works.
Prior authorization is when physicians have to seek advance approval from an insurance company before the company covers a prescribed procedure, service or medication that is not an emergency.
If an insurance organization denies a prior authorization claim, a consumer could be forced to pay for a prescription or medical procedure out of pocket.
“What we don’t want to happen is an adversarial relationship between a doctor and a patient,” Michel told reporters. “It’s to everyone’s advantage to get the prior approval from the insurance company to know the procedure is going to be paid for.”
Insurance companies typically believe prior authorization helps ensure doctors only provide medically necessary services, while doctors argue the process is typically handled by clerical insurance staffers ill-equipped to understand medical procedures.
The Senate proposal would require insurance companies to create a “portal” or website by January 2025 for doctors to submit prior authorization applications.
For emergency services like treating a heart attack, prior authorization is not required. For urgent services or procedures that can help treat someone in intense pain, insurance companies have 24 hours to process requests. For non-urgent services, insurance companies have five days.
The state Insurance Commission is responsible for regulating the program and can fine people up to $10,000 for violating the law.
Republican Insurance Commissioner Mike Chaney told Mississippi Today that he can “live with” the Senate proposal, but he would like for the Legislature to appropriate more money to the insurance commission to enforce the program.
The bill passed without any dissenting vote, and it moved to the House for more work. The House Public Health Committee passed a similar measure this week, but the entire House chamber has not yet considered the proposal.
Republican Gov. Tate Reeves last year vetoed a similar measure that the Legislature passed by a wide majority. The governor, at the time, believed the proposal would increase health care costs in the state.
Corey Custer, Reeves’ deputy chief of staff, told Mississippi Today in a statement that the governor’s office has worked with necessary stakeholders to address some of his concerns in last year’s version of the bill.
“The proposed legislation reflects a series of compromises by many of those stakeholders,” Custer said. “Gov. Reeves looks forward to working with the legislature to move prior authorization reform through the legislative process.”
Michel, a Republican from Ridgeland who wrote the bill, believes his latest proposal satisfies the governor’s concerns from last year.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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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