How can the poor’s healthcare crisis spill over to the not-so-poor?

A little Mississippi political history

There are a lot of really cool things about Mississippi, but our healthcare system is not among them. As leaders of the nation’s “poorest and sickest” state, Governor Phil Bryant and his Lieutenant, Tate Reeves, have made political decisions that will give Mississippi an even stronger grasp on that unenviable title for the forseeable future. What Haley Barbour built before he left office, Bryant and Reeves wasted no time in tearing down.

Mississippi could serve as a harbinger of the fate to befall the entire country, if we continue to ignore economic imperatives. America, we simply must “get real.”

Though he may have held his nose the whole time, former Governor Haley Barbour had laid plans which would have, for once, put Mississippi in the forefront of efforts to improve healthcare, especially for its “working poor.” Barbour and his Insurance Commissioner, Mike Chaney, had initiated plans for MississippiOne.com, a website for marketing a state-based insurance exchange/pool for the small businesses which dominate the state’s economy and often do not provide healthcare benefits to employees.  Don’t get me wrong, this was not an esoteric undertaking; it would have, most definitely, benefitted insurance companies willing to do business in this state.

However, when the Affordable Care Act came along, the planned site was already poised to become the exchange site for Mississippi, and Barbour made that case to the federal Health and Human Services Department in 2011.

Having completed these preparations and a great deal of other heavy lifting for the state of Mississippi, Barbour finished his last term as governor and left office. His former Lieutenant Governor, Phil Bryant, moved up into the Governor’s chair.

Hailed as “the Tea Party’s first governor,” and desirous of proving his distaste for “all things Obama,” Bryant oversaw the dismantling of the plans for the MississippiOne website. He was so successful in broadcasting his distaste for the Affordable Care Act, known as Obamacare, that MS became the only state to have its plan for establishing its own insurance exchange rejected by the federal government, for fear that adequate funds would not be forthcoming to properly launch the exchange. As a result, Washington now runs the MS exchange for individuals; the state runs an exchange for small businesses.

At the end of the Affordable Care Act’s first year, Mississippi hit another high mark — the only state whose percentage of uninsured residents went up, not down.

Who are the Mississippi working poor?

Most Mississippians know their fair share of the state’s “working poor,” those who get up every day and go to jobs that provide no health insurance and possibly pay enough to keep workers slightly above the poverty level, but still too poor to afford health insurance premiums on their own. They are cashiers and waitresses at our favorite restaurants and grocery stores; they are our housekeepers and yard workers and the aides who care for our loved ones in nursing homes and even in hospitals. Many of them hold more than one job, because part-time work is all they can find. Many of the “working poor” are single parents, some are grandparents struggling to raise youngsters. Those youngsters are also counted among the “poor.”

Here is one way we produce an unending supply of uninsured “working poor.” Adults in MS must earn below $5550 ($106/week) to qualify for MS Medicaid and its insurance; most “able-bodied” adult individuals will not qualify at any income. Rules for children vary by age, but, for example, children age 1-6 must be in families making less than $34,680 (143% of federal level, $675 weekly) for a family of four.  As a result, one in four adult Mississippians (one in three blacks) is uninsured…in the nation’s “sickest” state.

If you have a family and don’t work at all, at least your children can be insured. It’s no surprise that a parent might choose this route. The surprise is the great numbers who choose to work despite remaining uninsured.

A glimpse of Mississippi’s future finances

The Sheps Center for Healthcare Research lists 57 rural hospitals closed nationwide since 2010; 24 of those are in the deep South, with two in Mississippi.

A study by the Urban Institute estimates that failure to expand Medicaid will cost MS hospitals another $4.8 BILLION in lost revenue over 10 years. There are already small community hospitals throughout the state in danger of closing their doors; Kosciusko’s hospital narrowly avoided closing within the past few months. This is one direct way that a crisis for “the poor” spills over to the not-so-poor. There are others.

Governor Phil Bryant

Bryant says Mississippi “cannot afford” to expand Medicaid– Tea Party lingo for “we must balance the budget at all costs.” Studies done for MS Medicaid estimate that Mississippi’s cost of expansion would be about $450 million over the next seven years.  That $450 million expenditure would net the state an estimated $8.6 BILLION in expansion funds over the same seven years. For the first two years, the federal government pays all Medicaid expenses, thereafter, the state will be responsible for a portion of the expenses. By 2020, the state portion rises to 10%. This is the hook where Bryant hangs his “no expansion” hat.

Several studies theorize that states with expanded Medicaid will also benefit from increased tax revenue from new businesses and jobs spurred by the influx of more federal funds, thus decreasing states’ actual costs for any future financial obligation. This is just a theory, but it generally works out this way in disaster areas, etc. that receive huge infusions of federal money.

Additionally, Mississippi is not exempted from the federal government’s scheduled across-the-board provider cuts. Luckily, those cuts will be off-set by higher funds coming in through Medicaid expansion. Oh, wait. Mississippi won’t be getting those supplementary funds…so we will end up spending more, anyway, to provide less for our poorer citizens.

Mississippi currently has a budget surplus of about $150 million. We do not know what return on investment Bryant, et al. expect to earn on that money, but we are certain that, over the next seven years, it will not come anywhere close to the over 1900% (no, this is not a typo) we could have gotten by committing $450 million to secure $8.6 BILLION in increased healthcare funding.

Questions for the future of Mississippi

Is the future uncertain? Yes.

Does federal money usually come with strings? Yes. But,really, how much of a concern is this for a state that currently receives $3 back for every $1 it contributes to Washington. Nearly half of the MS budget already comes from one federal disbursement or another. We are already going to Washington with a very big hat in our hands.

Does anyone actually believe that Mississippi’s refusal to expand Medicaid will result in the federal government suddenly taking action to get its budget problem in hand? We must have a realistic, long-term plan that benefits those at every level of society. This is not going to be quick, easy or painless.

Are Mississippi’s “working poor” likely to become miraculously more healthy in the immediate future?

Can anyone actually say, with a straight face and a clear conscience, that budget balancing should begin with the poorest citizens’ healthcare?

There are many other places to look for immediate budget cuts. We suggest the search begin with anything that is producing unreasonable profits for some levels of our society, to the detriment of other levels.

What is the alternative?

As much as it pains us on some fronts to say this, we believe that, in the current climate, the only realistic solution for healthcare in this country is a single-payer system.

With the implementation of Affordable Care, individuals and small business alike are having difficulty affording insurance, while insurance companies continue to reap unreasonable benefits. With reference to Governor Bryant’s SCOTUS statement– it is possible that our current healthcare system needs to be destabilized, since it is clearly not working for the benefit of those who need to be insured.

The Affordable Care Act’s Individual Mandate is swelling the number of Americans seeking health insurance. The federal government is already covering the expenses of those who use most of the nation’s healthcare resources: the elderly and the poor. That leaves the rich, the healthy young working adults and the “working poor.”

The “working poor” are mostly out of luck, as we have addressed above.

The rich and the healthy young adult workers look to coverage by private insurance companies, in some form or another. That gives private insurance companies the customers who pay the highest premiums and cost their insurers the least. Not surprisingly, their profits are demonstrably outrageous, their power is great and their influence, far-reaching.

As long as private enterprise is allowed to siphon off the cream of  the customers, the government will struggle unsuccessfully to balance its healthcare budget. Everyone needs to be swimming in the same pool, and the pool needs reliable lifeguards to make sure that everyone has room to swim.

Yes, we know. Everything is not that simple.  But the financial models are irrefutable. We cannot sustain our current course.

For insight into the declining ability of small businesses to insure employees as insurance company profits soar, see: Center for Public Integrity article.

Some things we DO know

When the legislative portion of our government is not doing its job, it provides opportunity for the courts to overstep their boundaries.

Because the Democrats are not even fielding a real candidate for Mississippi Governor this year, there is little chance of this issue being addressed at the state level for at least four years. We must have a two party system to have any hope of keeping everyone “reasonably honest.”

Admittedly, there is a great deal of speculation involved in this whole Medicaid/Healthcare issue. However, one thing is sure. Bryant and his supporters knew, with a certainty, that refusing to expand Medicaid would do immediate harm to the state’s budget and to the state’s poor.

Four years is a long time to be poor and uninsured.

Lastly, a topic for future discussion: how did we get is such sad shape, both locally and nationally, for politicians?

For the disturbing details of Mississippi’s path to refusing Medicaid expansion, see: Mississippi Burned, Again.

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