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Stubborn Legislators Unlikely to Deliver More than Band-aids to Failing Hospitals

Mississippi legislators have repeatedly failed to expand Medicaid and save their own rural hospitals.

Mississippi legislators, under current Republican leadership, will likely fail to enact lasting solutions for a rash of hospital closures across the state, despite a whopping $3.9 billion revenue surplus.

State health officer Dr. Daniel Edney warned senators last November that more than half of Mississippi’s rural hospitals—38—could close, aggravating already poor health conditions in the nation’s poorest state. Edney called the situation “intolerable” and explained that rural hospitals were suffering long before the COVID-19 pandemic stressed them past their breaking point. The Mississippi Hospital Association says, “The hospital crisis “has been fermenting” and “has been foreseeable for years and was indeed predicted.”

Several hospital advocates agree with Edney.

“The fact is, there is a sizable gap that exists for working Mississippians who cannot afford private health insurance, yet whose income is too much to qualify for Mississippi Medicaid. When these individuals need healthcare, hospitals are required to treat them regardless of their ability to pay,” MHA explained in a January letter. “And because these individuals are uninsured, the hospital is not compensated for this necessary care. Such an economical strain on hospitals is one that even the most successful private business could not endure.”

Mississippi legislators have failed to pull their state out of decades of poverty, and its comparatively high number of low-income uninsured people means hospitals are on the hook for more uncompensated care than most. Mississippi is one of 11 states with Republican leadership that has stubbornly refused to expand Medicaid eligibility, leaving about 300,000 Mississippians stuck in a healthcare coverage gap with no health insurance. The state’s current plan insures only disabled, poor pregnant women, children, and the elderly. However, most able-bodied Mississippians working poverty-level jobs do not qualify for coverage, despite the state ranking 50th in poverty rate, at 21.5%.

The Lighthouse has written how rising medical labor costs have been working in tandem with legislative obstinacy to drive essential care facilities to close, including Mississippi’s last and only burn center. Nurse and doctor pay outside the state is much higher than Mississippi pay, and medical care advocates warn that out-of-state competitors are siphoning off medical personnel and med students as fast as Mississippi schools can graduate them.

Mark Horne, MD., chief medical officer of South Central Regional Medical Center, of Laurel said even if doctors and nurses were willing to work a pittance, the medical field in Mississippi would still be unable to sustain itself under current conditions.

“Even if I could give away my time, I can’t give away the medication patients need,” Horne said. “If they had insurance then we could take care of that, but most low-income patients can’t afford these things.”

Many hospitals and clinics that do manage to survive the insurance gap are shutting down medical wings. The Greenville Neonatal Intensive Care Unit closed this year, leaving the Delta with no NICUs. The state, under the Mississippi GOP, has also initiated a series of health department cuts that closed facilities across the state. Eleven county health department sites have shuttered within the last seven years.

Republican leadership has done precious little to expand Medicaid despite the rash of closures. The Senate conceded to a small expansion last year and attempted to pass a bill to extend postpartum care for new mothers to 12 months. However, Mississippi House Speaker Philip Gunn, a sitting member of an out-of-state, corporate-paid organization that openly writes Mississippi’s laws, trampled the legislation. Gunn argued that the state should “look for ways to keep” pregnant mothers off Medicaid, “not put them on.”

Thanks to a flurry of federal spending initiatives and pandemic-related individual cash payouts, impoverished Mississippians have been spending more money than usual. According to Legislative Budget Committee staff, legislators will begin the 2023 session with a $3.9-billion surplus, roughly half the size of the state’s entire $8 billion budget. This year, legislators have less and less reason not to offer some financial assistance to shuttering clinics and hospitals, and even less reason to cinch Medicaid eligibility.

Lt. Gov. Delbert Hosemann, who runs the state senate, and House Speaker Philip Gunn have both claimed an intent to help clinics and hospitals, but any temporary financial boost they propose would be a band-aid for the bigger issue of more than a decade of Medicaid-related closures. Gov. Tate Reeves said he planned to continue the trend of rejecting more than $10 billion in federal funds to expand Medicaid, but also advocated against spending too much to save hospitals and clinics.

“I would just caution everyone, unless the Mississippi Legislature wants to invest and run hospitals in every community across Mississippi, it’s a very slippery slope as to how big the check is that they want to write because keeping inefficient systems is not a good answer,” he told reporters at the onset of the 2023 Legislative Session.

A 2020 Chartis Center for Rural Health study predicts an additional 64 percent of Mississippi’s remaining rural hospitals are now at risk of closing. With nothing but patchwork measures, Mississippi will likely continue the trend of killing its own healthcare system.

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