Mississippi is one of ten states, all with Republican-led legislatures, that continue to reject federal funding to expand health insurance for the underprivileged, increasing the financial strain on hospitals.
With 208 beds, an intensive care unit, a number of walk-in clinics, and a contemporary brick-and-glass structure, Greenwood Leflore Hospital has grown to become a medical center for this area of Mississippi’s fertile but impoverished Delta. It first opened in a converted wood-frame mansion 117 years ago.
However, on a recent weekday, there were only 13 inpatients gathered in one ward. Due to a lack of staff, the intensive care unit and the maternity ward were closed, and the rest of the facility was eerily quiet—all indications that the facility had been overrun by needy patients.
Gary Marchand, the hospital’s interim CEO, claimed that Greenwood Leflore lost $17 million last year alone and has only a few million in cash on hand. “We’re going away,” he said. “It’s happening.”
Because of population declines, rising labor costs, and a long-term shift toward outpatient care, rural hospitals across the country are struggling. However, political decisions made in Mississippi and nine other states with Republican-controlled legislatures have made these issues worse.
They have declined the offer from the federal government to pay for almost all of the expansion of Medicaid for the poor. And because hospitals are unable to turn away patients, regardless of insurance, this has forced hospitals to incur additional costs.
According to the American Hospital Association, between 2010 and 2021, nearly three-fourths of rural hospital closures occurred in states that chose not to expand Medicaid or had only recently done so.
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Most opponents of expansion, who have been successful in Texas, Florida, and much of the Southeast, typically claim they want to limit government spending. The federal government will only release the remaining 90% of the cost if the states contribute 10% of the total.
But the number of holdouts is decreasing. As of Monday, North Carolina had expanded Medicaid to include all adults with incomes below 138 percent of the poverty line, making it the 40th state to do so since the 2014 opening of the option under the terms of the 2010 Affordable Care Act. The law, a significant victory for President Barack Obama, has resisted Republican attempts to repeal or restrict it.
“This argument about rural hospital closures has been an incredibly compelling argument to voters,” said In seven states, Medicaid expansion ballot initiatives have been successfully pushed by Kelly Hall, executive director of the Fairness Project, a national nonprofit.
The lack of federal funding for healthcare has contributed to what is now a severe hospital crisis in Mississippi, one of the poorest states in the country. Few, according to experts, of Mississippi’s more than 100 hospitals operate at a profit on a statewide level. According to the state hospital association, providing free care costs them about $600 million annually, which is equivalent to 8 to 10 percent of their operating expenses. This is a higher share than almost anywhere else in the country.
According to a 2021 report by the office of the state economist, expanding Medicaid would open a spigot of roughly $1.35 billion in federal funds annually to hospitals and healthcare providers.
Additionally, it would ensure access to healthcare for 100,000 uninsured adults earning less than $20,120 annually in a state where mortality rates from heart disease, stroke, diabetes, cancer, kidney disease, and pneumonia are among the highest in the country. The Delta has the highest rate of foot and leg amputations due to diabetes or hypertension in the country, along with extremely high infant mortality rates.
Health officials attribute these figures in part to the high percentage of residents without insurance who forgo preventive care.Health Care in the United States
- Expanding Medicaid: The Affordable Care Act’s expansion of Medicaid to North Carolina marked the 40th state to do so, the most recent indication of how Republican opposition to the health measure has waned.
- Forgoing Funds: One of the ten states with the G.O.P. is Mississippi.-led legislatures, that continue to reject federal funding to expand Increasing financial pressure on hospitals is Medicaid, a political decision.
- Medicare Advantage Changes: An extensive and vocal opposition front from insurers has been launched in response to a Biden administration plan to combat fraud and abuse in the private program.
- Drug Shortages: According to a Senate report and testimony, the growing lack of affordable yet essential medications poses a threat to national security.
“I can tell you I have a number of patients who are on dialysis with renal failure for the rest of their life because they couldn’t afford the medication for their blood pressure, and that caused their kidneys to go bad,” said a surgeon from Greenwood Leflore named Dr. John Lucas.
Only adults in Mississippi who are disabled and parents who make an extremely low income, along with the majority of pregnant women, are eligible for Medicaid. The Affordable Care Act’s tax credits for insurance are ineligible for many of the ineligible because they are too poor to qualify, leaving them without any viable alternatives.
The same is true for the other nearly two million Americans who reside in the states where Medicaid has not been expanded. The Center on Budget and Policy Priorities, a nonprofit research organization, found that three out of five adults are people of color. Over 50% of the population in Mississippi is Black.
Republican Governor Tate Reeves is a significant G.O.P. state lawmakers argue that a bigger Mississippi program is not best for taxpayers. The governor claims that the state’s $3.9 billion surplus would be best applied to assisting in the abolition of Mississippi’s income tax.
“Don’t simply cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine,” In January, Mr. Reeves delivered his yearly State of the State speech.
The newly insured would depend on Medicaid, according to detractors, and would be less likely to work as a result. “I believe we should be working to get people off Medicaid as opposed to adding more people to it,” said Speaker of the powerful Republican House, Philip Gunn.
However, due to a lack of funding, access to any form of medical care is dwindling in Mississippi’s Delta, a flat region covered in fields of corn, soybeans, and other crops that is almost as large as Delaware. About two-thirds of the more than 300,000 residents who call this place home are Black. Three times as many people live in poverty in this area as the national average.
The state’s top health official, Dr. Daniel P. Edney, asserted that he did not create Medicaid policy and that he has taken care to remain neutral. He foresaw, however, that there would soon be “health care deserts,” wherein pregnant women would have to travel great distances to deliver their babies and more sick people would pass away from lack of access to care.
Of the state’s hospitals, “I have maybe heard of two that are generating any profit,” he said. When he asks hospital executives if Medicaid expansion would help their balance sheets, he said, “they say it’s a game changer.”
He predicted that five hospitals would soon become little more than emergency rooms, where medical staff works to stabilize patients before transferring them to the closest hospital.
According to Dr., some of the sickest patients won’t survive if that occurs. Jeff Moses, a medical professional who works at Greenwood Leflore.
“Where are they going? Davy Jones’s locker,” he said. “I’m not joking when I say it’s pitch-black. What will happen to this community if this hospital closes is just beyond my comprehension.”
Nine years after states started to broaden Medicaid, there is mounting proof that doing so actually saves lives. According to a 2021 analysis, the National Bureau of Economic Research’s researchers calculated that over a four-year period, expanded coverage helped 19,200 more adults aged 55 to 64 survive, and that number would have increased to nearly 16,000 if coverage had been available nationwide.
According to additional research, this is the reason: Increasing access to affordable medical care increased the number of routine checkups, cancer screenings, chronic disease diagnoses, and prescriptions for necessary medications.
Many states found that the Medicaid expansion program was a net fiscal gain, particularly during the first six years of the program when the federal government covered 95 to 100% of the cost. In order to help pay for other Medicaid expenses, some states have implemented taxes on hospitals or healthcare providers to help cover their portion of the cost.
The federal government is now providing a fresh incentive for states to expand Medicaid eligibility as part of a 2021 pandemic relief measure.
According to projections made by the state economist’s office in Mississippi, for at least the first ten years, savings like these and others would completely offset the roughly $200 million a year that Medicaid expansion would cost the state’s budget.
Tim Moore, the president of the Mississippi Hospital Association, said expansion was “a no-brainer.” He claimed that because of its extreme poverty, the federal government invests four dollars for every one the state spends on Medicaid.
Regardless of their political affiliation, Mississippians appear to support Medicaid expansion, according to surveys conducted by Siena College and Mississippi Today. Democratic governor candidate Brandon Presley cites hospital closures as justification for Mr. Reeves won re-election in November to a second term.
The governor and the legislature recently agreed to extend Medicaid coverage to expectant women for 12 months after they give birth, extending a federal pandemic-era policy, which may be a sign of political unease.
The legislators are also attempting to support the hospitals with a one-time injection of at least $83 million. However, that pales in comparison to the Medicaid payments the state has forgone.
The hospital association reports that the state has lost four hospitals since 2008, and Dr. It inevitably would lose more, according to Edney, the state health officer. He claimed that as the offspring of working-class parents without health insurance, he was most concerned about health care access in the Delta, where he grew up.
Democratic Mississippi Representative Bennie Thompson claimed on Saturday that patients from a tornado that hit the Delta last week had to be transported 50 miles away for care because the nearby hospital was without power. He claimed that adding an emergency generator would have required more Medicaid funding.
Another significant hospital operated by Delta Health System, located an hour due west of Greenwood Leflore, is also experiencing severe problems. The hospital only had 72 inpatients on one day last month despite having a license for more than 300 beds.
Due in part to nursing staff reductions, 32 of them were kept in the emergency room. According to Amy Walker, the chief nursing officer, one effect is that patients seeking emergency care now have to wait an average of two hours, which is four times longer than they should. Some simply walk out.
Since last July, the neonatal ICU has been closed. Now, babies in need must be transported 125 miles south to Jackson by ambulance or helicopter.
The hospital’s CEO, Iris Stacker, stated that it might stay open through the end of the year, but she makes no guarantees after that. Despite the state’s failure to expand Medicaid, she is hoping that grants from the federal government will help keep the doors open.
But she said, “When there is a pot of money sitting here that we won’t touch, it is very difficult to ask the federal government for more money.”
A donation request is currently the most prominent message on Greenwood Leflore’s website. Less than $12,000 has been donated to the hospital so far.
One recent day, a small group of inpatients included Mike Hardin, a 70-year-old retiree. Two days prior, he had arrived at the emergency room with slurred speech. His stroke was quickly diagnosed, and he was now being sent home with new medications.
“They have to do something to keep this hospital open,” he said as he was wheeled out of his room. “There would be nowhere else for the local population to go.”
The majority of the hospital’s outpatient clinics are still operating, and the doctors there claim that their caseloads are loaded with underprivileged patients who ought to have received treatment sooner.
Dr. Abhash Thakur, a cardiologist, claimed that he frequently saw patients in the advanced stages of congestive heart failure who had never been to a cardiologist or been given a prescription for heart medication. Some people still only have 10% of their heart’s original capacity.
“They are not the exception,” he said, before examining a 52-year-old man who uses a wheelchair because of his heart disease. “I’ll likely see a few of them each day.”
The patient, a man in his late 50s, had just received care from general surgeon Dr. Raymond Girnys. He claimed that while walking in his tennis shoes in a field a week prior, the man had punctured his foot on a sharp stick.
Due to his lack of money and insurance, the man waited until his foot became infected before seeking medical attention. Ironically, Dr. Girnys noted, if his patient lost his foot, he would be qualified for Medicaid because he would then be disabled.
“If they had insurance, they wouldn’t be afraid to seek care,” he said.
