Studio portrait of Sid Salter. (photo by Beth Wynn / © Mississippi State University)

By: Sid Salter

Republican Lt. Gov. Delbert Hosemann used his Neshoba County Fair political speaking time to kick the political ant hill of making public health care more affordable and accessible in Mississippi.

“The time for simply saying ‘no’ to our options for working Mississippians has passed,” Hosemann said in a speech prepared for delivery at the Neshoba County Fair. “When a cancer diagnosis can bankrupt a family, we have a responsibility to help. Further, no Mississippian should be further than 30 minutes from an emergency room.”

Hosemann said “everything is on the table” in that ongoing debate. He has been talking about public health care for some time now based on two motivating factors.

One, Hosemann simply believes that Mississippi is at a crossroads on the subject – particularly in looking at the financial future of rural hospitals across the state. Second, Hosemann sees the handwriting on the political wall if the Medicaid expansion issue is left to Mississippi voters through some form of direct initiative.

Earlier this year, lawmakers were nervous over the prospects of a voter referendum on the Medicaid expansion issue much in the way that state voters took the medical marijuana question into their own hands in Initiative 65. The Mississippi Supreme Court later ruled the state’s entire initiative process invalid based on petition signature distribution requirements.

Most observers see the current Legislature under some pressure to restore the right of direct voter initiative to state voters, but those same observers likewise expect that the process will be far more difficult for voters to utilize in bypassing the lawmakers. Initiative 65 was a political wake-up call that most legislative leaders intend to answer with stricter rules.

Back on the Medicaid expansion front, there has been little political will to adopt Medicaid expansion by legislators because the issue is such a political lightning rod particularly in Republican primary politics.

Some 39 U.S. states have adopted the federal Medicaid expansion program coverage that become effective in 2014. Mississippi is one of the 12 states – including Alabama, Florida, Georgia, Kansas, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming – that have not adopted Medicaid expansion.

Hosemann did not expressly express support for Medicaid expansion at Neshoba, but he talked about the consequences of the state staying on its current path. He is aware that Mississippi “pays” for that health care delivery to the poor either through Medicaid dollars or through the delivery of uncompensated care in state hospitals.

Nationally, uncompensated care in the U.S. is estimated to comprise 55 percent of all emergency care delivered. In Mississippi’s financially beleaguered state-owned rural hospitals, that percentage is believed to be significantly higher.

The COVID-19 pandemic and the current resurgence illustrates new and growing pressures on Mississippi’s rural hospitals. A 2020 scholarly journal article in the American Journal of Public Health on “The State of Rural Public Health” found:

“COVID-19 revealed how rural parts of America struggle with major public health catastrophes, including a lack of equipment, supplies, medical personnel, and intensive care facilities. Rural America faces numerous health care challenges – unhealthy lifestyles and diets, reduced or less robust availability of high-quality health care, poverty, insularity from major medical hubs, and other chronic health disparities.

“The Hill-Burton program elevated some rural communities, but much of the burden for preventative care and vaccinations rests with local health departments (LHDs), ill-equipped, underfunded, and understaffed deal with the medical load they are carrying. The COVID-19 pandemic revealed how overwhelmed the LHD system is.”

Sound familiar? The fact that it is politically unpopular to utter the words “Medicaid expansion” in solid red states doesn’t change the fact that Mississippi faces some difficult policy choices in the provision of public health care – and we face those choices sooner rather than later.