In college I took two years of Greek, the language of the New Testament. On a daily basis the professor reminded us that “the context IS the message.” In other words, one sentence in a text has to be understood in a broader context to bring out the full truth of the sentence. Another way to put it is “A proof-text, without a context, is a pretext.” Context is crucial to avoiding a logical error.
So it is with the journalism of today. The narrative of the press in Mississippi often includes one-liners, sound bytes and snapshots that may give the appearance of meaning, but in fact the broader context has been omitted, misleading the public. A perfect example of this is the most recent narrative appearing in Section C of the Clarion Ledger on Sunday, March 19, 2017. The large, bold headline stated: “MORE CUTS COMING FROM LAWMAKERS.”
Just above that headline, a Marshall Ramsey cartoon titled “Beauty and Starve the Beast” promoted the idea that the Beast, captioned “State Gub’ment” is “gonna die.” But this kind of journalism, without a proper context, is misleading to Mississippians. “MORE CUTS COMING FROM LAWMAKERS” does not address the broader context of the state budget, nor the context of a very complex federal/state Medicaid program. Today we are publishing our first “The rest of the story” initiative. Our information includes Exhibit 1) a February 22, 2017 email sent by UMMC leadership to all UMMC faculty and staff detailing the specific reasons for cuts; and Exhibit 2) a set of publicly-available historical budget data from the Legislative Budget Office (LBO) at this link:
THE TRUTH ABOUT UMMC CUTS/LAYOFFS
UMMC’s February 22, 2017 email (see Exhibit 1) references the chief cause of UMMC’s recent financial difficulties to be “a decrease in our disproportionate share (DSH) funding.” DSH is a payment made through Medicaid to hospitals for uncompensated care, or as put in the email “for providing care to large numbers of Medicaid and uninsured patients.”
On March 22, 2017 MS Truth Journal contacted the Mississippi Division of Medicaid and learned that the reduction to UMMC was driven primarily because under federal rules UMMC had less “uncompensated care” than had been anticipated. That is, UMMC actually had less patients who were uninsured and unable to pay their medical bills.
Although the intro to the CL article focused on the current year’s budget cuts of $8 million and potential future FY 2018 cuts of $1.4 million to UMMC, the “rest of the story” from UMMC and Medicaid is that the bulk of cuts are from Medicaid DSH program reductions, due to less actual uncompensated care at UMMC. In light of the pending repeal and replacement of the Patient Protection and Affordable Care Act (known commonly as “Obamacare” or the “ACA”), it is a timely discussion as noted by journalist Sid Salter in his article of March 19, 2017, because “uncompensated care makes hospitals vulnerable.”
Not only is uncompensated care a risk, but as illustrated by UMMC, the DSH subsidy itself which is designed to compensate for uncompensated care, may well be a risk. But we digress. The point of this article is that UMMC’s own analysis noted that the recent $8.2 million State cuts “would be manageable in a normal year, but coupled with the DSH reduction they require a more aggressive response.” Regrettably, that response obviously included some 195 layoffs.
THE TRUTH ABOUT MEDICAID GROWTH
To give the public further context, we are also publishing the official state budget appropriation “pie charts” and supporting data from LBO for fiscal year 2009 to 2017, from $4.97 billion to $5.79 billion (Exhibit 2). These charts show the context of the growth of the State budget over almost ten years’ worth of data. The data demonstrates that the State Medicaid budget has been the number one driver of State budget growth in Mississippi since FY 2009 at almost half a billion dollars in growth. According to LBO, Medicaid growth is a result of several factors including federal Medicaid rules and regulations over which the State presently has little control. The data shows funding of Medicaid at far higher levels since the passage of the Patient Protection and Affordable Care Act (known commonly as “Obamacare”) in March, 2010. It is noteworthy this significant increase at higher levels has come to pass in Mississippi even without expanding Medicaid.
How much higher, you ask? Looking at State general funds alone, the pie charts and data demonstrate that for the fiscal year (FY) 2009 the State general fund Medicaid budget was $392,905,977 (7.9%) within a total “Social Welfare” slice of $520,901,623 (10.49%), out of a $4.97 billion general fund budget. For FY 2016 Medicaid general funds had grown to $927,655,576 (16.2%) of a total $5.71 billion general fund budget. Last year, FY 2017 Medicaid general funds were at $860,671,713 (14.9%) within a Social Welfare slice of $1,043,333,411 (18.02%) out of a $5.79 billion general fund budget. Not counting other funds besides general funds, Medicaid alone has grown from 7.9% to a high of 16.2%, and currently stands at roughly 15% of the total appropriated State general fund budget. In your taxpayer dollars that is roughly $393 million to nearly $1 billion, and only in eight (8) short years. Consider that today, Medicaid is the second largest line item of the State budget (education is first). A review of the pie charts shows where your State tax dollars are going.
What drove the increase? According to LBO some of the factors include increased enrollment as the result of the ACA’s “woodwork” effect; medical inflation; an over 68,000 person increase since 2012, and aging of the population.
Questions that journalists might want to research about these facts include:
1) Will the pending repeal and replacement of the ACA give Mississippi more local control over the Medicaid budget?
2) Will changes to “uncompensated care” be addressed as part of the new federal Medicaid program, whatever shape it takes?
3) What does it mean that UMMC had less uninsured, less indigent patients than it expected?
4) Could future savings in the Medicaid program be used for other state priorities such as education and infrastructure?
As my Greek professor said: “The context IS the message.”