But what does that mean for the average working person in the State of Mississippi? Well it's like this: let's say you aren't covered by your parents insurance, either because they don't have a plan that offers family coverage, or you're too old. You work a job that is not required to offer you insurance (say at a small business, with less than 50 employees) or you work two part time jobs where you don't get the hours required to qualify for coverage. This leaves you with the option to use the exchanges set up by the law to purchase your own insurance.
However, once you do that you find that the premiums are still too steep for your budget. Not to worry, you think, there's still subsidies that will make it affordable right? Wrong, because the design of the law had not considered the potential of the ruling offered by the Supreme Court, many Mississippians are finding themselves caught in the dreaded coverage gap highlighted here.
This leaves you with the other option of applying for Medicaid coverage. But there's a problem there, Mississippi didn't vote to expand Medicaid. So how does one qualify for Medicaid coverage as a working adult? Simple, get pregnant. It seems counterintuitive doesn't it? You're already on a tight budget and can't afford health care premiums so why have a baby? Because part of the Medicaid statute is that it must cover all new mothers and their babies up until five years of age. And it's a good thing; it was originally devised in order to lower the infant mortality rate by increasing the number of babies born in hospitals, and improving access to prenatal care in order to prevent birth defects. And it has worked marvelously:
(Source)
Note the sharp decrease around 1965 in figure 11. Which almost directly coincides with the passage of the Medicaid act of 1965, as part of LBJ's Great Society programs.
But let's say you're a man, does fathering a child qualify you for Medicaid coverage? It does not. So how else could you get Medicaid coverage as an adult male? Well first you have to quit your job or jobs, and try to apply for Social Security disability coverage. And if you don't want to apply for disability? Well then you're yet another statistic in the nations falling, but still large number of uninsured adults.
Let's say you get hurt on the job or have some pre-existing condition that you believe might qualify for disability. Then you can get Medicaid right? Wrong, not until you are approved for disability. And how long might that take you? According to the Social Security guidebook it can take anywhere from 3 to 5 months to process your first claim.
And that assumes that you get it on the first try, many don't! Hence the proliferation of lawyers advertising disability services on TV in the last several years. And all the while you are waiting for a disability claim, you have no income, no insurance, and you must pay for all medical costs out-of-pocket. If you managed to make it this long, then congratulations, you can get back payments and retroactive Medicaid to pay for the expenses that you incurred during this time. There is one other option to acquire automatic Medicare coverage even if you were under the age of 65, that involves being in renal failure and needing dialysis treatment. So there you have it, as it stands those are the perverse incentives and obstacles that one has to navigate in order to find affordable healthcare if you are a low income Mississippian.
The conservative leadership of the state of Mississippi justifies their rejection of the Medicaid expansion by saying that it will cost of the state too much money. But let's look at a breakdown of where our Medicaid funding comes from at the present moment.
As you can see the federal government already pays for the lion's share of Mississippi Medicaid dollars. This is owing to the fact that Mississippi is, by almost all metrics, the poorest state in the union. But our state government, never one to eschew ways of cutting costs or privatization, has in the past several years found a new way to save a few extra dollars that we spend towards Medicaid, through the MississippiCAN program. What this program aims to do is to encourage a reduction in healthcare costs among the neediest patients by taking state and federal Medicaid money and enrolling those patients in a Managed Care Organization through private insurance providers, Magnolia Health Plan, and United Healthcare Group. So, by giving private companies financial incentive to reduce access to services, and requiring prior authorization for specialty services, these companies aim to make money through the department of Medicaid. However this has created problems for healthcare providers, by creating extra paperwork and delaying payment up to three months. Kingfish blog had a pretty good piece on it from back in 2011:
Nationwide 56% of Medicaid patients are now on Managed Care Plans. This can create problems for both Medicaid patients and the providers who bill them as highlighted in this recent article in Modern Healthcare.
"Primary care Physicians say it's hard to find specialists who will take the Medicaid managed-care patients on referral" said Dr. James Rish, President of the Mississippi State Medical Association.
So these private managed-care private insurance companies are supposedly saving the state money. But at what cost? Clearly it affects the ability of patients to access medical care, and providers say that the additional paperwork has made their jobs more onerous to do, while denying payments, or delaying payments for services delivered months ago. All to enrich the bottom lines of private insurance companies and saving the state some money, at the expense of Medicaid beneficiaries and healthcare providers.
And all of this brings me to the grand overarching point. Mississippi is in trouble, we have the worst statistics on health care in the nation. Some of it's self-inflicted, we eat too much, smoke too much, and we don't get enough exercise. Many of those things are symptomatic of the culture of poverty, a persistent, inescapable fact. We have a rural population and a poor population.
Not only does rejecting Medicaid expansion hurt our healthcare delivery, it hurts our economy. According to Reuters "In rejecting the Medicaid expansion, Republican Governor Phil Bryant is turning down an estimated $426 million in federal funds for next year." These are funds that would go towards paying more doctors to move into the improverished Delta region, among other expenses. These funds would improve our healthcare, allow our citizens to keep their money in their own pockets and contribute to the consumer economy, and would bring in more wealth to the state. Imagine if you will, hundreds of new doctors moving into Mississippi. Imagine the economic impact that would have on our communities. Imagine what would happen to consumer demand? How many jobs could be created? It is a travesty that accepting Medicaid expansion is not the first priority in the statehouse.
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