Mississippi shows us why we need a national health program

In the state with the highest medical debt, it’s the middle class who carries the burden

By Max Blau
STAT, March 24, 2017

Americans are no strangers to medical debt, and the burden is most severe in Mississippi, where nearly 40 percent of adults under age 65 owe hospitals or doctors, according to the Urban Institute. But the men and women carrying that debt are not always poor — they’re increasingly middle class.

And their inability, or refusal, to pay their bills is straining hospital budgets and threatening the availability of care.

Mississippi, where the median household income hovers near $40,000, has one of nation’s highest rates of uninsured and underinsured adults. As a result, the state has one of the highest percentage of adults who avoid doctors due to potential costs, said Therese Hanna, executive director at the Center for Mississippi Health Policy.

At the same time, medical debt remains the leading cause of bankruptcies, according to Roy Mitchell, executive director of the Mississippi Health Advocacy Program.

Over the past five years, James Henley Jr., a bankruptcy trustee in Jackson, said he has seen a sharp increase in the number of middle-class residents with bankruptcy claims after “extending their lines of credit, maxing out credit cards, [robbing] Peter to pay Paul.”


Welfare Audit Bill Passes With No Statistics Given on Fraud

By Sarah Smith
U.S. News & World Report, March 29, 2016

Mississippi could hire a private company to audit Medicaid, welfare and food stamp recipients and make sure they aren't cheating the program under legislation approved by the Senate on Wednesday after a debate in which supporters offered no statistics about welfare fraud.

The bill, which is on its way to Gov. Phil Bryant, had already passed the House on Tuesday.

House Bill 1090 would let the state hire a contractor to help check that recipients live in Mississippi and are who they claim to be. The contractor would also check recipients' income levels. The measure also requires able-bodied recipients to be working, and it tracks where recipients use their money.

Republican proponents say the bill will bring the state one-time savings of about $4 million to $5 million. Sen. Brice Wiggins, a Republican from Pascagoula who presented the proposal Wednesday, said the state Department of Human Services gave him the estimate.

But that number started to fall apart under questioning from Democratic Sen. Hob Bryan of Amory. He had never seen a number, he said. Could he take a look?

"I am told that — I'm not going to lie, numbers get thrown around all the time," Wiggins said. "We need this bill to get to that."

Bryan asked again if the figures came from the Department of Human Services.

"As I said, numbers were all over the place," Wiggins replied.

Several Democrats pointed out the sponsors have no numbers on fraud.

"How many people are riding the system who aren't deserving?" asked Sen. David Jordan, a Democrat from Greenwood. "Don't you think you should have some statistics?"

Wiggins had no statistics to offer. Finding out just how much fraud is going on, he said, is part of the bill's purpose.

"What is driving some of us up the wall is the notion that somehow the entire class of people receiving Medicaid or other benefits are a bunch of clever, crafty people out trying to steal money from hard working folks and if we could only crack down on this we could balance the state budget," Bryan said.



By Don McCanne, M.D.

The residents of Mississippi have a serious problem with medical bills and resulting debt impacting 40 percent of adults under 65. The fact that their state legislators are not particularly responsive to this problem is represented by the fact that they rejected an expansion of Medicaid under the Affordable Care Act which would have provided coverage to an additional 300,000 Mississippians.

Of course the medical debt problem persists, so the legislature finally acted. But talk about a non sequitur, in this case a double non sequitur.

First, defining the problem. These people needed medical care but did not have adequate means of paying for it and thus were saddled with medical debt. It seems that a logical response would be to set up a health insurance program to pay for the medical expenses. No, even a Medicaid program with 90 percent federal funding was rejected by the legislators.

So they had a second chance, and what did they do? They somehow decided that these people in need were a bunch of flakes who were just after free handouts, so, with no supporting evidence whatsoever, they voted to authorize a private contractor to ferret them out if they relied on public benefits. In spite of this double whammy of incompetence, it does look like the legislators have had one dubious success - they have managed to blame the victim.

Sometimes this states’ rights thing goes overboard. We cater to the legislators and governors of the states while we neglect the needs of the people. Mississippi desperately needs a universal insurance program. It is not as if the federal government has no rightful role because seniors and individuals with long term disabilities have the right to Medicare. Why shouldn’t we extend that right to everyone in Mississippi, or, for that matter, to everyone in the United States? Well, we should.

Several states have proven that it is unethical for us to continue to allow the states to make their own decisions about who should or should not be entitled to health care when so many are harmed by bad governing decisions. Limiting health care coverage to the gentry or whatever other qualifying social order is un-American. Mississippi shows us that it is an absolute imperative that we have a national health program that includes everyone and is effective in removing financial barriers to all needed care. That is just what an improved Medicare for all would do.

“…our fathers brought forth on this continent, a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal. Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated…”

No, let's not go there again. Let’s just get heath care out to everyone.