Mississippi is hardly a picture of perfect health. To the chagrin of most citizens, Mississippi often finds itself in the worst position of most important state rankings. A 2011 analysis of obesity in the United States conducted by The Heart Forum determined the adult obesity rate in Mississippi to be 34.9%, which earned it the distinction of being the fattest state in the union. This rate is expected to grow to 66.7% by 2030. Keep in mind that these statistics only describe the portion of the population that is obese and do not account for people who are merely "overweight." This means that it is quite possible that less than 10% of the population could be persons at a normal weight by 2030, which is absolutely frightening. Along with obesity comes a myriad of expensive health issues - metabolic syndrome, type 2 diabetes, heart disease, and cancer.
According to the Kaiser Family Foundation, an estimated 442,900 of the state's 3 million citizens are uninsured. Many uninsured persons are members of the working poor class. They hold jobs that do not offer health insurance and earn too little money to pay for health insurance on the open market. Moreover, they often do not qualify for medicaid because they make too much money.
To top it off, the Mississippi health delivery system is facing a severe doctor shortage - both primary care and specialties - particularly in rural areas of the state.
The general state of Mississippi healthcare can be easily summed up as follows: we're fat and we lack access to health insurance and healthcare. Unless something changes soon, Mississippi will face an all out health crisis within the next couple decades. The state is truly at a healthcare crossroads.
Fixing the Doctor Shortage
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| Governor Phil Bryant |
Plans to increase the number of physicians should be commended. But, should the state also find ways increase access to healthcare?
Medicaid Expansion
On March 23, 2010, President Obama signed into law the Affordable Care Act. Dubbed Obamacare, the law sought the expansion of health insurance coverage for millions of Americans, reform of the health insurance industry, and changes to many aspects of the current fee-for-service reimbursement scheme. Under the law, states have an incentive to expand medicaid coverage because the federal government will pay for 100% of the expansion from 2014-2017, and then 90% of the program costs after that. For every $1 that Mississippi spends on expansion, the federal government will pay $14. On the surface, this appears to be "free" money, but in the words of the late economist Milton Friedman, there is no such thing as a free lunch. The expansion of state medicaid programs will be financed through large increases in federal taxes and fines on individuals who do not purchase health insurance as well as businesses who do not make health insurance available to employees.
Just what are the costs of expanding medicaid? A University Research Center study estimates that the state would spend $159.1 million more on medicaid in 2025 than it spends now. Moreover, the state can reasonably expect to generate $63.3 million in revenue; thus, leading to a loss of $95.8 million.
Some experts believe that the costs are overestimated. Retired state health officer Dr. Alton Cobb believes expanding medicaid will increase visits to primary care physicians and reduce the number of costly visits to ER. Mississippi currently ranks 7th in per-capita ER visits. From my own experience, I tend to agree with Dr. Cobb. Too many people go to the ER for ailments that could have easily been treated by primary care physicians at a considerably lower cost. Most trips to the ER result in a plethora of tests - urine tests, blood tests, CT scans, and x-rays - many unnecessary but performed out of fear of litigation. Expanding medicaid could curb such visits. In addition, retired state economist Phil Pepper believes expansion would create 9,000 new jobs in the health sector. Of course, this would mean that if medicaid expansion were to be undertaken, it would be nearly impossible to reverse for fear of job loss and devastating economic consequences.
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| CEO Evan Dillard |
Who is against medicaid expansion? Primarily Republican politicians who fear the high cost of expansion and political repercussions for appearing to support Obamacare. Governor Phil Bryant has said that he will not support medicaid expansion. His position was bolstered last week when a poll showed that 76% of registered Republicans are against expansion even though only 13% claimed to be knowledgable on the issue. Bryant's two arguments against expansion are 1) the federal government will not actually end up paying as much as it says it will because it cannot afford it and 2) the medicaid system is currently replete with waste and fraud. Both arguments are sound, but does that mean the state should do nothing at all?
The Crossroads
The choice confronting Mississippi lawmakers will have a profound impact on the health, wellness, and economy of the state. If the state chooses not to expand, there will still be individuals who lack health insurance but need healthcare. They are not going away. Expansion could potentially curb overall healthcare costs by providing access to primary health care for thousands of people who need it. Moreover, expansion could be considered an economic investment as healthy people are more productive workers, more likely to work and pay taxes. If supplying a single physician in a rural area has a $2 million economic impact, what economic impact does making healthcare more accessible ultimately have? Even if lawmakers choose not to expand, they should find ways to make the system more efficient so that the dollars can be better spent. Choosing to keep the status quo would be the most devastating outcome. It will be interesting to see which road the state chooses to travel.
