One of the most important issues in statewide elections this year — especially in the races for governor and lieutenant governor — has to be whether Mississippi is missing the boat, and endangering the economy and the public health, by not expanding Medicaid.

Mississippi is six years into its resistance. It’s now just one of 14 states left that has not accepted the federal government’s sweet offer to provide health coverage for the working poor, with Washington covering at least 90 percent of the cost. It’s estimated that Mississippi’s failure to expand is costing the state at least $1 billion a year in federal money and thousands of well-paying jobs in health care.

It might also be pushing rural hospitals in Mississippi toward extinction.

A handful of rural hospitals have closed or declared bankruptcy in the past few years. There are a couple of dozen more that could soon join them, according to a national survey of rural hospitals by the independent consulting firm Navigant.

If that survey doesn’t get the attention of Mississippi’s Republican leadership, which has been opposed to Medicaid expansion, we don’t know what will.

The survey, as reported last week by Mississippi Today, identified 31 rural hospitals out of 64 in the state that are in danger of closing due to troubled finances. At 48 percent, Mississippi’s rate of hospitals at “high financial risk” is more than double the national average, the survey found.

Thankfully, Greenwood Leflore Hospital, despite $38 million in losses over the past 40 months, wasn’t on the list. But a lot of hospitals in the area are, including several that critics of the Greenwood hospital have cited as being on a supposedly better trajectory. Among the endangered are a half-dozen within 60 miles of Greenwood.

According to the article, these hospitals are suffering from poor profits, high debt and low cash reserves. “Some hospitals on the list have just a few days of cash on hand,” the article said.

The failure to expand Medicaid is not the only factor causing their financial distress. Population declines, the squeeze in reimbursements from private and public insurers, and the move away from inpatient to less lucrative outpatient care all play a part into making rural health care such a difficult proposition these days.

These factors, though, are either largely beyond the control of state government or cannot be fixed quickly. What is in its control, and can provide an immediate infusion of cash, is Medicaid expansion.

Physicians in private practice may not want more Medicaid patients since they feel that the federal-state program reimburses them at less than what it costs to provide the treatment. But for hospitals, which by law must treat everyone who shows up at their doors, regardless of ability to pay, more Medicaid dollars means less uncompensated care. Even if the reimbursement is not enough to fully cover costs, it’s a lot better than the zero hospitals usually get from patients who do not have insurance.

A few weeks back, it was reported by Mississippi Today, among others, that Gov. Phil Bryant, one of the most stubborn opponents to Medicaid expansion, was softening in the final year of his two terms in office. If so, he’s yet to produce a plan.

If Bryant punts this to the next administration, that means this year’s election could well decide how many rural hospitals close their doors. Tate Reeves, the current lieutenant governor and a front-runner in the governor’s race, is unequivocally on record against Medicaid expansion. The other major candidates in that contest and in the lieutenant governor’s race either support expansion or at least have a somewhat open mind to the idea.

The outcome in November could not be more critical for rural hospitals and the communities they serve.

(1) comment

Charlie

The public knows what’s pushing our hospital to the brink of closing. We the people know what goes on in our community, And our hospital, Blow your smoke somewhere else.

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