After Congress repeals ACA, state still confronts public health care realities

Published 2:00 am Sunday, January 8, 2017

What is the future of public health care in Mississippi if Congress proceeds with the Republican majority’s plan to do away with the Affordable Care Act?

Mississippi’s sad litany of chronic health problems are now familiar — diabetes, heart disease, obesity, and the highest infant mortality rate in the nation — as is the state’s status as the poorest U.S. state.

Sarah Varney of Kaiser Health News in exposed some of our state’s lesser known but even more cruel health ironies, observing that Mississippi has the nation’s highest rate of leg amputations while one of the nation’s lowest rates of simple blood testing, used to monitor and prevent diabetes complications.

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Even sadder was Varney’s finding that our state has high breast cancer death rates despite a relatively low incidence of breast cancer diagnoses. The fact is that by the time many cases were diagnosed, the cancer had advanced too far.

Just as well known in government circles is the fact that despite those health care challenges and the unrelenting poverty that exacerbates them, Mississippi avoided the Affordable Care Act or “Obamacare” like the veritable plague.

The proposed Medicaid expansion that was part and parcel to ACA got the same cold shoulder. In 2014, Mississippi Gov. Phil Bryant said: “For us to enter into an expansion program would be a fool’s errand. I mean, here we would be saying to 300,000 Mississippians, ‘We’re going to provide Medicaid coverage to you,’ and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that. We have no way to continue the coverage.”

Now, after the Republican takeover of the U.S. Senate and the election of Republican Donald Trump as president, Bryant may soon be a political prophet if the new Republican majority in Congress makes good on the stated intent of many to repeal the ACA.

In 2013, Bryant defined his perception of the issue in Mississippi more succinctly: ““Medicaid expansion puts another 300,000 Mississippians on the Medicaid rolls. We have 640,000 people on Medicaid. That is 940,000 Mississippians on Medicaid. We cannot financially sustain that.”

Bryant’s assessment also plays to many legislators who know all too well that that perhaps the single most difficult thing for them to do and survive politically is to first extend a service to a constituent and then a few years down the road take it away.

Mississippi’s decision not to expand Medicaid under ACA left around 138,000 Mississippians without Medicaid coverage by Kaiser Family Foundation estimates.

Despite that, total Medicaid spending in Mississippi (adjusted for inflation) over the period 2000 to 2012 doubled from $2.6 billion in 2000 to $4.6 billion in 2012. For the same period nationally, Medicaid spending in the U.S. grew from $263.7 billion to $429.2 billion.

Based on those numbers, the study proved Medicaid spending in Mississippi grew over that period by 76 percent while the national growth rate in Medicaid spending was 63 percent.

If Congress dispatches the ACA, the fact remains in Mississippi that public health care is the second largest expenditure by the states after they pay for their educational systems.

Mississippi’s poverty dictates that demand for public health care in this state is not likely to decrease. Therefore, the wild card then becomes the cost of uncompensated care, which is also subsidized by taxpayers and health insurance ratepayers.

Historically, Mississippi has offered a more generous public health care program than state taxpayers truly funded — paying the difference with the three federal dollars the state receives for every dollar paid in federal taxes.

So the public health care questions in poor states like Mississippi become what is next for public health care and who pays? Mississippi taxpayers — both state and local — may well not like the answers.

Sid Salter is a syndicated columnist. Contact him at