Consensus Perspective Needed on Medicaid

Perspectives, hmmm.

“It is the obvious which is so difficult to see most of the time,” wrote Isaac Asimov. “People say ‘It’s as plain as the nose on your face.’ But how much of the nose on your face can you see, unless someone holds a mirror up to you?”

A conservative Republican legislator, speaking about Medicaid cuts, shared this perspective with Mississippi Hospital Association members, “some don’t think government should be involved in health care at all.”

Prominent social conservatives like Gary Bauer also reflect this notion. While “liberals have traditionally been seen as standing up for the weak and the vulnerable,” said Bauer, “conservatives can be just as empathetic. But they believe that, in most cases, it’s not government’s role to be the primary dispenser of empathy.”

Other conservative mirrors, however, reflect a different perspective. As C. S. Lewis wrote, “For what you see and hear depends a good deal on where you are standing: it also depends on what sort of person you are.”

Even Mississippi’s old 1890 Constitution reflects a role for government in caring for the insane, indigent, and “those persons who, by reason of age, infirmity, or misfortune, may have claims upon the sympathy and aid of society.” (See Sections 86 and 262).

Sen. Roger Wicker appears to support an active role rather than no role. Last week he told MSNBC, the Senate is working to give the 50 states greater say in how Medicaid works, “while also preserving the system that was meant to protect poor children and disabled people.”

Wicker’s perspective no doubt reflects that of most Mississippi conservatives. Turns out lots of them have elderly relatives in Medicaid funded long-term care facilities. This includes many not-so-poor conservatives who pragmatically move nursing home costs to Medicaid by transferring their elders’ assets to other family members.

“Our country is great because it is built on principles of self-reliance, opportunity, innovation, and compassion for others,” reflected Ronald Reagan.

It was Reagan who, in 1986, created one of the most intrusive roles of government in health care. He signed the Emergency Medical Treatment and Active Labor Act (EMTALA) that requires all hospitals that accept Medicare and Medicaid payments to provide people emergency room care “regardless of ability to pay.”

Missing in action are social conservatives willing to undo the government’s intrusive EMTALA dictates, despite the abusive and costly use of emergency rooms by patients with no emergency medical conditions.

Also missing in action are conservatives willing to have government pay for the free care EMTALA requires hospitals to provide, which puts many Mississippi hospitals in financial jeopardy.

This was particularly evident last week when Gov. Phil Bryant’s Division of Medicaid ignored Mississippi hospitals’ proposal to provide managed care for Medicaid recipients, a proposal designed to keep money in Mississippi to help offset losses from uncompensated care. Instead, millions in fees for Mississippi Medicaid managed care will continue to flow to out-of-state vendors.

While most may join with Reagan and Wicker in seeing an active role for government in health care, our state and nation are far from a consensus perspective, especially regarding Medicaid.

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Voters Are Sovereign except When They Aren’t

Strong words from Governor Phil Bryant in his state-of-the-state address back in January:

“To the taxpayers who hear this message, rest assured your Governor recognizes that you are sovereign. You, by the power of your vote, grant us the authority to govern. The Mississippi Constitution makes clear that, ‘All power is vested in and derived from the people.'”


In this vein many legislators cite the 2001 public vote as good reason to retain Mississippi’s controversial state flag. “The people have spoken,” they say.

So, people are sovereign and speak through their votes.


How, then, can legislators ignore the people’s vote in 1992 in favor of a state lottery?

Just one of several examples suggesting most legislators’ thinking on the lottery isn’t terribly rational.

There are those who sincerely contend that gambling is bad. Okay, then how does Mississippi justify having legalized casino gambling, bingo gambling, and, just recently, fantasy sports betting?

And, there’s that special committee Speaker of the House Philip Gunn appointed to get the facts about a lottery. Surely similarly sized Arkansas generating about $85 million in state revenue from its lottery would dominate discussion. However, the committee, chaired by Rep. Richard Bennett of Long Beach, seems not too interested in Arkansas, but very interested in how much money Mississippi loses from residents traveling to neighboring states to purchase tickets. Bobby Harrison with the Northeast Mississippi Daily Journal reported Bennett has the Legislature’s PEER Committee “trying to figure that out,” along with how much Mississippians may be spending on gasoline and other items while they buy the tickets.

Legislators’ thinking on the lottery is peculiar at best.

Maybe that’s because Mississippi casinos don’t want a lottery and they have great sway with legislators. Yes, the Mississippi Gaming and Hospitality Association, as Geoff Pender with the Clarion-Ledger wrote, is not, as yet, actively opposing a lottery as they have in the past. But, (it’s always the “but” that matters) MGHA wrote Gov. Phil Bryant a letter that said, “In addition to avoiding unintended and potentially harmful consequences, our members would like to ensure there is ample time to study the economic impact (of a lottery).”

Oh, they also want to make sure casinos can sell lottery tickets should one be approved.

The Governor had considered adding the lottery to last week’s special session, but after the MGHA letter and other push back, he decided not to.

In his January state-of-the-state address, the Governor suggested it might be time to institute a lottery. Referring to heavy traffic on the Mississippi River bridge, such as that headed to Delta, LA, he said, “We can no longer contain the people’s desire for a lottery; we can only force them to travel.” Then in February, as he made one of his many mid-year cuts to the state budget, he again spoke up in favor of a lottery as a way to boost revenue.

Interestingly, most Republican legislators don’t seem inclined to listen to their Governor, much less to sovereign voters.

There are exceptions, like Rep. Mark Baker of Brandon. Read his lottery guidance here:

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American Politics Declining into Profiteers vs Moochers

Americans now live in a political environment dominated by extremes.

One burgeoning faction, looking through red tinted lenses, seeks “freedom from.” Another, looking through blue tinted lenses, seeks “access to.” A fading faction, looking through clear lenses, fears all will become tinted.

The grassroots conservative movement sees national government as the great enemy and seeks freedom from oppressive taxation and regulation, while the grassroots liberal movement sees national government as the great provider and seeks access to expanded government succor.

No representative democracy can survive for long with either extreme in power. Indeed, our founding fathers, whom Providence blessed with the uncanny collective ability to see through clear lenses during the stressful birthing of our nation, designed the U.S. Constitution to force balance among extremes. They put in place checks and balances, deliberately gave different roles and representation to the House and Senate, limited the power of the federal government, and mitigated the power of the majority through the first 10 Amendments.

Regrettably, those willing and able to peer through clear lenses to protect us from extremism are fading away. Red and blue tint has seeped into most of our institutions and the processes by which our leaders are chosen. Even judges, the intended ultimate stronghold of clear-seeing patriots, are now chosen based on their tinted views of the law. Our Constitution’s intent for balance is largely ignored.

The founders also intended for this Providence favored nation to be steeped in virtue. The growing and intense hatred of conservatives for liberals and vice versa – Americans all – shows America’s virtue is fading too.

All this, essentially, because of greed.

Ayn Rand schooled us about greed in her 1957 epic work “Atlas Shrugged.”  Looters and moochers she called them, the profiteering businesses and non-productive masses who thrive off the accomplishments of productive citizens and siphon off their opportunities for prosperity.

A great irony for grassroots conservatives is that they may become the victims in this political environment, not the grassroots liberals who portray themselves as victims. The freedom dogma attractive to so many sounds good, but if established will primarily benefit the profiteers who fund the tinted foundations and advocacy groups spreading this creed. Big business profits would soar exponentially more than livable wages and broad prosperity.

On the moocher side, we already see government unable to sustain Social Security, Medicare, Medicaid and other entitlement programs at current levels, much less at the expanded programmatic and funding levels desired by grassroots liberals.

Government’s role is not to benefit either looters or moochers, but to bring competing politics into balance so as to determine the appropriate level of taxation and regulation needed to sustain the national defense, commerce, homeland security, and public safety while providing adequate support for the general welfare. Representative democracy expects the push and pull of politics, but relies on clear-eyed patriots of good will from all sides who will come together to provide balanced government.

Sadly, there is no mood for compromise between the red and the blue, nor much good will. A nation cannot be indivisible and under God, or debt free, without both.

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Mississippi Back on Bottom in Senior Health Rankings

Mississippi is getting older. No, this is not about our Bicentennial, but our people.

Since 1980 Mississippi’s total population increased 18.5% but the population of residents aged 65 and older jumped 43.3%.  This pushed the median age up from 27.6 years in 1980 to 36.5 years in 2015. Over that time, the percentage of population aged 65 and older moved from 11.5% to 14%.

Guess what, health rankings rate Mississippi the worst place to be old.

The United Health Foundation just released its latest America’s Health Rankings – Senior Report. This is the fifth annual report. In the first two reports, Mississippi ranked 50th. We got off the bottom for two years. Now, we’re back again, dead last in senior health.

The foundation says it publishes the senior health report to encourage “continued conversations among policymakers, public health officials and community leaders” and to drive “action to promote better health for our nation’s seniors.”

The report subtitle was “A call to action for individuals and their communities.”  We’ll have to see if Mississippi is paying attention.

The report does treat Mississippi kindly. It doesn’t spotlight our bottom ranking. Rather, it says we’re one of the three states “with the biggest opportunities for improvement.”  Nice twist. Kentucky (#49) and Oklahoma (#48) join us in these opportunities.

The rankings are based on 34 measures of senior health distributed among five categories. The categories and our ranking in each were: Behaviors (45th); Community & Environment (50th); Policy (41st); Clinical Care (47th); Outcomes (45th).

Interesting that our policies outrank our provisions for seniors.

The report included several lowlights and a few highlights for Mississippi:

Lowlights: In the past three years, food insecurity increased from 20.5% to 24.3% of adults aged 60+; in the past two years, volunteerism decreased from 25.3% to 20.3% of adults aged 65+; since 2013, obesity increased from 27.9% to 30.8% of adults aged 65+.

Highlights: In the past three years, preventable hospitalizations decreased from 85.8 to 67.8 discharges per 1,000 Medicare enrollees; in the past two years, poverty decreased from 14.3% to 12.5% of adults aged 65+; since 2013, the percentage of adults aged 65+ with no disability increased from 54.0% to 57.4%.

We ranked in the bottom 10 on 17 of the 34 measures and in the top 10 on only two.

The bottom 10 measures were: physical inactivity, obesity, dental care, poverty, volunteerism, community support, food insecurity, number of geriatricians, health screenings, hip fractures, hospital deaths, hospital readmissions, preventable hospitalizations, percent able-bodied, self-reported high health status, premature deaths, and teeth extractions.

The top 10 measures were: excessive drinking, with only estimated 3.9% of seniors indulging at that level; and pain management, with 50.6% of seniors with arthritis who reported that related pain does not limit their usual activities.

Oh, the top five states for senior health were Minnesota, Utah, Hawaii, Colorado, and New Hampshire. The top ranked state in the cluster around Mississippi was Alabama at 43rd.

The state and national turmoil surrounding healthcare funding suggests our ranking is unlikely to improve any time soon.

Stay healthy my fellow seniors.

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Are State Leaders Ready for Big Cuts in Federal Funds?

Topnotch finance experts assess risks and plan for downturns as diligently as they evaluate and promote upside opportunities.

Mississippi’s economy has become more reliant than ever on federal funds. Should President Donald Trump and conservative leaders succeed in their plans to slash federal spending, the risks to our state economy would be substantial, if we aren’t ready.

So, do our state leaders have topnotch experts assessing risks facing state finances? If so, what do their forecasts show should federal dollars decline dramatically? And what are our leaders’ plans should the cuts come true?

The President’s guiding light for federal spending cuts appears to be the Heritage Foundation. Its “Blueprint for Balance: A Federal Budget for Fiscal Year 2018” calls for another base closure round (BRAC), cuts to food stamps (SNAP), auctioning off TVA, cuts to FEMA, cuts to Medicare, Medicaid, and Veterans’ benefits, cuts to Earned Income Tax Credits and Additional Child Tax Credits, and eliminating Head Start, the National Endowment for the Arts, the National Endowment for the Humanities, the Economic Development Administration, the Appalachian Regional Commission, Americorps, SSI benefits, rural airport subsidies, all WIOA job-training grants, and much more. Long-term recommendations include cost-cutting reforms to Social Security, Medicare, Medicaid, and education.

Read the entire document here:

Then, consider these facts.

Mississippi’s Joint Legislative Budget Committee Budget Bulletin for fiscal year 2017 showed $8.3 billion, or 44%, of Mississippi’s $18.9 billion total budget funded with federal dollars. That’s up from $3.5 billion, or 35%, of Mississippi’s $9.9 billion budget in 2000.

Indeed, the latest Tax Foundation rankings had Mississippi moving to the top as the government most reliant on federal aid.

But the money flowing through state government is a small part of the overall inflow of federal funds to Mississippi.

The Bureau of Economic Analysis (BEA) showed over $27 billion in transfer payments to Mississippians for 2015, more than double the $11.5 billion for 2000.

These are mostly federal funds transferred through government programs to benefit individuals. The programs include Social Security, Medicare, Medicaid, SNAP, SSI, Veterans’ Benefits, Earned Income Tax Credits, Temporary Assistance for Needy Families, unemployment benefits, and education grants and benefits … all targeted for cuts under the Heritage plan.

In addition to transfer payments, funding for Mississippi’s federal employees and federal contracts would be at risk. The National Priorities Project reported that 53,720 people in Mississippi worked for the federal government in 2014 bringing in about $3.9 billion in federal funds. The think tank also reported the federal government paid about $3.8 billion to vendors to perform contracts ranging from supplying the military with weapons to building websites.

The Pew Charitable Trusts estimates 32.9% of Mississippi gross domestic product (GDP) comes from federal spending.

Surely state leaders are not ignorant of the economic risks posed by proposed cuts and are readying plans to cope with what Washington decides?

They owe it to taxpayers to reveal their readiness and plan details.

Standard and Poor’s, Fitch, and Moody’s credit rating services, which have recently issued negative outlooks on state finances, probably want to know too.

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Who Cares about Health Care in Mississippi?

Mississippi finishes last – again – among all states in annual health ranking,” read the December headline in the Biloxi Sun-Herald. “Mississippi dropped to dead last this year among all 50 states in the annual ‘America’s Health Rankings’ released by the United Health Foundation,” continued the story. “As one of the nation’s poorest states, Mississippi has a legacy of poor health because poverty is often a driver, and consequence, of bad health.”

How did our state leaders respond to this finding? Here are the latest stories:

Mental Health to lay off 650 workers by June 30, 2018,” read the Mississippi Today headline. “The Department of Mental Health announced plans this week to eliminate 146 jobs at two state facilities as the agency struggles to close a $19.7 million budget gap in 2018,” the story said. “These cuts are the first wave in a total of 650 layoffs the agency said it will need to make by June 30, 2018. Central Mississippi Residential Center in Newton and East Mississippi State Hospital in Meridian will cut 52 positions and 74 positions, respectively. In addition, Central Mississippi will close its Footprints Adult Day Services program and its crisis stabilization unit while East Mississippi plans to consolidate its adolescent psychiatric services program with one at Mississippi State Hospital in Whitfield.”

Health Department looking to streamline,” read the Northeast Mississippi Daily Journal headline. “Public Health districts will be reduced from nine to three to deal with budget cuts, state Health Officer Mary Currier explains in a YouTube video,” the story read. “The Health Department was budgeted $36 million in the 2016 session, which already represented a cut of about $4 million. But in reality, as a result of mid-year budget cuts Gov. Phil Bryant made because revenue collections were not meeting projections, the Health Department will receive $31 million for the current fiscal year instead of the $36 million approved by the 2016 Legislature.”

UMC cuts 195 jobs, eliminates 85 positions in budget cut,” read the Mississippi Business Journal headline. “The University of Mississippi Medical Center today announced it is cutting 195 jobs and eliminating another 85 positions in action to address a recent $32.7 million budget cut, part of budget cuts ordered by Gov. Phil Bryant,” the story read.

Lawmaker: State budget ‘robbing Peter to pay Paul’,” read the Clarion-Ledger headline, quoting House Appropriations Chairman John Read. “Medicaid: Keep level at about $919 million but only $60 million of its reported $90 million deficit is being funded for the current year,” the story said.

Well, it certainly appears health care in the unhealthiest state is not much of a state priority.

Add to this the crisis overwhelming rural hospitals and the picture looks even worse. Sid Salter recently quoted Andy Taggart on this. Taggart helped conduct in-depth research on Mississippi’s rural, government-owned hospitals:

“Unless fundamentally reorganized from the ground-up and combined with a larger sustainable delivery system, we believe that the vast majority of these hospitals and their associated health care services will ultimately become financially unsustainable and unable to meet an acceptable standard of care.”

Stay healthy, my friends.

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Controlling the Kudzu of State Spending

One of my many anonymous critics on the Jackson Jambalaya blog zapped me last week over my column “A Peek behind Legislative Leaders’ Rhetoric.” In particular, he/she said I lack “a coherent alternate plan” of my own.

Well, I never guessed it might be a columnist’s job to propose a whole budget plan. But, an avid reader could find elements of such a plan already published. Let’s take a peek.

Last month I suggested rightsizing the Legislature by cutting it in half. That step alone would signify legislators are serious about cutting non-essential programs.

In February I wrote about rightsizing universities. By raising admission standards, moving all remediation to community colleges, and eliminating subsidies for out-of-state tuition, enrollment would fall, thereby reducing IHL’s need for more state funding, higher tuition, and more bond money. Previously I supported consolidating university back-office and administrative functions.

Back in 2010, I wrote, “There are no operating or financial reasons for eight universities and 15 community colleges – or 142 state agencies, 152 school districts, 82 counties, and 200 plus municipalities for that matter – to maintain separate back room operations.” Since, I have written favorably about limiting school districts to one per county, thereby consolidating financial, administrative, transportation and other non-classroom services to reduce costs.

I agreed with Governors Phil Bryant and Haley Barbour on their proposals to allow state agencies exemptions from personnel regulations to rightsize their workforces. I supported Barbour’s calls to consolidate school districts and to reduce tax-dollar support for school athletics and community college sports.

I have written numerous times about the excessive costs of our broken PERS system. Charging employers 15.75% of wages is exorbitant. That’s at least $350 million too much per year, most of it coming from state funds. Reducing this burden on taxpayers should be a priority.

There’s more, but maybe you and my critic can sense what I think a coherent spending plan should include.

The key is this – to effectively reduce and control government spending, legislatively mandated changes in targeted agency/institution operations must occur in tandem with budget cuts. Just squeezing budgets won’t work.

As I have written many times over the years, businesses can readily merge and/or shut down unproductive operations, but not government. That’s because government behaves more like kudzu than business. Despite attempts to prune it back, it just grows and grows.

Experts say control of kudzu requires a process to kill or remove the kudzu “root crown” and all “rooting runners.”

That’s legislators’ great dilemma. Every agency has a “root crown” – a powerful legislator, state official, or business group. All have “rooting runners:” take on university funding and you take on the alumni; Cooperative Extension Service funding and you take on the county agents and their friendly farmers, foresters, tomato growers, and quilters; school funding and you take on parents, teachers, and their formidable allies; and so on.

Squeezing agency/institution budgets isn’t so hard. But, a focused plan that takes on root crowns and rooting runners to consolidate/eliminate targeted operations is too hard for most politicians.

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