Brookhaven resident Washuma Murphy faces more than $3,500 in medical bills every year, without the benefit of medical insurance. Doctors diagnosed her 12-year-old son, Devon Murphy, with Sturge-Weber Syndrome at age 2, a deformity that restricts blood flow in his brain and causes frequent, severe seizures.
"Insurance companies won't cover him because of his condition," Murphy said. "They don't have to, so they don't. Blue Cross/Blue Shield told me they would cover him, but it would cost $400 a month, and I can't afford that."
Devon used to qualify for Children's Health Insurance Program money, but Murphy's new $38,000 wages as an LPN moved her out of the poverty-level bracket required for CHIP. She also no longer qualifies for Medicaid.
Murphy's new job at a Hazlehurst nursing home hardly softens the blow of the repeated emergency-room visits. Devon has seen the inside of an emergency room twice this year, racking up an average of $1,500 a visit, including doctor bills and separate service charges. And he has frequent outpatient visits. Murphy must also pay out of pocket for Devon's seizure medication.
To the Rescue?
More than half a million Mississippians—600,000 individuals—have no health insurance. The U.S. Census Bureau reports that the number of Mississippians with no insurance rose almost 25 percent from 2005 to 2006, and now includes about 20 percent of the state's population—a 120,000-person jump from the 2005 census number of 483,000. The number of children without insurance increased even more sharply—up 72 percent—from 85,000 in 2005 to 2006's proud number of 146,000.
"The state of Mississippi's uninsured is dismal," said Mississippi Health Advocacy Program Director Roy Mitchell. "The average cost of a health insurance premium for a family of four is $12,000 a year, and businesses either don't offer insurance at all or it's not affordable, and it's putting more and more people into a dangerous situation."
The numbers create a tumultuous environment for debate in a state attempting to frame itself as a giving, compassionate region. Gubernatorial candidate John Arthur Eaves capitalized on the situation recently, submitting a plan to provide health insurance for all Mississippi children under 18.
"We need a new approach to health care based on prevention," Eaves said in a released statement. "We all know it's a whole lot cheaper to prevent an illness than to treat it, and that it's cheaper to pay for a visit to the family doctor than to the emergency room. We should focus on cutting costs up front instead of paying for them after the fact."
Eaves submitted a plan called Kid Care, which is modeled after the Illinois program, All Kids, created by Illinois Gov. Rod Blagojevich in 2006. Eaves said his Kid Care program will cost Mississippi $197 per child per year—or about $29 million, with 100 percent statewide enrollment.
The program relies on parents paying premiums and co-payments, based on their annual income and number of children. A two-parent family with one child and an income of about $50,000 will pay $70 a month, up to an annual maximum of about $500, and make a maximum co-payment of $100 a year. A single-parent home with one child and an income of less than $27,380 pays no monthly premium, and a maximum annual co-payment of $100. Wealthier parents have less incentive to apply for the state program. A two-parent household with one child and an annual income above $111,605 will pay a monthly premium of $300 per child, and have no co-payment cap, should they choose to enroll in the program.
Murphy, with her income of less than $40,000, would be in the Level 2 bracket. Her monthly premium would be $70, and her maximum co-payments $500 a year.
For the vast majority of the state, the plan is far less expensive than the average annual $1,400 health insurance policy covering one healthy minor, because 20 percent of Mississippi citizens are below the nation's poverty line. Under Eaves' formula, the individual co-payments and premium payments will put an estimated $166 million back into the state coffers, reducing what would otherwise be a $195 million program to about $29 million a year.
'A $100 Million Mistake'
Division of Medicaid Communications Director Francis Rullan said Eaves' formula is starting out with the wrong numbers. "Eaves relies on numbers that are from the Census Bureau that were taken as a survey, and survey numbers aren't as accurate as hard data numbers," Rullan said.
Eaves describes his program as a tweak in the existing program under SCHIP, the State Children's Health Insurance Program. He says the only difference is the expanded coverage available through the sliding-scale co-payments and monthly premiums from participating parents. The program estimates the state getting $1,333 per child from the federal government, but the Mississippi Division of Medicaid released data earlier this year showing that in fiscal 2006, 63,547 Mississippi children received SCHIP benefits that cost $124.2 million—or $1,954 per child. The difference amounts to a $621 per child annual increase between the state's numbers and Eaves' figures.
Barbour spokesman Brian Perry called the discrepancy "a $100 million mistake" in an Associated Press article, explaining that Eaves' plan "doesn't add up."
While coming up short on one end of the formula, Eaves' people say the plan over-accommodates on another. The Eaves formula projects that taxpayers would pay $28 million annually with almost 150,000 children enrolled. Reduce that number to the more likely initial enrollment figure of 50,000, and the state pays less than $10 million.
Eaves spokeswoman Sharon Garrison said the program has many variables. "If you look at Illinois in the first year, it wasn't every single, uninsured kid in the program that first year. It was about 50,000 kids. But there are about 150,000 to 200,000 potential beneficiaries in that state, so many didn't join. The figure we submitted predicts that all 146,000 eligible kids will join, but they won't. If you have lower enrollment, you're going to have lower costs," Garrison said.
Barbour's campaign reacted to Kid Care by unleashing the "new taxes" bogeyman, with Barbour telling an audience at Biloxi's Saenger Theater that Eaves' plan will "raise taxes" and charged his opponent with not knowing enough details. "He's not saying everything," Barbour said. "He isn't telling you that (his plan) will raise taxes."
Barbour's campaign has since framed the voluntary enrollment plan as a new tax on the middle class, claiming "middle-class families will get less but pay far more under the Eaves' plan," according to Perry.
Eaves' campaign is short on details regarding how the plan will deal with annual fluctuations in the number of beneficiaries and the availability of federal money, though he argues the plan will largely finance itself through the savings of preventive maintenance that it provides.
"We don't need any new taxes because we already pay to take care of the uninsured, and switching to a preventive model will save the state money," Garrison said. "A doctor's visit for the sniffles costs much less than an emergency-room visit for bronchitis."
Where's Barbour's Plan?
More discouraging to Roy Mitchell, however, is the fact that the "nit-picking" governor is offering no alternative plan of his own to curtail the rising population of the state's uninsured.
"Eaves' plan, like any plan, is a starting point for discussion, but we have gotten nothing from the current administration," Mitchell said. "The governor has never been a fan of inclusion when it comes to the state's children and the Medicaid rolls."
Barbour is disdainful of anything smelling faintly of "socialized" health care on the national level. The governor bucked the trend of governors all over the country last week by telling Mississippi congressmen and senators to vote down Congress' proposed SCHIP, which provides health insurance coverage to children in low-income households.
President George Bush is fighting the Democratic Congress' attempts to expand the SCHIP program. Bush and congressional Republicans compare the expansion of the program to encouraging a form of socialized medicine run by the ubiquitous demon of big government—evoking two of their favorite chimeras at once. Only 22 percent of U.S. adults share that view, according to a recent Harris Interactive Survey. Fifty-eight percent of adults agree with expanding the program, the same survey found.
Count Barbour among the 22 percent. He claims he directed the Mississippi delegation to oppose the expansion because it would strain funds going to Mississippi.
"Even a proposed new funding formula would leave Mississippi's (fiscal year) 2008 federal allotment nearly $100 million short of the amount needed to cover all children under 20 percent of the federal poverty level," Barbour said in a press statement. "In other words, Mississippi would still be shortchanged by an enormous amount of money."
Mary Troupe, executive director of Mississippi's Coalition for Citizens with Disabilities, was in Washington last month, helping to force the SCHIP funding bill through the House. Troupe said Barbour's reasoning was flawed.
"I don't see how his argument adds up, and Barbour's never fully explained it," Troupe said.
Other motivations may go unmentioned. One of the methods Congress proposed to finance the SCHIP expansion is a federal increase on cigarette taxes. Barbour is a former tobacco lobbyist who allegedly still gets $300,000 annually from the tobacco-representing lobbying firm in Washington still bearing his name, according to Bloomberg News. (Barbour refuses to disclose details on his association with the firm.)
Of Mississippi's delegates in Washington, only Rep. Bennie Thompson ignored Barbour's plea. Troupe and others eventually convinced the House to pass the legislation, without the support of the Mississippi delegation. The Senate approved the bill last week, though Bush vetoed it last Wednesday, without the usual fanfare with which he surrounds his vetoes.
Barbour's unfriendliness to government health intervention goes back a little further on the state level. In 2004, the governor proposed a plan, approved by the Legislature, to cease Medicaid health coverage to 65,000 low-income retirees and permanently disabled Mississippians, known as Poverty-Level Aged and Disabled, or PLAD, beneficiaries. The legislation also required the state to seek a waiver from the federal government to provide limited Medicaid coverage to some of the freshly booted beneficiaries.
The governor argued that the waiver would allow the state to continue coverage for the most vulnerable of PLAD recipients, though legislators and health advocacy groups warned that the substitute coverage would be woefully insufficient. Many senior citizens with fixed incomes—who had largely supported Barbour during his election—opposed the move. Senior citizen advocates AARP even joined the Mississippi Center for Justice and some legislators in filing a successful lawsuit demanding that the state and Barbour reverse the legislation. Barbour's stance delivered a hit to his poll numbers in 2004.
Then in 2005, the governor instituted a "face-to-face" re-enrollment policy for SCHIP and Medicaid, requiring every government-funded health-care recipient to annually meet in person with a Medicaid representative to re-certify their eligibility. Barbour, again, bucked the trend of most of the rest of the country in this, with 47 other states abandoning the practice entirely.
Rullan defends the practice as a logical step in helping Mississippians help themselves. "Other states don't end up on the top of the hypertension list, on top of the diabetes list, on the top of the heart attack list like our population does," Rullan said. "(Division of Medicaid) Executive Director (Bob Robinson) says that doing the same thing over and over again while expecting a different result is the definition of insanity. We're no longer just paying the bills of sick people. We're trying to put into effect a holistic approach to wellness, and to do that you have to be able to change people's expectations. Poor health should not be an inter-generational legacy, like it has been since the beginning of the Great Society program, because if (a poverty-fighting program) does work, then why is it that there are more poor people now than there was back then?"
The tactic is effective—at dropping the Medicaid rolls, in any case. A 2006 annual report from the Division of Medicaid shows that Medicaid beneficiaries dropped from 621,394 recipients in 2005 to 605,157 recipients in 2006. The same data indicates CHIP beneficiaries dropped from 67,470 to 63,547 that same year. Rullan attributed the drop to a "better economy," explaining that "when you have a better economy, fewer people are qualified for the program." The Medicaid 2006 annual report contradicts Rullan, characterizing the decrease as "primarily a result of Medicaid program changes related to face-to-face eligibility re-determinations."
'What Chaps My Ass'
Mississippi currently ranks 49 in terms of overall health-care quality and No. 50 in terms of infant mortality. Rep. Steve Holland, D-Plantersville, links those numbers to the governor's policies.
"Here's what chaps my ass about 'face-to-face,'" said Holland, chairman of the House Health Committee. "They called it an exercise in eliminating waste, but that ain't what it's about. Hell, I don't want anyone on Medicaid who shouldn't be there, but this was more a chance to automatically get them off so they could say, 'look, what we've done. Look what conservative government has brought you. We've trimmed the Medicaid rolls down.' What they do is you get your three (warning) letters, and then they drop your ass if you can't show during work hours. It's really more of a way to harass these people than anything."
Holland caught grief in 2004 after sending the contentious PLAD bill out of his committee, lamenting (very loudly, at the time) that the division was gearing up to sunset and that he put the bill on the books "only to keep the department solvent and out of direct control" of the governor's office. Holland and Rep. Jamie Franks, D-Mooreville—who is running for lieutenant governor—later joined AARP and others in successfully overturning the PLAD law in federal court.
Holland accused Barbour of wanting to set a painfully low threshold on all state social services. "That's just the way the state is run these days. We didn't even re-apply for a $1 million Robert Wood Johnson Grant, which was ours for the asking for Medicaid outreach, because that's how insensitive they are to the idea of outreach. They don't want to reach out," Holland said. "We had the grant for three years under Musgrove, but (Medicaid Executive Director Bob) Robinson and the Division of Medicaid dropped it."
Rullan said that slip was accidental, blaming the loss of the grant on high turnover at the department. "We've had six executive directors in seven years. When you have six directors, you have six executive teams that come in, and they have to learn what's going on with the program and put their own agendas in place, and you don't do that in a year, or even two years," Rullan said.
Holland said Robinson's motivation is shiftier than that. "I remember when Robinson told me that the (Robert Wood Johnson Foundation) had done away with the grant, but when I called the foundation, they said nobody from Mississippi had applied," Holland said. "And that's the administration's mindset right there in a nutshell."
Mitchell said the state even sabotaged its own efforts to expand health-insurance coverage to its uninsured in 2006 when it shelved an extensive report by the Lewin Group of Virginia.
The Division of Medicaid created a 37-member blue ribbon task force to develop a portrait of the state's uninsured. Using federal Health Resources and Services Administration money, the Division of Medicaid commissioned Virginia-based Lewin Group to analyze alternative approaches to expanding health-insurance coverage. Analyzing reports from two major state universities, the report outlined a buy-in program that would extend coverage to 90,000 Mississippians, without costing the state a dime, according to Mitchell, by allowing Mississippians to buy into a program at lower-than-market rates. The state never officially released the report to the public, however.
"Nothing in regards to the final report was posted on the Internet. I called over there asking for a copy of it, and even though I was one of the participants in the project, spending hours and hours of personal time working with the state on this, they insisted I pay $100 for a copy of the thing," Mitchell said.
Rullan said the state never released the report because it was flawed. "The flaw of the report is that there isn't any way of determining how many people are insured in this state; therefore, how can you determine how many are uninsured," Rullan said, discounting the fact that the report was based on Census data.
John Sheils, of the Lewin Group, helped devise the report. Sheils said he stands by the information he helped compile.
"Many government and private agencies base information in their reports on Census data. Census data is sometimes the only information available for such purposes, unless individual states compile their own information, and many states don't have the resources to do that," Sheils said. "I certainly wouldn't discount the report because it was based on Census information."
Rullan said the information in the report was also piecemeal. "Medicaid had a grant to determine how many uninsured there were, so they put Mississippi State and the University of Southern Mississippi on (the task). Both came up with voluminous reports, so we hired the Lewin Group to decipher (the report), but the Lewin Group, instead of sharing it with us, decided to give it to this advocacy group that released selective parts of it without telling the whole story," Rullan said.
Mitchell denies his group cherry-picked report results. "There was no part of the report we'd want to hide. One of the authors came down and did a PowerPoint presentation of the whole report for a Cover the Uninsured week event," he said. "(Rullan) can spin that any way he wants to, but that was $1.2 million in federal money buying that report, and then they shelved it. They deliberately concealed it. That's the kind of indifference the state's uninsured are up against, and if Eaves wants to try to take on the problem, he'll be one of a small handful willing to do it, because it's a Herculean task."
The whole Medicaid/CHIP thing is so frustrating. While folks are going back and forth arguing about what to do, there are sick people who need help NOW. What are they supposed to do in the meantime?
excellent story, adam. from my perpesctive public health policy should be THE issue of the governors race.your story has the barbour administration portrayed as miserable ideologues.
I was trying to find the appropriate place to blog this issue: MIKE ESPY ENDORSED HALEY BARBOUR. Poor Mikey. He got caught eating some of that REPUBLICAN POISON (MONEY) and now it is time to pay the piper. This was a cheap, backdoor deal.
You know, I'm reminded of another of those Espy boys who did a last minute back-door deal with a group of Whites. He actually promised to turn back the hands of time on Affirmative Action, if they would financially support and vote for him.
Then there was Chucky Espy, nephew of Mike Espy. Rumormill had it that most of the money that financed his campaign, when he ran for Congress and against Benny Thompson, was given by Republicans. I know that anyone should have the RIGHT to VOTE/ENDORSE anyone he/she chooses; however, realizing that Mike has spent many Democratic dollars in the past and was supported by Democrats and was finally vendicated from the Washington mess, while serving as the first African-American Secretary of Agriculture, this is more than a slap in the face.
The QUESTION IS: Who is the real MIKE ESPY and WHO DOES HE SERVE?
Too funny, Justjess! I remember when Mike's people were soliciting money for his defense. I told them I'd rather burn mines than send any to Mike. He was never "for the people," no matter the commercial.
- Ray Carter