In all the chaos of 2020, the 2018 special election that saw former U.S. Rep. and Agriculture Secretary Mike Espy returning to vie for national office seems a distant memory. That contest is a prologue to this fall's rematch, one that touched on vastly different themes than those now troubling the nation.
Of all the issues separating Espy from his opponent, Republican incumbent Cindy Hyde-Smith, their approach to health care may represent the starkest divide. Certainly, it is the most resonant question in a year of anxiety and agony over the pandemic and the state of America's public health. Medicaid expansion, a critical issue in last year's statewide elections, looms large above all else but coronavirus.
Espy sat down for a video chat with the Jackson Free Press to discuss the topic of health care: both his plans for achieving Medicaid expansion in Mississippi and his thoughts on the state and national response to the coronavirus pandemic.
You've stated that health care is your top priority and central to that is Medicaid expansion. Why is Medicaid expansion the achievement you say you want to be remembered for?
Well, health care is the number-one issue in the campaign for the simple reason that it's the number-one problem in Mississippi right now. We have incredibly awful health-care outcomes—obesity, hypertension, heart disease. All these things can be reduced with preventative care.
And the reason in Mississippi that so many people lack preventative care is because they are reticent to go to the doctor. And that's because they don't want to get a bill that they can't pay. So even when they have an emergency and go to the doctor and there's a bill, they still can't pay it.
So now you have a bill that the rural hospital is sitting with that they didn't cover. So they have reason to close.
This one problem—if we were able to do something material and significant about this one problem, we would already do these things: We would undergird the rural hospitals, and we would close the chasm for uncompensated care.
(The hospitals would) have more reason to stay open. Number two, we would have more people with the confidence and the assurance that they could be seen medically, if they were able to have an emergency, they would be able to avail themselves of preventative care. And the third reason is that it's going to drop the cost of medical care in Mississippi and the cost of prescription drugs.
All those three things we could do right away if we had Medicaid expansion. I think Medicaid expansion is a fundamental tenet of Obamacare. In the majority of states in the country, they already have it. As Mississippi taxpayers we paid federal taxes; part of our tax bill goes to pay the cost of Medicaid expansion for California, Arizona, Massachusetts.
So why don't we have it? And now our sister states that are also similarly conservative, Oklahoma and Missouri, have now seen the light—they voted on a referendum for Medicaid expansion. If we were able to do this, we would cover almost a quarter million Mississippians in one fell swoop.
We would give people the confidence that they would have medical insurance, those that are under-insured ... and we could help the rural hospitals stay open. So that's why this is the number-one issue in the campaign. And that's why, if I'm fortunate enough to be a U.S. senator, it's going to be the number-one thing that I'm going to try to tackle.
Gov. Tate Reeves and your opponent, Sen. Cindy Hyde-Smith, oppose Medicaid expansion on both fiscal and ideological grounds. Reeves has said explicitly that one of his chief fears about Medicaid expansion is that it leads to more Americans depending on "government health care." Is this a meaningful fear to you?
That to me is an irrational fear, because I don't want government health care—meaning Medicare for All. I don't want a single-payer system. I believe in competition. In the health-care industry, I want to be able to go to Canada and compete for drugs. I believe that if you have your own doctor and your own medical insurance, and you like both of those, you ought to be able to keep those.
What I want to do is focus on the low-income folks that are unable to pay for their health care because they don't have insurance. So I think in your example with Gov. Tate Reeves, I think that's irrational because we're always going to have, in my estimation, a private system. We should have a private system; it's always going to be there. So we don't have government health insurance for everybody. We shouldn't have it.
I've had countless conversations with public-health leadership from across Mississippi during the pandemic, and whenever I bring up Medicaid expansion, what I hear is "I can't speak on that because that's a political question." But can we speak about health care without speaking about politics?
Yeah, because it's for everybody. If you're black (or) you're white, I mean, it involves everybody. I can speak to it explicitly without involving myself in politics, because I almost died of an asthma attack when I was 5 or 6 years old.
I didn't ever know that I was going to be in politics. I had no idea that I was going to ever be in Washington at all. All I knew is that I ended up comatose with an asthma attack, ended up in a hospital without a canister of oxygen.
My father had to run to the whites-only hospital called King's Daughters in Yazoo City, and beg them for an available canister of oxygen. So we could take it and hook me up to that ventilator, and that's why I'm living today. So this is something that just should be done irrespective of whether you are Republican or Democrat, Black or white. It's a matter of improving health care for everybody.
I can speak about it in a non-political context, because if you're white or you're Black, if you're Republican or Democrat or Independent, you want your children and your grandchildren to just have a better life. So this is something that everybody wants irrespective of your party.
Plus, if you have a preexisting condition, you don't want to be involved in a system that denies your comfort. That is just fundamentally unfair. The insurance company that you pay your premiums to should be forced to cover your preexisting condition. I just think it's a moral issue. It's an issue of fairness and it's an issue of right and wrong, and that's not political.
In terms of process, what does securing Medicaid expansion for Mississippi look like?
Alright. Let's say I'm Senator Espy in January of 2021. ... Knowing that this thing would more easily pass through votes of the Mississippi Legislature—and those are hard to come by—I would go to the Mississippi Legislature, and I would ask, as a new senator from Mississippi, to sit down with them. Then when I would come in the room, I would bring with me a health-care expert and an economist. And within our conversation, I would do my best to influence these leaders, to tell them that it's helpful to reducing costs.
It's helpful in reducing health-care outlays, and it's better for the entire state. Then I would bring in people from Missouri and Oklahoma to tell them that similarly conservative states that also might've been reticent to do it, because it was a function of Obamacare, they got beyond that. It was just something they could do to help everybody.
I would do my best to inform them, cajole them, entice them to take this on as an expansion effort. However, if that wouldn't work I would do two things. I would go back to Washington, and I'd say OK, there's some reluctance in Mississippi to ask for expansion from the local level. Maybe a reason is that the State cannot afford the 10% copay.
So what I would do as a federal legislator is try to waive that 10% copay. Where a hundred percent of the cost of Medicaid expansion would now come from the federal government. I think I could do that.
Let's say I couldn't do that. So then I would do my best if I was on the Appropriations Committee, (or) some relevant health-care financing committee, I would use the stick. Then I would use the leverage as a senator to maybe force the state Legislature to consider the fact that it's going to have less Medicaid funding unless they accepted Mike Espy's wish that they would expand it by 100%. So you have a carrot, and you have a stick.
The carrot is me trying to influence them through logic, and the stick is returning to Washington and trying to use leverage to prevent funding for Medicaid without the expansion.
And that's what I would do.
The stick aside, I get the sense from you that you have faith in the collaborative approach. It seems the current Mississippi Legislature and some of their disagreements with the state's administration might mean they could embrace a collaborative approach.
I was in the State Senate gallery a month ago, and I watched the debate over the Confederate flag. I was sitting there pinching myself. I would've never thought that this would have happened so soon. I mean it happened literally (right) after the Black Lives Matter movement; you could count the days until this happened.
To me the past is prologue. I never thought that would've happened in a conservative, red Senate and House.
So why can't this happen as well? Oklahoma did it, Missouri did it, other states are now doing it. I think we're the third domino to fall. I really do.
COVID-19 has defined 2020 like no catastrophe in living memory. How would you grade our preparedness for this pandemic, and how would you grade our ongoing response?
Preparedness from the federal level, or preparedness from a state level?
You could talk about both, because they intersect.
All right. Well, I want to separate that. First of all, on the federal level, that's an F. We have a president who denied this from the inception. He said that it was a Democratic hoax. He said that it would magically disappear. He said that it involved a couple of people coming from China. He said that he's going to close the border, and by Easter everything's going to be fine. He said a lot more that I don't want to repeat.
But the fact is that (Donald Trump) did all of that without sitting down with his medical professionals, sitting down with the CDC and (National Institute of Allergy and Infectious Diseases Director Dr. Anthony) Fauci, and coming up with a coordinated national plan.
In order for this thing to really be arrested, in order to suppress the spread, we had to make sure that we would do something that was coordinated through at least the 48 contiguous states. Because we all traveled frequently state to state to state, there was no way for this to be confined without some sort of a cohesive, coherent, coordinated national approach. And he did not do that, so I'm going to give him an F. And then his sycophant Cindy Hyde-Smith did almost as badly because when he (President Trump) said it was a hoax, she said, and I quote her, "Oh, this is going to be over in the matter of a couple of weeks."
Well, that was just wrong. It was denial, and it was wrong. So that was a time they could've spent actually sitting down with Dr. Fauci and coming up with an approach that would make some sense, not just washing the hands and social distancing and wearing masks, but making sure that on a comprehensive basis we could shut down parts of the United States, and we wouldn't have to sequester ourselves until this thing passed over, and then we could have automatically come in with a CARES Act. We could have followed the advice of the chairman of the Federal Reserve board when he said this is not something to play with.
He said we have to put the accelerator down and spend what is necessary to provide for the support of the American people while we went through this pandemic, and they did not do that. So I'm going to give this a concrete F.
So what about Mississippi?
Now on the state side, I will say, I'm going to give that a C minus. That's because Tate Reeves did listen to Dr. Dobbs. Until he stopped.
And he did listen to LeeAnn Woodward from (the University of Mississippi Medical Center). I remember she had a press conference, and she said, "I'm really afraid that we're going to be overcome in Mississippi with our beds being filled to capacity." ... And I noticed that after she said that, things began to move. I think Tate Reeves began to listen to her—until he stopped.
I was reasonably confident that we would come out of this without spiking. But then we stopped. We shut down too late and we opened too early. Now we have a mask mandate—and I'm happy that we do, I wish we'd had this a month ago, so we could have prevented the communal spread a lot more easily, and I don't think our numbers would have been like they were. Then when it comes to the CARES Act, I applaud that. I think it should have happened more quickly. I think they should have spent more money like the Chairman of the Federal Reserve board exhorted us to do, and I don't think they should stop now.
They watched and fought about what should be in this third package. Look, anything that makes sense, put it in the third package. More PPE and all of that. I think Cindy Hyde-Smith is stalling. I think that as Trump fails, she's failed. I think that she's waiting on her signals from (Senate Majority Leader) Mitch McConnell, and Mitch McConnell is part of that F, so I'm going to give him that F as well.
So I give her an F, I give Trump an F, and I give the state effort a good try. So now we have the relief in the U.S. Senate. I just wish they would just go ahead and get about the Lord's work and just go ahead and finish. Cindy Hyde-Smith is in there stalling. She's voting to take dollars out of the workers' pockets.
They're fighting over $200. You know, it was $600, now it's $400. It ought to be $700. I think Mississippi already has the worst rate of unemployment compensation in the nation. We're so low it's embarrassing. So now they're fighting about $200. I wouldn't fight about it. I would listen to medical science, I would listen to doctors. I would do what was necessary to move us back.
The fear coming from leadership right now is the notion that if you extend some of these unemployment benefits that you push people away from seeking work. Again, legitimate fear or not in your eyes?
Certainly not a legitimate fear. The Mississippians that I know, the Mississippians that I speak with every day, they want to work. They need to work. They're not trying to avoid any labor. My goodness, I mean, if you're gainfully employed, it provides much more than an income. It provides family support. It involves reduction of stress. It helps you become less ill, you know? So that is a ruse.
I think it's something that we've been hearing in different contexts all of our life. I'm going to compare this with what (former Gov.) Phil Bryant did when it came to supporting the low-income persons in the Mississippi agency that dealt with job training.
So here's federal money for job training, here's federal money to get unemployed people a GED to help them get a job, help them write a resume, help them have more confidence and build their capacity, and we have people like our governor and others who were able to corrupt that program for the good of others, I'll say it that way.
Then they say that welfare is for people who don't want to work, so it's just a canard. It's the same branch of a poison tree. That's why it is not reasonable.
Let's go back to the pandemic preparedness plan. You're not saying there are fundamental changes that you would have made, but that you would have done all these actions far sooner and far longer?
I would have listened to the doctors. If Dr. Fauci or Dr. Dobbs would have been with me, I would turn to my right, I would turn to my left, and I would have done whatever they said. Shut it down. Put on masks. Socially distance. I just would've done it. I would've done whatever they would've advised and I would have done it earlier.
Whatever it costs. I would have been on the side of those who would have checked that mark. Because I thought we were going to do well at one point, but here we are now in the middle of August and we're spiking. We are the worst in the nation when it comes to a rolling average of daily positives. ICU beds are filling up again.
Rural hospitals are at risk of closing, and it's just so utterly unnecessary. I'm no genius. I would have followed the advice of those who are geniuses, like Dr. LouAnn Woodward. I think she is a genius, and I would've followed her advice.
Dr. Woodward told me at the end of last week that she feels very strongly that we need to keep schools delayed until after Labor Day. What are your thoughts on Mississippi returning to school, to sporting, to all of these events?
Well, number one, if we had followed CDC guidelines earlier, we would not be in this situation. Look at New York. Everybody was talking about (how) New York was the worst. Now it's the best.
It's only because they did what had to be done. It was strict and stringent, but they shut that state down, and now they can open that state up.
I wish we had done the same in Mississippi. But now that we haven't, I'm not in favor of shutting the state down again. I'm not in favor of sequestering people and having them go back into their homes. I think now that horse is out of the barn. That horse is gone.
And I wouldn't want to bring it back to the corral. But the schools, using that same analogy ... the horse is not out of the barn. I don't want to open it. So we now know that children can spread this virus. If an infected child goes to school and infects the teacher, the teacher goes home, the child goes home to grandma and mom and dad, and here we go again.
I would much rather listen to Dr. Woodward and Dr. Dobbs. I heard them say we shouldn't open up the schools this early, so I wouldn't do it. I would listen to their sage advice. I would make sure that we monitor the situation and not open up until at least after Labor Day. And wait until this spike passes over us. Then I would begin to ease up opening.
There's a very stark racial inequality to the coronavirus crisis. You spoke about your direct experience with medical racism. To what degree does it manifest today, and what can we do about it?
In many ways. We know that there's a disparity in the effects of the coronavirus, because we see an inordinate amount of African Americans who are dead and who are dying.
That's because we have had a drastic lack of investment in medical care in Mississippi for generations. This is a legacy problem, and it manifests itself today. That's why we have so much heart disease. That's why we have so much obesity.
That's why we have so many maladies that people impute to African Americans for many reasons. Lack of diet, lack of exercise, lack of income. So you're not able to afford the healthiest fruits and vegetables, can't afford medical insurance. That's why exactly I'm trying to go and give them Medicaid expansion. In many ways, the health impact on Black Mississippians is even more acute than Mississippians of any other ethnicity. I've seen it.
I had my asthma attack when I was 6 years old. That was 60 years ago. Shy Shoemaker from Chickasaw County died last year. An African American woman—she had an asthma attack, and the ER that she was used to going to was closed because of lack of funding.
It's amazing to think that the problem I had 60 years ago when I almost succumbed to an asthma attack, despite the technical advances over the last 60 years, if you look at Shy Shoemaker, she still died. A young African American woman.
What is needed to protect Mississippi's rural hospitals, and how can the system be reformed to support them?
Beyond Medicaid expansion ... what I would do is provide financial incentives for medical students after graduating medical school to fund their student debt if they have any.
If they don't have any, I would provide them a stipend, on the condition that they will go to Itta Bena, that they would go to Clarksdale, to Greenwood, Greenville, that they go to Cleveland County in the Mississippi Delta, the other areas of Mississippi that are medically underserved and serve them for at least two or three years, almost like the Peace Corps and the Job Corps. I would make sure that they were funded to an extent that was very, very attractive.
A lot of these places tend to have surprisingly attractive salaries and benefits for some of these individuals. Is there an incentive or program beyond the financial that tries to provide these services-tries to build this health-care infrastructure where there currently is none?
You're talking to someone who's actually done this—for the last 25 years I've worked on this issue, ... I've been a member of a nonprofit in Mississippi. It's very, very large. We're capitalized now at about $400 million. And we support health care in Mississippi, Louisiana, Tennessee, Alabama and Arkansas in the low-income areas.
We go into medically underserved areas and build clinics and hospitals, do it based on the New Market tax credits, given to us from wealthy people who want a tax credit—and we do it through grants and loans from the U.S. Treasury Department and the USDA Rural Development Administration.
So we take that money, and we look at these five states and say where are the areas that are medically underserved?
Where with doctors, even though you're coming into an area with a lot of distractions, let's say, it's first-class medical facilities. Paid for by this nonprofit. That's what I'm doing already.
So it's not something that I want to do. It's something that I'm doing already. ... So that's the best we can do to build medical infrastructure in these rural areas.
State intern Julian Mills contributed to this report. Email tips to [email protected].