Ellington

Mississippi Gov. Phil Bryant exposed his ideology to the world in a recent interview with Kaiser Health News. He demonstrated just how strongly he believes in conservative memes defining who gets government assistance and why.

Among Bryant's assertions is that giving low-income people access to health insurance is a disincentive to bettering their lives, echoing back to President Ronald Reagan's mythical "welfare queens," who allegedly lived high off the hog on public assistance.

"It's free, and you have nothing else to do," Bryant said. "...There is very little incentive ... to find a better job, or to go back to school or to get (into) a workforce training program because they say, 'Look, if I go over $33,000, (I) will lose Medicaid.'"

No evidence exists that people with health insurance are complacent or unmotivated any more than Reagan had evidence of people buying brand-new Cadillacs with their welfare checks. Instead, overwhelming evidence shows that healthier people are more productive. They're less likely to take time off--or lose their jobs--due to illness.

The $33,000 that Bryant cited approximates the 2012 national poverty level for a family of six. That's far from a comfortable living for that many people, even in Mississippi where the cost of living is low. In states that choose to expand Medicaid under the Affordable Care Act, families of four with household incomes of $30,656 will be eligible to receive benefits.

Bryant's logic, that low-income people are lazy "takers," feeds conservative opposition to Medicaid expansion. What it completely ignores is that America's health-care costs are completely out of proportion to our health. We spend twice as much as any other country for health care, yet, in comparison with other "rich" countries, our health is worse, and we die younger. Pre-publication summaries of "U.S. Health in International Perspective: Shorter Lives, Poorer Health" (The National Academies Press, 2013, $72)," place America dead last among 16 nations in numerous markers including maternal death, deaths of children 5 years old and younger, and deaths from preventable illnesses such as heart and lung disease.

In presenting the book's conclusions to reporters, Steven Woolf, director of the Center for Human Needs at Virginia Commonwealth University, said that our resistance to providing health care to more Americans "may work against our ability to achieve optimal health outcomes."

Bryant vehemently disagrees with how the ACA would make health care possible for currently uninsured low-income Mississippians. By his reasoning, more privatization of health care is the way to go,.

"I would rather pay extra to Blue Cross (to help cover uncompensated costs for the uninsured), rather than have to raise taxes to pay for additional Medicaid recipients," he said, although he did not say how additional funds for insurance companies would be generated. "Medicaid recipients multiply their visits to a physician. It's clear once someone goes on Medicaid, the number of times they go to a physician doubles, quadruples."

Evidence shows that insured people do go to doctors more often. That's exactly the point. Health-care experts say that increasing regular doctor visits will give the U.S. a healthier population. Access to regular health care positively affects health outcome. "Uninsured people generally receive much less care, either preventive or for acute and chronic conditions, than insured people," states an April 2010 issue brief from Mathematica Policy Research, Inc., a New Jersey-based think tank.

Bryant also stated: "There is no one who doesn't have health care in America. No one." His rationale? Anyone can go to an emergency room. ERs, though, are the most expensive and least effective way to deliver care.

"Because uninsured people are less likely to have a usual source of care, they generally have poorer control of chronic conditions, such as hypertension. ... (or) have a usual source of care (for) regular checkups," the Mathematica brief continued. "As a result, they have more emergency department visits and report greater short-term reductions in health; if they return to full health, they take longer to do so."

From an economic standpoint, Mississippi stands to get much more than it spends if it expands its Medicaid program, said Rachel Garfield, senior researcher and associate director of the Kaiser Commission on Medicaid and the Uninsured, in a Jan. 24 presentation to legislators sponsored by the Mississippi Health Advocacy Program.

"Mississippi can draw down more than $14 (in federal funds) for every $1 (it spends) under the expansion," she said. The cost to Mississippi to receive $14.5 billion in new federal subsidies over the next decade is an increase of $1.2 billion over the next 10 years, Garfield said.

Those funds, paid mostly to health-care providers, will flow into the state's economy in the form of new jobs and economic opportunities, such as Bryant's goal of making Mississippi the nation's center for premium health care (with federal help). It will also give low-income people a better chance to live healthier and more productive lives.

Let's face it: Far from the governor's portrayal of the state as ruggedly independent from the federal government--"I am not going to violate the federal law if I believe that law to be fair," he said--as the poorest state in the nation, Mississippi is heavily dependent on federal dollars. From 1990 to 2009, Mississippians paid $164.7 billion in federal taxes and received $404.6 billion in federal funds, an imbalance of $239.9 billion in Mississippi's favor, reported The Economist magazine in 2011. Only New Mexico and Puerto Rico received more, proportionately..

Another side to the ACA equation is the lower amount of money going to hospitals for uncompensated care--much of it from the ER care Bryant advocates for the uninsured. Because the law anticipates an increase in patients covered under Medicaid, it reduces the amount of funds paid under the Disproportionate Share Hospital program. Without expansion, Mississippi hospitals stand to lose millions. Some hospitals in rural areas depend on Medicaid and DSH payments for 90 percent of the care they provide, said Gwen Combs, vice president of policy for the Mississippi Hospital Association, last month. Without those payments, approximately $210 million last year, hospitals will be forced to reduce services and lay off staff. At worst, some will close their doors.

Mississippi hospitals could see 300,000 new patients with insurance by expanding Medicaid. If not, "you've got all the cuts coming and none of the potential," Combs said.

Bryant and the state's lawmakers should carefully consider the reality of just maintaining the status quo--both in economic and human costs--for the poorest, least healthy citizens in America. The ACA isn't perfect, but it is a step forward. Careful consideration would, of course, require setting aside some ideological dogma, and we've seen precious little of that from Mississippi's Republicans, including Bryant, so far.