The Boston Globe’s Christopher Rowland looks at why Mississippi Governor and potential presidential candidate Haley Barbour (R) is so vigorously opposed to expanding the state’s Medicaid program, which could result in “new Medicaid benefits flowing to 300,000 to 400,000 Mississippi residents.” In a phone interview with the paper, Barbour made it clear that he doesn’t believe that the state — which has an 18 percent uninsurance rate, 28 percent poverty rate and suffers from very high instances of obesity and chronic diseases — is experiencing a health access problem. Residents just need to eat better and exercise, he maintains:
“There’s nobody in Mississippi who does not have access to health care.” … Hospitals and doctors in the state routinely provide charitable care, he said. Residents also can get care from clinics such as the one by the side of Route 49 in Yazoo City, as well as larger and better-equipped community clinics scattered around the state. And Barbour pointed to his efforts in the Mississippi Legislature, unsuccessful so far, to win passage of a voluntary insurance exchange where small businesses and individuals could shop for insurance at discount rates. [...]
“Most of the health disparities in Mississippi are not because of the inability to get access or afford health care,’’ said Barbour. “They are because of diet, alcohol, because of drugs, the very high incidence of illegitimacy that leads to high incidence of low-birth weight children.
“I grew up in a society where if it wasn’t fried you were asking, ‘Why not?’ If it was good you would make it even better with a lot of sugar and butter on it.’’
He added that substance-abuse prevention and encouraging healthier diets do not require a massive expansion of Medicaid.
An ounce of prevention is worth a pound of cure, but expanding access to coverage would actually improve access to preventive services and help tackle the high instances of chronic conditions in the states. In fact, the health law actually provides enhanced Federal Medicaid matching funds to States that offer evidence-based prevention services.
What baffles providers in the state is why Barbour is turning down a deal under which the federal government — because of the expansion to Medicaid under the Affordable Care Act — “will pick up 100 percent of the cost of the Medicaid expansion from 2014 to 2016 and 90 percent of the cost after 2020.” It’s true that the state will have to spend extra dollars to cover the expanded population, but those services are worth paying for in a state where many people “earn too much to qualify for Medicaid but not nearly enough to purchase private insurance” and go without needed medical care. Barbour estimates that the state’s share of expanding the Medicaid eligibility umbrella, “while starting at zero, could climb to as much as $237 million a year by 2020 — when the state would have to start picking up 10 percent of the cost.” That’s a good investment — a tiny share of the total price tag — and well worth it for the benefit of expanding access to care for hundreds of thousands of residents and reducing the heavy costs of uncompensated care that hospitals and doctors now have to provide.
In fact, it’s far more sensible than the current system in which every resident of Mississippi has access to care in the emergency room. Barbour is right on that point, but he can’t possibly think that having uninsured individuals flock to the emergency room for something that could have been handled in a primary care setting or addressed through preventive care is a smart or efficient use of taxpayer dollars.