Standing inside a shuttered hospital’s abandoned emergency room in Newton County, Miss., on Monday night, Democratic candidate for governor Brandon Presley blamed Gov. Tate Reeves for the fact that more than half of the state’s rural hospitals are in danger of closing.
“This is the reality that Tate Reeves has chosen to put us in. Make no mistake, he made this choice,” Presley, a public service commissioner who hopes to unseat Reeves in this year’s elections, said in a video he released on YouTube Monday night.
Earlier that day, Reeves had delivered his annual State of the State address on the Capitol steps in Jackson, where he reiterated his opposition to expanding Medicaid—a policy that many state health-care leaders, Democrats, and some Republicans say would save lives and prevent more ailing hospitals from closing.
“Instead, seek innovative free-market solutions that disrupt traditional health-care delivery models, increase competition and lead to better health outcomes for Mississippians,” Reeves said. “Do not settle for something that won’t solve the problem because it could potentially and only temporarily remove the liberal media’s target on your back.”
As in past years, no Medicaid expansion bill survived the legislative deadline for lawmakers to pass one out of committee. Within 24 hours of Reeves’ address, multiple Medicaid-expansion bills died, including Democratic and Republican-sponsored bills that would have allowed residents to vote on the issue in a referendum.
“If hospitals continue to close, the impact will be catastrophic—jobs lost and health care for thousands gutted,” Presley said in his response to Reeves’ speech. “Every time we close a rural hospital, folks have to drive farther and farther to see a doctor, and the true, sad fact is that some will die.”
Presley confirmed to the Mississippi Free Press that he filmed his address inside Pioneer Community Hospital of Newton, which closed in December 2015, as the Meridian Star reported at the time. Reeves was lieutenant governor and president of the Mississippi Senate from 2012 to 2020, when the Newton hospital and five others ceased operation.
“It is emblematic of what is happening throughout the state,” Presley told the Mississippi Free Press this week.
A press release from the administrator of the center at the time stated that the closure was due to Centers for Medicare & Medicaid Services’ re-interpretation of their Critical Access Hospital distance requirement regulation.
The 2015 rule stated that a “CAH must be located more than a 35-mile drive from any hospital or other CAH.
“The loss of the CAH designation makes the operation of the hospital no longer financially feasible,” the press release said.
In November, Mississippi State Health Officer Dr. Daniel Edney told lawmakers that 38 rural hospitals, or about 54% of all rural hospitals in the state, could collapse. Hospital leaders in the state have urged lawmakers to expand Medicaid, saying that without it, rural hospitals will continue to suffer financial losses from treating uninsured patients.
“When these individuals need health care, hospitals are required to treat them regardless of their inability to pay,” the Mississippi State Medical Association said in a statement earlier this month. “And because these individuals are uninsured, the hospital is not compensated for necessary care. Such an economical strain on hospitals is not one that even the most successful private business could not endure.”
‘Can We Call It Trumpcare?’
During his State of the State address on Monday, Gov. Reeves told Republican lawmakers not to “cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine.” (The governor often invokes “socialism” when criticizing ideas or opponents, including his 2019 Democratic and Republican challengers).
Reeves frequently calls Medicaid expansion “Obamacare expansion,” referring to the fact that funds come from the Patient Protection and Affordable Care Act that former President Barack Obama signed into law in 2010.
In April 2021, SuperTalk host Paul Gallo asked Rep. Becky Currie, a registered nurse and Republican lawmaker who sits on the Mississippi House Medicaid Committee, why she thought state leaders were continuing to turn down federal money to expand Medicaid.
“Well, because it has Obamacare, the word Obamacare—people have attached Medicaid expansion to Obamacare,” she replied. “And you know, how I look at it is, it went through four years of Trump also. So can we call it ‘Trumpcare?'”
But the leader of Currie’s chamber, Mississippi House Speaker Philip Gunn, takes a hardline against expansion. On SuperTalk Mississippi radio Wednesday afternoon, Gunn suggested the Legislature will not take dramatic steps to save the ailing hospitals.
“I think the model for health care has got to be changed in the rural areas. There’s just not a population base to support full-blown hospital care,” Gunn told host Gerard Gibert. “I’ve actually had conversations with people in the rural area who agree with that and acknowledge that.” Gunn is a board member and past chairman of the American Legislative Exchange Council, which opposes Medicaid expansion and writes conservative legislation for state legislatures.
In recent months, Reeves, too, has argued that hospital closures are a natural result of population declines in rural areas, like the majority-Black Mississippi Delta.
“The fact of the matter is, the delivery of care today and going forward is going to be a little different than what the delivery of care was in rural areas in Mississippi and across America, due in large part to some of the changes that have been made by the federal government,” the governor told WDAM last month. “We’re also seeing population shifts in our state, and you know In the Mississippi Delta for instance, we lost approximately 20% of total population in the Mississippi Delta from 2000 and 2020, so therefore the delivery of care there is going to have to be adjusted as well.”
Mississippi is one of just a dozen states that have declined to expand Medicaid. Despite representing less than a quarter of the country, states that refused to expand Medicaid accounted for 74% of all rural hospital closures between 2010 and 2021, an American Hospital Association report found last year.
Though the governor framed Medicaid expansion as a media fixation, polls in recent years have repeatedly found that a majority of Mississippians favor expanding Medicaid. A June 2021 Millsaps College/Chism Strategies survey found that Mississippians said they “support expanding Medicaid in Mississippi” by a 55%-27% margin.
More recently, a January 2023 Mississippi Today/Siena College poll found that about 80% of Mississippi voters said the State “should accept federal funds to expand Medicaid,” including 70% of Republicans and 95% of Democrats.
“When Tate Reeves finally wakes up and asks why hospitals are closing, he should look in the mirror,” Presley said in his video from the shuttered Newton hospital on Monday. “And this hospital is just one example of how Tate Reeves and his policies are hurting our families.”
Reeves Wants to Repeal CON Laws
During his address Monday, Gov. Reeves said that, instead of expanding Medicaid, Mississippi lawmakers should repeal regulations, known as Certificate of Needs laws, that require approval from the Mississippi Department of Health to build new facilities and make changes to existing ones.
“We are all frustrated and worried by the threats that some hospitals may close,” the governor said. “The first step should be allowing new ones to open.”
“By reforming Mississippi’s Certificate of Need laws, we can root out anti-competitive behavior that blocks the formation of medical facilities and prevents the delivery of lifesaving healthcare to Mississippians,” he continued. “Because, at the end of the day, the real answers to our problems are not contained in the same old proposals that only serve to delay the inevitable at the expense of taxpayers. The real answer to our problems lies in innovation.”
The Mississippi Department of Health says on its website that “Mississippi’s Certificate of Need process plays a central role in planning the state’s health facilities, based on need for services, location, size and other factors.”
“The CON process is designed to increase accessibility and quality of health services while avoiding unnecessary costs.”
Reeves previously told the Mississippi Free Press on Jan. 3 that CON laws are “particularly bad in metro areas like (Jackson) because competition is already here.”
“But I would submit to you that if we quit telling those potential competitors that they can’t open, then we would find ourselves in a market that worked far better,” he said.
The American Medical Association, which advocates for Medicaid expansion, published a document in 2015 offering what it called “evidence for repeal” of CON laws. A 2011 Journal of Health Care Finance study found that CON laws “reduce the number of beds at the typical hospital by 12%, on average, and the number of hospitals per 100,000 persons by 48%.”
‘Mississippi Is At The Bottom’
In his address Monday, Gov. Reeves boasted about economic gains under his leadership, including “$6 billion in new capital investment in 2022.”
“Since 2019, we’ve raised per capita personal income in Mississippi by approximately $7,000, or almost 18%,” he said. “We are boosting the money that Mississippi families are bringing home—especially right now, as we combat rising inflation from wasteful spending in Washington, D.C.”
Presley is unconvinced, noting in his response that “Mississippi is at the bottom of the nation for economic growth,” and that “the numbers recently released by the Bureau of Labor Statistics show zero job growth in Mississippi.”
In the BLS report on Jan. 24, the agency reported that Mississippi’s unemployment rate fell from 4.7% in December 2021 to 4.0% in December 2022; the national unemployment rate is 3.5%. Mississippi’s employed population increased by 4,900 between December 2021 and December 2022, the report showed. Still, Mississippi remains the poorest state in the country, with 18% of its residents living below the poverty line.
Presley and Reeves will both compete in their respective party primaries on Aug. 8, 2023. The Democratic candidate faces a challenge for his party’s nomination for governor from Gregory Wash and Bob Hickingbottom, while the incumbent Republican governor faces a primary challenge from Dr. John Witcher and David Grady Hardigree.
Primary elections for all of Mississippi’s legislative and statewide offices, including governor, are
Aug. 8, 2023. The general election will follow on Nov. 7, 2023. Voters must be registered at least 30 days before a primary, general election or runoff in order to cast a ballot.
Ashton Pittman contributed to this report.