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(MUSIC)
>> HI, I'M DR. RICK DESHAZO.
THANKS FOR JOINING US FOR THIS
SPECIAL EDITION OF SOUTHERN
REMEDY.
OUR MISSION HERE IS A HEALTHY
MISSISSIPPI AND WE WORK HARD TO
ADDRESS ALL OF THOSE TOPICS
THAT AFFECT THE HEALTH OF
MISSISSIPPIANS.
ONE ISSUE HAS PEOPLE ALL OVER
THE STATE TALKING: MEDICAID.
IT'S COMPLICATED, IT'S WONKY
AND YOU MIGHT THINK IT'S
SOMETHING FOR POLITICIANS TO
FIGURE OUT.
BUT YOU'RE WRONG.
FROM THE VERY BASICS ON HOW IT
WORKS TO THE WAY PROPOSED
CHANGES COULD AFFECT IT,
THERE'S INFORMATION YOU NEED TO
KNOW.
>> IT HAS BEEN ONE OF THE MOST
CONTENTIOUS TOPICS IN RECENT
MISSISSIPPI LEGISLATIVE
HISTORY: MEDICAID AND MEDICAID
EXPANSION.
BUT WHAT IS IT, AND HOW DOES IT
APPLY TO YOU?
RIGHT NOW, MEDICAID PROVIDES
HEALTH INSURANCE COVERAGE TO
OVER 600,000 MISSISSIPPIANS.
THESE PEOPLE USUALLY ARE, VERY
SIMPLY PUT, DISABLED, YOUNG
CHILDREN OR PREGNANT WOMEN.
THE MAJOR DEBATE RIGHT NOW IS
WHETHER OR NOT TO OPEN THE
PROGRAM TO POTENTIALLY 300,000
MORE PARTICIPANTS.
>> MEDICAID PROVIDES VERY BROAD
COVERAGE AND FOR THOSE
BENEFICIARIES, YOU BASICALLY
CAN'T BUY A POLICY AS
COMPREHENSIVE.
>> MEDICAID COVERS JUST ABOUT
EVERYTHING YOU MIGHT NEED IF
YOU'RE SICK AND UNABLE TO GET
AROUND EASILY: THINGS LIKE
DOCTORS OFFICE VISITS AND
HOSPITAL CARE TO PRESCRIPTION
DRUGS AND EYEGLASSES.
EVEN HOME HEALTH CARE AND
TRANSPORTATION TO AND FROM
DOCTORS OFFICES IF YOU DON'T
HAVE A WAY TO GET THERE
YOURSELF, AS LONG AS YOU FALL
INTO CERTAIN CATEGORIES.
>> RIGHT NOW, IN ORDER TO BE
ELIGIBLE FOR MEDICAID, YOU HAVE
TO MEET BOTH INCOME CRITERIA
AND CATEGORICAL CRITERIA.
SO YOU NEED TO BE VERY LOW
INCOME, IN ADDITION, FIT INTO A
CATEGORY.
THOSE CATEGORIES ARE CHILDREN,
PREGNANT WOMEN, AND SOME
PARENTS.
THE ELIGIBILITY LEVELS FOR
ADULTS ARE QUITE LOW, BOTH
NATIONWIDE, AND IN PARTICULAR
IN MISSISSIPPI.
FOR EXAMPLE, IN THE STATE, IF
YOU ARE A PARENT AND YOU'RE
MAKING MORE THAN HALF THE
POVERTY LEVEL, WHICH THE
POVERTY LEVEL IS ABOUT $11,000 A
YEAR, YOU ARE NOT ELIGIBLE FOR
MEDICAID COVERAGE.
IF YOU ARE AN ADULT WITHOUT
CHILDREN, YOU ARE INELIGIBLE
FOR COVERAGE REGARDLESS OF YOUR
INCOME.
>> CURRENTLY, OVER 600,000
MISSISSIPPIANS GET THEIR
COVERAGE THROUGH MEDICAID.
THAT'S ONE IN FIVE PEOPLE IN
THE STATE AND BECAUSE OF THAT,
MEDICAID IS ALSO A HUGE SOURCE
OF REVENUE FOR MISSISSIPPI.
>> THE FEDERAL SHARE OF
MEDICAID COSTS IS DETERMINED
THROUGH A FORMULA THAT IS SET
IN LAW AND BASICALLY, THE WAY
THE FORMULA WORKS IS THE LOWER
THE STATE'S PER CAPITA INCOME,
THE LARGER THE SHARE THE
FEDERAL GOVERNMENT PAYS.
SO, MEDICAID IN MISSISSIPPI
RIGHT NOW IT'S CLOSE TO 80% OF
THE COSTS ARE BEING PAID BY THE
FEDERAL GOVERNMENT.
IT GOES TO PROVIDERS, IT GOES
TO HOSPITALS, IT GOES TO
PHYSICIANS, IT GOES TO NURSE
PRACTITIONERS, IT GOES TO
CLINICS, ALL OF THE HEALTH CARE
PROVIDERS THAT ARE GOING TO SEE
THESE INDIVIDUALS.
RIGHT NOW, WHEN PEOPLE DON'T
HAVE INSURANCE COVERAGE, THEY
EITHER GO WITHOUT SERVICES,
MOST TYPICALLY, OR WHEN THEY DO
NEED TO SEEK SERVICES, ARE
FACED WITH EITHER PAYING IT OUT
OF POCKET OR SIMPLY ARE UNABLE
TO PAY THAT BILL.
>> IN 2010, THE AFFORDABLE CARE
ACT WAS PASSED IN WASHINGTON,
ALLOWING MEDICAID EXPANSION
ACROSS THE COUNTRY.
IT WAS BOTH APPLAUDED AND
REVILED.
THE LAW WAS CHALLENGED IN THE
SUPREME COURT, AND IN 2012, THE
SUPREME COURT UPHELD THE ACT
WITH A FEW CAVEATS.
PREVIOUSLY, THE LAW SAID THAT
ANY STATE WHO DID NOT EXPAND
MEDICAID WOULD BE PUNISHED BY
HAVING ALL OF THEIR MEDICAID
FUNDING TAKEN AWAY.
THIS PART OF THE LAW WAS STRUCK
DOWN BY THE SUPREME COURT AND
OPENED THE DOOR TO THE
POLITICAL SHOOTOUT THAT HAS
BEEN HAPPENING IN MISSISSIPPI
AND ACROSS THE NATION SINCE.
ANOTHER STICKING POINT?
DISPROPORTIONATE SHARE HOSPITAL
PAYMENTS OR DISH PAYMENTS.
>> UNCOMPENSATED CARE IS PAID
FOR BY THE DISPROPORTIONATE
SHARE HOSPITAL PAYMENTS, WHICH
ARE SET TO BE REDUCED, NOT
ENTIRELY ELIMINATED, BUT
REDUCED UNDER THE AFFORDABLE
CARE ACT, REGARDLESS OF WHETHER
THE STATE EXPANDS.
THAT REDUCTION OVER THE SAME 10
YEAR PERIOD TALKED ABOUT IS
ABOUT $56 BILLION ACROSS ALL
STATES.
IT'S STILL TO BE DETERMINED
WHAT THE IMPACT WILL BE ON
MISSISSIPPI.
>> CMS HAS NOT YET PASSED RULES
AND REGULATIONS IN TERMS OF IF
THEY'RE GONNA TRY TO TAKE AWAY
THE DISH PAYMENTS.
WE'LL HAVE TO WAIT AND SEE IF
THEY DO.
PERHAPS THEY'RE GONNA DO THAT
SOON, PERHAPS THEY'RE GONNA BE
THREE MONTHS FORM NOW, PERHAPS
IT'LL BE A YEAR FROM NOW, BUT
WHAT THEY HAVE SAID IS DISH
PAYMENTS WILL CONTINUE THIS
YEAR AND AS LONG AS THAT IS THE
CASE, I AM GOING TO OPPOSE THE
MEDICAID EXPANSION IN
MISSISSIPPI.
>> UNDER THE NEW HEALTH CARE
LAW, THERE'S SOME THINGS THAT
ARE FAVORABLE AND SOME THINGS
THAT ARE UNFAVORABLE.
THERE'S NO CHOICE ABOUT ALL THE
UNFAVORABLE THINGS.
THAT'S GONNA HAPPEN.
FROM THE PERSPECTIVE OF THE
PROVIDERS, THE QUESTION IS ARE
YOU GOING TO KEEP US FROM
GETTING THE FAVORABLE THINGS
THAT ARE SUPPOSED TO BALANCE
OFF THE UNFAVORABLE THINGS.
I THINK WE NEED TO LISTEN TO
WHAT THE PROVIDERS ARE TELLING
US.
>> DISH PAYMENTS IN MISSISSIPPI
ARE CRUCIAL TO THE DOORS
STAYING OPEN FOR MANY HOSPITALS
IN PARTICULAR, RURAL HOSPITALS,
WHERE THE POPULATION IS OFTEN
IMPOVERISHED AND UNINSURED.
THE DEBATE OVER THE FATE OF THE
DISH PAYMENTS IS OFTEN WHERE
THE DEBATE OVER MEDICAID
EXPANSION HANGS UP.
IN THEORY, IF MEDICAID IN
MISSISSIPPI WERE TO BE
EXPANDED, THERE WOULD BE FAR
FEWER UNINSURED PEOPLE GOING TO
DOCTORS AND HOSPITALS THEREBY
ELIMINATING THE NEED TO
COMPENSATE THEM WITH THE DISH
PAYMENTS.
INSTEAD, UNDER THE AFFORDABLE
CARE ACT, THAT MONEY USED FOR
DISH PAYMENTS WILL BE ROLLED
INTO OVERALL FUNDING FOR THE
PROGRAM.
IF MEDICAID IS EXPANDED IN THE
STATE, AROUND 300,000 PEOPLE ARE
EXPECTED TO BE ADDED TO THE
ROLLS, TAKING THAT 1 IN 5
NUMBER MENTIONED EARLIER TO 1
IN 3, AND THE LIMITATIONS ON
WHO CAN ACTUALLY GET MEDICAID
WILL BE DRAMATICALLY DIFFERENT.
>> THE EXPANSION WILL GET RID
OF THOSE CATEGORIES AND SO IT
WILL ONLY BE BASED ON INCOME
AND IT WILL COVER EVERYONE UP
TO 138% OF THE POVERTY LEVEL,
SO ABOUT $12,000-$15,000 A YEAR,
DEPENDING ON HOW LARGE THEIR
FAMLY IS.
>> THAT WOULD BE ALMOST ONE
MILLION PEOPLE ON MEDICAID IN
MISSISSIPPI, A NUMBER THAT
MAKES MANY POLITICIANS VERY
NERVOUS.
>> AT SOME POINT IN EVERY
SOCIETY, TOUGH DECISIONS HAVE
TO BE MADE.
DO ANY OF MY COLLEAGUES BELIEVE
THAT PEOPLE SHOULD GO WITHOUT
HEALTH INSURANCE OR GO WITHOUT
HEALTH CARE?
NO, THAT'S NOT WHAT WE'RE
SAYING.
BUT WE'RE SAYING LIKEWISE THAT
THEY SHOULDN'T GO WITHOUT FOOD
OR THEY SHOULDN'T GO WITHOUT
THE OTHER AMENITIES OF LIFE.
BUT AT SOME POINT, WE HAVE TO
ADMIT TO OURSELVES, IF WE ARE A
FAIR REPUBLIC, THAT THERE'S
SIMPLY NO WAY TO PAY FOR EVERY
WISH AND EVERY WANT AND EVERY
DESIRE.
IT'S A PRACTICAL IMPOSSIBILITY.
>> ANYBODY WHO CARES ABOUT
HEALTH CARE AND THE ABILITY TO
GET ADEQUATE CARE FOR THEIR
FAMILY OR ANYONE ELSE WITHOUT
HAVING TO GO TO AN EMERGENCY
ROOM OUGHT TO TRY TO SUPPORT
EXPANSION OF MEDICAID.
>> A LOT OF DEBATE STILL
REMAINS ON THE TOPIC OF
EXPANSION, BUT BEFORE OUR
LAWMAKERS EVEN GET THERE,
THERE'S AN ISSUE OF THE CURRENT
MEDICAID PROGRAM.
AT THE MOMENT, IT'S SET TO
EXPIRE ON JUNE 30TH.
AND THE PEOPLE WHO SUFFER THE
FALLOUT CAN'T AFFORD TO PICK UP
THE PIECES.
(BIRD SQUAWKING)
>> THIS IS LUCKY THE COCKATIEL,
ONE OF THE MOST POPULAR
RESIDENTS OF COMMUNITY PLACE, A
NURSING HOME FACILITY IN
JACKSON, MISSISSIPPI.
LUCKY'S ONE OF THE FEW
RESIDENTS HERE WHO IS NOT
SUPPORTED BY MEDICAID.
>> COMMUNITY PLACE IS A SKILLED
AND LONG-TERM CARE FACILITY
THAT WAS ESTABLISHED IN 1932 BY
THREE LADIES WHO SAW A NEED IN
JACKSON TO CARE FOR THOSE WHO
HAD NO ONE TO CARE FOR THEM.
WE ARE THE ONLY NON-PROFIT
NURSING HOME IN JACKSON.
>> CURRENTLY HOME TO 54
RESIDENTS, COMMUNITY PLACE CAN
TAKE UP TO 60 PEOPLE.
AND 95% OF THOSE PEOPLE ARE ON
MEDICAID.
THAT'S RIGHT, MEDICAID PEOPLE.
>> ARE THE AVERAGE PEOPLE WHO
QUALIFY FOR MEDICAID HOBOS OR
PEOPLE WHO HAVE NEVER DONE
ANYTHING?
WHAT IS THE AVERAGE MEDICAID
PERSON THAT YOU SEE HERE?
>> NOOO, IT'S MIDDLE INCOME
AMERICA.
IT'S PEOPLE THAT THEY'VE WORKED
ALL THEIR LIFE OR THEY'VE
WORKED UP TO THE POINT OF
CATASTROPHIC EVENT WHERE THEY
CAN'T CARE FOR THEMSELVES
ANYMORE AND THEY DON'T HAVE THE
MONEY TO TAKE CARE OF
THEMSELVES.
THAT'S WHAT A LOT OF THE
MEDICAID PATIENTS ARE COMING
FROM.
>> CURRENTLY, THERE ARE OVER
600,000 MISSISSIPPIANS ON
MEDICAID AND OF THOSE, AROUND
17,000 OF THEM ARE NURSING HOME
PATIENTS.
ACCORDING TO THE MISSISSIPPI
DIVISION OF MEDICAID, OVER 75%
OF THOSE 17,000 MISSISSIPPIANS
LIVING IN NURSING HOMES RELY ON
MEDICAID.
AND THIS IS JUST ONE OF THE
REASONS WHY THE FAILURE TO
RE-AUTHORIZE MEDICAID DURING
THE 2013 LEGISLATIVE SESSION IS
SUCH A POLITICAL HOT TOPIC.
BEING LINKED TO MEDICAID
EXPANSION DIDN'T HELP EITHER.
>> DEMOCRATS IN THE HOUSE VOTED
TO KILL FUNDING FOR MEDICAID.
NOW, THEY CAN MAKE ANY EXCUSE
THEY WANT TO, SPIN IT ANY WAY
THEY WANT TO, THE TRUTH OF THE
MATTER IS, TWICE THEY VOTED TO
KILL MEDICAID.
WHEN YOU VOTE NOT TO FUND AN
ENTITY LIKE MEDICAID, THAT
MEANS YOU WANT TO DO AWAY WITH
IT!
>> THE GOVERNOR NEEDS TO STEP
UP TO THE TABLE AND THERE'S
PLENTY OF, IF HE WANTS TO CALL
THAT BLAME, THERE'S PLENTY OF
BLAME FOR HIM TO TAKE.
IT'S ALL IN THE GOVERNOR'S
COURT.
IT'S 700,000 PEOPLE WHO ARE ON
THE MEDICAID PROGRAM NOW, AND
300,000 WORKING FAMILIES THAT
COULD BE IF THE HEALTH CARE WAS
EXPANDED AND IT'S $30,000 A DAY
TO COME BACK TO SPECIAL
SESSION.
AND THAT'S HIS CHOICE AND
THAT'S REPUBLICAN LEADERSHIP'S
CHOICE.
>> I THINK, BETWEEN NOW AND
JUNE, DEMOCRATS ACROSS THE
STATE, AND EVERY DEMOCRAT IN
THE HOUSE VOTED TO DO AWAY WITH
MEDICAID, AND THEY'RE GONNA BE
ASKED WHEN THEY RETURN HOME,
WHY THEY DID THAT.
SOMEONE'S GONNA SAY, WHY DO YOU
WANNA TAKE MY MOTHER OUT OF THE
NURSING HOME TO EXPAND
OBAMACARE?
THAT'S A SIMPLE QUESTION I HOPE
ALL MISSISSIPPIANS ASK.
>> THE MEDICAID PROGRAM IS NOT
GONNA BE STOPPED IN THIS STATE.
WHEN YOU'VE GOT $800 MILLION
STATE TAX DOLLARS GOING TO GET
YOUR MATCH, IT'S NOT GONNA
HAPPEN.
THIS IS A MULTI-BILLION DOLLAR
PROGRAM WITH THOUSANDS OF JOBS.
BUT THE GOVERNOR ALSO HAS, AT
HIS FRONT DOORSTEP RIGHT NOW,
THE OPPORTUNITY TO LOSE
BILLIONS OF DOLLARS FOR THIS
STATE AND THOUSANDS OF JOBS
WITHIN THE NEXT 90 DAYS.
>> IT'S A POLITICAL GAME OF
CHICKEN THAT HAS BEEN GOING OF
FOR THE LAST SEVERAL MONTHS AND
SO FAR THERE HAVE BEEN NO
WINNERS.
AND UNLESS REPUBLICANS AND
DEMOCRATS COME TO SOME
AGREEMENT, THERE WILL BE MANY
LOSERS ESPECIALLY THOSE LIVING
IN PLACES LIKE COMMUNITY PLACE.
>> 95% OF OUR RESIDENTS ARE ON
MEDICAID AT COMMUNITY PLACE.
IF WE DID NOT HAVE THE FUNDING
FOR MEDICAID, WE WOULD NOT
CONTINUE TO EXIST.
THESE PEOPLE WOULD HAVE TO FIND
ANOTHER PLACE TO LIVE.
>> AND HOW MUCH IS THAT
FUNDING?
HOW DOES IT COST A TAXPAYER TO
HELP THESE RESIDENTS LIVE?
>> IT COSTS APPROXIMATELY $185
A DAY, BUT IT CAN COST MORE
THAN THAT TO COME IN PRIVATELY,
SO WHEN YOU TAKE $185 A DAY AND
YOU MULTIPLY IT TIMES HOW MANY
DAYS TEHRE ARE IN A MONTH OR A
YEAR, IT CAN ADD UP TO BE QUITE
SUBSTANTIAL.
>> AND BELIEVE IT OR NOT,
THAT'S CHEAP.
SINCE COMMUNITY PLACE IS NOT
FOR PROFIT, THEY CHARGE
EVERYONE THE SAME $185.
PRIVATE PAYERS, MEDICAID,
EVERYONE GETS THE SAME LOW
RATE.
AT OTHER FACILITIES, PRICES CAN
RUN MUCH HIGHER: UP TO $230 A
DAY.
DO THE MATH.
THAT'S ALMOST $7000 A MONTH.
>> THE MONEY THAT COMES TO
NURSING HOMES FROM MEDICAID,
THE MAJORITY OF IT IS SPENT ON
THE LABOR, ON PROVIDING JOBS, A
LOT OF JOBS, FOR PEOPLE THAT
COME IN AND CARE FOR THESE
ELDERS THAT HAVE NO ONE ELSE TO
CARE FOR.
SO THAT'S WHERE THE MAJORITY OF
THE MONEY GOES.
WE ALSO USE THAT MONEY TO
PROVIDE FOR THE LIGHT BILL, FOR
THE FOOD, FOR THE MAINTENANCE
OF THE BUILDING.
WE PROVIDE LAUNDRY,
HOUSEKEEPING, WE PROVIDE
EVERYTHING THAT THE PATIENT
WOULD NEED.
WE ALSO PAY FOR MEDICATIONS
THAT MAY NOT BE PAID FOR BY
MEDICAID OR MEDICARE.
>> ALL OF THESE THINGS ARE PAID
FOR AT A RATE THAT'S NOT QUITE
UP TO 2013 LEVELS, EITHER.
>> IT'S BEING FUNDED AT COST AT
2008 COSTS.
AND THEN IT WAS INFLATED FOR
2009-2010, AND THEN IT WAS
STOPPED.
IT'S IMPORTANT FOR PEOPLE TO
UNDERSTAND THAT NURSING HOMES
NEED TO BE ABLE TO EXIST AT OUR
CURRENT COSTS, WHAT IT COSTS TO
ACTUALLY RUN A NURSING HOME.
AND THAT'S SOMETHING THAT WE
COUNT ON OUR LEGISLATORS TO
CONSIDER AS THEY MAKE THE
DECISIONS THEY DO.
WHEN MEDICAID FUNDING IS FROZEN
OR WHEN THE MEDICAID FUNDING IS
NOT THERE FOR NURSING HOMES,
THEN YOU HAVE TO CUT CORNERS.
AND SOMETIMES AND THAT MEANS
CUTTING THE STAFF.
A LOT OF TIMES IT DOES BECAUSE
THE BIGGEST EXPENSE WE HAVE IN
NURSING HOMES IS THE LABOR.
SO THAT MEANS WE HAVE TO CUT
THE STAFFING, WHICH DECREASES
THE QUALITY OF CARE WE ARE ABLE
TO GIVE TO OUR ELDERS.
IT MAKES IT REALLY TOUGH.
ADMINISTRATORS HAVE A REALLY
TOUGH JOB DECIDING HOW TO
BALANCE THAT, HOW TO MAKE SURE
WE CAN GIVE AS MUCH AS WE CAN
TO THE PATIENTS AND YET BE ABLE
TO KEEP THE DOORS OPEN.
>> REGARDLESS OF THE DEBATE AT
THE MISSISSIPPI STATE CAPITOL
AND ELSEWHERE IN THE COUNTRY,
THE DAYS AND WEEKS GO ON AT
COMMUNITY PLACE.
THEY CAN'T FOCUS TOO MUCH ON
THE POLITICS OF THE ISSUE,
INSTEAD, THEY FOCUS ON REAL
PEOPLE AND REAL LIVES.
>> THESE ARE PEOPLE THAT HAVE
SPENT THEIR LIFE GROWING UP
THROUGH THE TIMES THAT WE HAVE
BEEN IN AND MORE, WATCHING WHAT
HAS HAPPENED ALL THROUGH OUR
LIVES AND BEYOND AND HAVE
WORKED VERY HARD IN TOUGHER
TIMES THAN WE HAVE AND THEY
NEED TO BE CARED FOR.
AND THAT'S WHAT MEDICAID DOES.
IT PROVIDES CARE FOR THOSE
PEOPLE IN NURSING HOMES.
>> FROM THE NURSING HOME TO THE
STATE HOUSE WE GO.
THE ISSUE CAN ALMOST BE DIVIDED
DOWN PARTY LINES.
DURING THE 2013 LEGISLATIVE
SESSION, MISSISSIPPI'S
LAWMAKERS WERE INTENT ON TOEING
THOSE PARTY LINES.
>> IT'S ALMOST A CLICHE THAT A
BAD SPORTS WRITER MIGHT TAKE
TOO FAR.
IN THIS CORNER WE HAVE THE
REPUBLICANS!
OVER IN THAT CORNER, THE
DEMOCRATS!
BUT WE'RE TALKING ABOUT THE
HEALTH AND LIVES OF REAL
MISSISSIPPIANS, SO PUNS AND
JOKES WILL HAVE TO WAIT.
FROM THE VERY FIRST DAYS OF THE
MISSISSIPPI 2013 LEGISLATIVE
SESSION, MEDICAID AND MEDICAID
EXPANSION HAVE BEEN A HOT AND
DIVISIVE TOPIC.
>> WE CAN'T AFFORD IT.
ALL THE INFORMATION THAT I HAVE
RECEIVED INDICATES THAT IT IS
AN ENORMOUSLY EXPENSIVE
UNDERTAKING.
AND IN MY CONSULTATION WITH THE
GOVERNOR, LT. GOVERNOR, THERE
IS NO APPETITE TO EXPAND.
>> THAT SEEMS TO BE THE GENERAL
CONSENSUS COMING FROM THE
REPUBLICAN PARTY, WHAT THEY
WANT TO DEAL.
THEY DON'T WANT TO DEAL WITH IT
AT ALL.
DEMOCRATS, WE WANT TO DEAL WITH
IT.
>> THE BATTLE BEGAN EARLY WHEN
THE HOUSE VOTED DOWN A MEDICAID
RE- AUTHORIZATION BILL BECAUSE
IT DID NOT INCLUDE EXPANSION.
>> WELL, YOU DO WHAT YOU HAVE
TO DO UP HERE, AND WE HAVE
ENOUGH NUMBERS TO DO THAT.
IT WAS A PROTEST VOTE TO SAY
REPUBLICAN LEADERSHIP WE
RESPECT YOU, BUT WE DO NOT
RESPECT THE FACT THAT YOU'RE
NOT GIVING SOMETHING THAT WILL
IMPACT MISSISSIPPI
ECONOMICALLY, IN GREATER HEALTH
OUTCOMES EXPONENTIALLY, THE
CHANCE TO BE DEBATED, AND WE
HAD TO DO WHAT WE HAD TO DO AND
WE CAN KILL THE NEXT BILL IF WE
HAVE TO.
>> AND SO THE DEMOCRATS DID.
IN THE MEANTIME, THE SENATE
PASSED ITS OWN VERSION OF THE
BILL.
BUT THIS ONE DID INCLUDE THE
OPTION OF EXPANSION.
BUT MORE POLITICAL GAMES WERE
AFOOT AND INSTEAD OF THE BILL
GOING TO THE HOUSE MEDICAID
COMMITTEE FOR REVIEW, SPEAKER
PHILIP GUNN SENT IT TO THE
HOUSE RULES COMMITTEE WHERE IT
EVENTUALLY DIED A SLOW DEATH.
>> WE'RE NOT GONNA ENGAGE IN A
DEBATE ON A BILL THAT'S HEADED
NOWHERE.
IT IS NOT GOOD STEWARDSHIP OF
THE TIME OR THE MONEY WE HAVE,
THE SHORT AMOUNT OF TIME WE
HAVE DOWN HERE.
IT WOULD BE DONE SIMPLY FOR
POLITICAL SHOWMANSHIP AND I'M
NOT IN THE BUSINESS OF
POLITICAL SHOWMANSHIP.
WE'RE NOT PLAYING POLITICS DOWN
HERE, WE'RE NOT GONNA ENGAGE IN
A DEBATE THAT WOULD END UP AND
RESULT IN NO BILL BEING PASSED.
THE VOTE THAT WE HAD ON
APPROPRIATION BILL, THE
DEMOCRATS WERE 21, I THINK 21
VOTES 20-21 VOTES SHORT OF
PASSING.
SO THE BILL CANNOT PASS.
>> WE ALSO HAVE HEARD, LOOK,
THE HOUSE DEMOCRATS DON'T HAVE
ENOUGH VOTES TO PASS EXPANSION
OF MEDICAID FOR 300,000 WORKING
FAMILIES, SO WE'RE NOT GONNA
TAKE IT UP.
BUT I POSE THIS QUESTION.
IF WE DON'T HAVE ENOUGH VOTES
TO PASS IT, WHY NOT LET US HAVE
A VOTE ON THE FLOOR AND JUST GO
AHEAD AND BEAT US?
JUST GO AHEAD AND BEAT THE
DEMOCRATS AND THE WORKING
FAMILIES AND BE DONE WITH IT.
>> SITTING DOWN ONE ON ONE WITH
MEMBERS OF BOTH SIDES OF THE
AISLE BRING FORTH EXCELLENT
POINTS BOTH FOR AND AGAINST
EXPANSION.
FIRST OFF, THERE IS THE ISSUE
OF STRAIGHT UP
RE-AUTHORIZATION, WHICH IS
CONTINUING THE MEDICAID PROGRAM
THAT ALREADY EXISTS.
IT MUST BE RE- AUTHORIZED BY
JULY FIRST OR OVER 600,000
PEOPLE IN MISSISSIPPI WILL
SUDDENLY BE WITHOUT HEALTH
INSURANCE.
AND SIMPLE RE-AUTHORIZATION
COMES WITH MANDATED CHANGES AS
WELL.
>> UNDER THE AFFORDABLE CARE
ACT, WE'RE GOING TO ADD
80-90,000 PEOPLE THAT ARE
MANDATED BY THE AFFORDABLE CARE
ACT.
>> THAT IS ALMOST 100,000 PEOPLE
WHO WILL BE ADDED TO THE
MEDICAID ROLLS WITH OR WITHOUT
EXPANSION.
ACCORDING TO REPRESENTATIVE
HOWELL, ANOTHER 25-30 STAFF
WILL NEED TO BE HIRED AT THE
DIVISION OF MEDICAID TO HELP
SUPPORT THOSE EXTRA PEOPLE, SO
THERE IS MORE COST TO THE
STATE.
BUT ON TO EXPANSION.
WE SPOKE TO REPRESENTATIVE
BOBBY MOAK, THE DEMOCRATIC
CAUCUS LEADER WHO HAS BEEN THE
SPOKESPERSON FOR THE PARTY ON
THE ISSUE, AS WELL AS TO
SENATOR CHRIS MCDANIEL WHO
OFTEN SERVES AS A MORAL LEADER
FOR HIS PARTY.
>> WE DO HAVE THE OPPORTUNITY
TO EXPAND OUR MEDICAID ROLES
UNDER THE AFFORDABLE CARE ACT.
ON THE OTHER HAND, THE QUESTION
IS, WHERE IS THE MONEY GOING TO
COME FROM IN REGARDS TO STATE
FUNDING?
>> THOSE OF US IN ELECTED
OFFICE, THAT'S GOTTA BE THE
FIRST THING THAT YOU THINK
ABOUT.
WHAT DO THE CITIZENS OF THE
STATE NEED?
AND CAN WE DO IT?
CAN WE AFFORD IT?
CAN WE MAKE IT HAPPEN?
SO TEHRE'S SOME 300,000 WORKING
FAMILIES THAT NEED IT AND THAT'S
WHY WE SHOULD EVEN CONSIDER
DOING IT BECAUSE IT'S GOOD
PUBLIC POLICY.
>> IT'S ONE THING TO BELIEVE
THE FEDERAL GOVERNMENT.
IT'S QUITE ANOTHER TO REALLY
BELIEVE THE FEDERAL GOVERNMENT.
AND THEY'VE GIVEN US ASSURANCES
OVER THE NEXT DECADE, BUT BEAR
IN MIND THAT THESE ASSURANCES
COMING FROM A CONGRESS THAT
RIGHT NOW IS DYSFUNCTIONAL.
NOT MUCH IS HAPPENING, THEY
CAN'T AGREE ON MUCH OF
ANYTHING.
THE REALITY IS MISSISSIPPI HAS
TO HAVE SOME VERY FIRM ANSWERS.
NOT SUGGESTIONS, NOT
RECOMMENDATIONS, BUT FIRM
ANSWERS ON WHAT THE FUTURE
HOLDS.
>> OUR INSTITUTIONS OF HIGHER
LEARNING, OUR COLLEGES HAVE PUT
TOGETHER A STUDY AND HAVE SAID
LOOK, WE'RE GONNA CREATE
THROUGHOUT THE STATE 9,000 NEW
JOBS IF WE HAVE THIS EXPANSION.
AND LOOK, THAT'S NOT JUST
DOCTORS, NOT JUST NURSES,
THAT'S THE RECEPTIONISTS,
THAT'S THE BOOKKEEPERS, THAT'S
THE PEOPLE WHO CLEAN UP THE
OFFICES.
THAT'S EVERYBODY.
>> OK, NO MIDDLE GROUND THERE.
WHAT ABOUT REACHING A
COMPROMISE.
IS THERE A WAY FOR THE PARTIES
TO MEET IN THE MIDDLE?
>> I'M TRAINED TO MAKE
DISPASSIONATE DECISIONS THAT
AFFECT MY CLIENT AND OTHERS.
I'M NOT WORRIED ABOUT A CRISIS
SCENARIO OR THE FACT THAT THE
END OF THE WORLD IS
APPROACHING.
I DON'T KNOW THAT THE END OF
THE WORLD IS APPROACHING.
I'VE BEEN HERE SIX YEARS, THE
END OF THE WORLD APPROACHES 15
TIMES A SESSION.
IT JUST DEPENDS ON THE ISSUE.
>> DEMOCRATS HAVE DUG THEIR
HEELS IN BECAUSE THIS IS AN
ISSUE THAT IS PROBABLY ONE OF
THE BIGGEST OF OUR GENERATION.
THE MONEY, LET'S FOLLOW THE
MONEY NUMBER ONE, THAT COMES
INTO THE STATE IS PROBABLY THE
BIGGEST INFLUX OF MONEY WE HAVE
SEEN IN QUITE SOME TIME.
THE JOB CREATION THAT COMES
ALONG WITH THAT IS TREMENDOUS.
NOT TO MENTION CARING FOR THE
PEOPLE IN OUR STATE AND GIVING
THEM HEALTH CARE.
SO WE HAVE DUG IN AS A GROUP.
BUT WE HAVE ALSO INDIVIDUALLY
SAID THAT THIS IS THE ISSUE,
THIS IS THE BIGGEST ISSUE THAT
IS IMPORTANT TO US AND WE HAVE
SIMPLY GELLED AROUND THIS ISSUE
BECAUSE WE KNOW HOW HUGE IT IS
AND WE DON'T THINK WE'RE
STANDING OUT THERE ALONE.
>> IF THERE IS REALLY INDEED A
CRISIS SCENARIO, IF THE END OF
THE WORLD TRULY IS APPROACHING,
I WOULD THINK, AT SOME POINT,
COOLER HEADS WOULD PREVAIL.
PEOPLE WOULD GET TOGETHER AND
THEY WOULD FIND OUT THE ANSWER
THE SAME THAT WE FOUND OUT THE
ANSWERS IN ALL THE CRISES THAT
HAVE AFFECTED OUR COUNTRY.
WHAT I DON'T WANT IS RUSH INTO
SOMETHING SIMPLY BECAUSE IT IS
POLITICALLY EXPEDIENT.
WHAT I DON'T WANT TO DO IS MAKE
A DECISION THAT IMPACTS THE
FUTURE OF THIS COUNTRY OR THE
FUTURE OF THIS STATE BECAUSE IT
FEELS GOOD.
>> SPEAKING OF COOLER HEADS,
REPRESENTATIVE BOBBY HOWELL,
HIMSELF A REPUBLICAN, DOESN'T
RULE OUT THE OPTION FOR
EXPANSION, BUT DOES CALL FOR
PATIENCE AND CAUTION.
>> YOU DON'T HAVE TO DO
EXPANSION THIS YEAR.
YOU COULD GO TO, LIKE, 2017 IF
YOU WERE GOING TO GO INTO
EXPANSION.
IF YOU FOUND THAT FACTS AND THE
PRACTICAL SENSE DICTATED IT, IT
JUST DOESN'T HAVE TO BE DONE
RIGHT THIS MINUTE, AND I THINK
WE'D BE BETTER SERVED TO LEARN
FROM SOME OF OUR SISTER STATES
AND STUFF TO SEE HOW SOME OF
THIS MOVES FORWARD.
>> AND IF THAT DOESN'T MAKE
SENSE, REP. HOWELL PUTS HIS
FEELINGS ABOUT MEDICAID
EXPANSION IN AN EVEN EASIER WAY
TO UNDERSTAND.
>> LIKE GOING TO A CAR DEALER
AND YOU DON'T HAVE ANY MONEY IN
THE BANK AND HE SAYS, WELL
WE'LL GIVE YOU THIS CAR FOR $50
DOWN AND THE FIRST PAYMENT'S
NOT DUE TILL SIX MONTHS.
ARE YOU GONNA HAVE YOUR PAYMENT
IN SIX MONTHS IS WHAT YOU HAVE
TO ASK YOURSELF.
>> WHILE THE WAIT AND SEE
HAPPENS AT THE CAPITOL,
HOSPITALS IN THE STATE ARE
PREPARING FOR CRISIS MODE
BECAUSE NO MATTER WHAT DECISION
OUR LAWMAKERS MAKE, THE EFFECTS
MAY BE HARDEST FELT BY
HOSPITALS AND ULTIMATELY THE
PATIENTS.
ACROSS MISSISSIPPI, YOU MIGHT
BE HARD PRESSED TO FIND ANYONE
WHO REALLY UNDERSTANDS THE
INTRICACIES OF MEDICAID AND
MEDICAID EXPANSION.
IT'S NOT A TOPIC THAT USUALLY
COMES UP AT THE DINNER TABLE.
AT THE MISSISSIPPI STATE
CAPITOL IN JACKSON, IT WAS ONE
OF THE MOST TALKED ABOUT THINGS
AT THE 2013 LEGISLATIVE
SESSION.
BUT OUTSIDE OF THE STATEHOUSE,
THERE ARE SOME PEOPLE TAKING
NOTICE.
PEOPLE IN MS HAVE A GREAT DEAL
OF CONCERN ABOUT MEDICAID
EXPANSION, ESPECIALLY
MISSISSIPPI'S BUSINESSPEOPLE.
AND THE BUSINESSPEOPLE WHO RUN
MISSISSIPPI'S REGIONAL
HOSPITALS ARE ESPECIALLY
CONCERNED BECAUSE HEALTH CARE
POLITICS CAN MEAN LIFE OR DEATH
AT REGIONAL MEDICAL CENTERS
LIKE DELTA REGIONAL MEDICAL
CENTER HERE IN GREENVILLE.
DELTA REGIONAL MEDICAL CENTER
IS HUGE FOR THE DELTA AND
WASHINGTON COUNTY IN
PARTICULAR.
>> IN WASHINGTON COUNTY, WE'RE
THE LARGEST EMPLOYER.
WE EMPLOY ABOUT OVER A THOUSAND
PEOPLE.
>> IT'S A REGULAR RURAL
HOSPITAL IN A TOWN WHERE MOST
PEOPLE KNOW MOST PEOPLE, AND
YOU CAN COUNT ON YOUR NEIGHBOR
FOR HELP IN TIMES OF NEED.
BUT ACCORDING TO STANSEL
HARVEY, CEO OF DELTA REGIONAL
MEDICAL CENTER, THERE MAY BE NO
ONE TO HELP SOON AND IT'S ALL
BECAUSE OF THE DEBATE OVER
MEDICAID EXPANSION.
>> EFFECTIVE OCTOBER FIRST,
WE'RE GOING TO GET A
$5.6 MILLION REDUCTION IN OUR
DISPROPORTIONAL SHARE PAYMENTS.
WITHOUT EXPANDING THE MEDICAID
ROLLS, WHICH WE ESTIMATE WE'D
PICK UP ABOUT $4.7 MILLION,
WITHOUT EXPANDING THOSE ROLLS,
THAT LEAVES US WITH A
$5.6 MILLION HOLE TO FILL.
AND UNFORTUNATELY, SINCE OUR
ENTIRE PROFIT LAST YEAR, WHICH
WAS A VERY GOOD YEAR OF
$2.9 MILLION, IT DOESN'T TAKE A
GENIUS TO FIGURE OUT IF YOU
MAKE $2.9 MILLION AND YOU TAKE
A $5.6 MILLION DOLLAR CUT,
YOU'RE IN THE HOLE.
>> HARVEY AND DELTA REGIONAL
MEDICAL CENTER IS IN THE SAME
SPOT AS MANY RURAL HOSPITALS IN
THE STATE TRYING TO DETERMINE
JUST HOW BAD THINGS WILL BE
WITH OR WITHOUT MEDICAID
EXPANSION AND TRYING TO FIGURE
OUT HOW TO SURVIVE REGARDLESS.
>> ABOUT $350,000 PER DAY IS
WHAT IT COSTS US TO KEEP THESE
DOORS OPEN.
SO, IF I HAVE A $5.6 MILLION
REDUCTION IN PAYMENT
WITH NO ADDITIONAL PICKUP FROM
THE EXPANSION OF MEDICAID,
WE'RE GONNA HAVE TO DO
SOMETHING WITH THE SERVICES WE
PROVIDE.
>> MEANING SOMETHING HAS TO GO
WHETHER IT'S PEOPLE OR SERVICES
PROVIDED AT THE HOSPITAL.
>> YOU COULD ELIMINATE YOUR
EDUCATION BUDGET, YOU COULD
ELIMINATE A NUMBER OF OTHER
LITTLE MINOR THINGS, BUT THE
REALITY IS IF YOUR'E GONNA MAKE
ANY CHANGES AND YOU HAVE TO
TAKE OUT THAT LARGE OF AN
AMOUNT OF MONEY, IT IS GOING TO
IMPACT THE NUMBER OF EMPLOYEES.
>> IT'S ALSO GOING TO AFFECT
THE HEALTH OF THE COMMUNITY THE
HOSPITAL SERVES.
>> IF WE'RE GONNA TAKE THIS BIG
OF A MONETARY CUT, THEN THERE
ARE JUST SOME SERVICE LINES
THAT WE'RE NOT GONNA BE ABLE TO
PROVIDE.
SO DEPENDING ON WHAT THOSE
SERVICE LINES MIGHT BE, THERE
ARE JUST GONNA BE HEALTH CARE
NEEDS THAT WE ARE NOT GOING TO
BE ABLE TO MEET IN GREENVILLE.
YOU'LL HAVE TO TRAVEL FOR YOUR
CARE.
AND A LOT OF PATIENTS HERE
DON'T EVEN HAVE CARS.
THEY'RE NOT GOING TO BE ABLE TO
GO ANYWHERE ELSE TO HAVE THEIR
NEEDS MET.
>> PACEMAKERS WITH
DEFIBRILLATORS.
THESE LITTLE DEVICES COST
$28,000.
WE DONT' GET PAID THAT FOR THE
ENTIRE STAY.
SO THE QUESTION'S GONNA HAVE TO
COME DOWN, DO WE CONTINUE TO
PUT IN PACEMAKERS?
PROBABLY NOT.
SO WE MAY HAVE TO REDUCE A LOT
OF THE SERVICES THAT THIS AREA
OF THE STATE IS USED TO GETTING
LOCALLY, WE MAY HAVE TO CURTAIL
THOSE SERVICES.
>> AND BESIDES THE HEALTH
EFFECTS ON THE COMMUNITY, THERE
IS THE FINANCIAL CONCERN.
IF THE LARGEST EMPLOYER STARTS
LAYING OFF PEOPLE, OR WORSE,
SHUTS DOWN, YOU SEE THE EFFECTS
ELSEWHERE.
>> THESE ARE WELL-PAYING JOBS.
THESE ARE NOT MINIMUM-WAGE
JOBS.
THEY'RE JOBS THAT COME WITH
BENEFITS.
AND SO THAT MONEY THEN
CIRCULATES THROUGH THE WHOLE
ECONOMY OF THE COMMUNITY.
>> IT'S LESS PEOPLE BUYING
CARS, IT'S LESS PEOPLE BUYING
INSURANCE, LESS PEOPLE GOING TO
THE MOVIES, LESS PEOPEL GOING
OUT TO EAT.
IT HAS A MAJOR CASCADING
EFFECT.
SO WHEN YOU'RE THE LARGEST
EMPLOYER IN WASHINGTON COUNTY
AND IN THE DELTA AS FAR AS ANY
HEALTH CARE GOES, ANY CHANGE OR
REDUCTION IN WHAT WE DO AS AN
INDUSTRY IS GONNA HAVE A VERY
NEGATIVE IMPACTS TO THE
COMMUNITY.
>> CURRENTLY, OVER HALF OF THE
HOSPITAL BEDS IN MISSISSIPPI
ARE IN RURAL AREAS, AREAS THAT
ARE ANXIOUSLY AWAITING THE
POLITICAL DECISIONS TO BE MADE
REGARDING MEDICAID AND MEDICAID
EXPANSION.
>> I CHOOSE TO LIVE IN
GREENVILLE.
I LOVE THE DELTA.
BUT I DON'T WANT TO LIVE IN A
PLACE WHERE I CAN'T TAKE MY
CHILD TO THE HOSPITAL FOR A
NEEDED SERVICE.
IF MY CHILD WAS OUT CLIMBING A
TREE AND BREAKS HER ARM LIKE
SHE'S DONE, I WANT TO BE ABLE
TO TAKE HER TO THE LOCAL
ORTHOPEDIST AND GET IT FIXED
UP AND MOVE ON.
WE ALL WANT WHAT'S BEST FOR OUR
CHILDREN, AND OUR HOSPITAL IS
THE LIFEBLOOD OF THIS COMMUNITY
AND IF WE DON'T HAVE THE
HOSPITAL HERE, THEN I JUST SEE
THIS COMMUNITY DRYING UP.
THIS IS NOT A RICH AREA, AND WE
SEE PATIENTS THAT ARE REALLY
SICK.
IF YOU LOOK AT THE HEALTH
STATISTICS, YOU KNOW, WE ARE
NUMBER ONE IN HEART DISEASE AND
DIABETES AND EVERYTHING BAD,
AND THESE PATIENTS DON'T HAVE
ANYWHERE ELSE TO GO.
AND IF THEY DON'T HAVE THE
SERVICE HERE, WHERE ARE THEY
GONNA GET THE SERVICE?
>> CARE THAT IS NOT PROVIDED
HERE IS SIMPLY DONE WITHOUT.
>> THE DEBATE OVER MEDICAID
CONTINUES ACROSS THE COUNTRY
AND ESPECIALLY HERE IN
MISSISSIPPI AS HOSPITALS WORK
TO KEEP DOORS OPEN NO MATTER
WHAT COMES.
>> WE JUST ABSORB IT AS MUCH AS
WE CAN.
AT SOME POINT, IT COMES TO THE
POINT WE CAN'T ABSORB IT ANY
FURTHER.
>> AND SO TO EXPAND OR NOT TO
EXPAND, THAT IS THE QUESTION.
THERE ISN'T A SIMPLE ANSWER NOT
FROM THE FINANCIAL POINT OF
VIEW OR THE POLITICAL POINT OF
VIEW.
IT'S UP TO YOU, THE MISSISSIPPI
RESIDENT TO MAKE A DECISION ON
WHERE YOU STAND AND TO DECIDE
HOW EITHER OPTION WILL AFFECT
YOU.
WE HOPE THIS INFORMATION WILL
BE HELPFUL AS YOU GO THROUGH
THAT PROCESS.
I'M DR. RICK DESHAZO.
THANKS FOR WATCHING.