The Florida legislature hasn’t accepted the Medicaid expansion either but Mississippi is a test case for lunacy. The poorest state has the poorest citizens. And no one gives a damn about them because they’re poor and won’t vote for GOP candidates. Democrats tut-tut at Kansas, but no other state has so successfully embodied what a GOP vassalage looks like in 2014. Overweight citizens without recourse to healthcare, voting against their interests or frightened into voting against their interests:
But the administration had few options. And the law was, after all, a federal-state partnership. If the state didn’t play, the feds were stuck. “When we were designing the legislation, we were very aware that the states that, in many cases, benefited the most were poor and generally anti-Obama,” Bob Kocher, a special assistant to Obama in 2009 and 2010 who helped draft the ACA, told me. But “you needed a state that at a minimum level is cooperative for this to work,” he said, which became more difficult after the Supreme Court’s Medicaid ruling in 2012. That meant even idealistic liberals had to turn their efforts away from needy states like Mississippi to more receptive regions. “It broke the heart of some folks at HHS,” Kocher said. “But I’m not sure they had another choice.”
The Medicaid gap hit hospitals hard, too. Without the cash infusion that a Medicaid expansion would have brought, Mississippi hospitals are being strained to a near breaking point, with a number of them shuttering entire departments and laying off staff. Poor people often flocked to the emergency room at Montfort Jones Memorial Hospital in Kosciusko, for instance. The central Mississippi town is best known as Oprah Winfrey’s birthplace, but that distinction has done little to change its fate. Earlier this year, the hospital shut down its intensive care unit and laid off 38 employees. Next, the psychiatric unit for seniors closed. One in five people who come to the hospital can’t pay their medical bills, and Montfort Jones had relied on supplemental Medicaid payments to defray the costs. But under the health law, federal aid for uncompensated care trails off. Without those payments, and with no softening in the demand for uncompensated care, Montfort Jones had been losing up to $3 million a year, and couldn’t meet payroll.
Read the whole story. The state that receives more money per citizen from the federal government than any other in the Union complains about the possibility of extending Medicaid. Life in these United States.