The shame of Mississippi, where racism and stupidity killed Obamacare

From Politico and Kaiser Health News comes this jaw-dropping look at Mississippi, the national graveyard of the Affordable Care Act’s promise:

“There are wide swaths of Mississippi where the Affordable Care Act is not a reality,” Conner Reeves, who led Obamacare enrollment at the University of Mississippi Medical Center, told me when we met in the state capital of Jackson. Of the nearly 300,000 people who could have gained coverage in Mississippi in the first year of enrollment, just 61,494 — some 20 percent — did so. When all was said and done, Mississippi would be the only state in the union where the percentage of uninsured residents has gone up, not down.”

The author, Kaiser Health News correspondent Sarah Varney, ascribes the state’s failure to errors, ignorance, racism and tea party-style ideology, among other distasteful qualities. The majority of the 138,000 Mississippians left stranded by the state’s refusal to opt in to Medicaid expansion are black. Hospitals, which were counting on the expansion to make up for federal funding they’ll be losing as the ACA takes hold, are unable to serve the uninsured even as charity cases.

What makes Mississippi typical among Medicaid-refusing states is that its health statistics are dismal. What makes it stand out is that its socio-economic statistics are the worst in the nation. Varney again: “It’s hard to find a list where Mississippi doesn’t rank last: Life expectancy. Per capita income. Children’s literacy.”

Even before opting out of Medicaid expansion, the state’s Medicaid standards were medieval. Adults aren’t eligible unless their household income is 22% of the federal poverty line or less. For a family of four, that’s $5,544 a year. Only one state is lower: Alabama.

The Mississippi story documents what can happen when a state’s privileged elites are determined to undermine a social program. Contrast that with the experience of Kentucky, where the state’s (Democratic) governor, Steve Beshear, pushed aggressively to implement the law and ended up with what may be the nation’s best record for covering the uninsured. And Mississippi Gov. Phil Bryant has the gall to assert the ACA is “a large burden” for his state.

Don’t let it be said that Mississippi is resting on its laurels. As Roy Mitchell, the executive director of the struggling Mississippi Health Advocacy Program, told Varney, “We work hard at being last.”

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