Health-care disaster in Mississippi

Access to affordable health care in the United States has been a major problem for years. Perhaps nowhere has it been worse than in Mississippi. And the Affordable Care Act (ACA), often referred to as Obamacare, has not made health care more accessible or affordable in Mississippi, according to two journalists there.

Writing for Columbia Journalism Review, Trudy Lieberman praises Sarah Varney, a senior correspondent for Kaiser Health News, and  Jeffrey Hess of Mississippi Public Broadcasting, who contributed research and reporting, for a “Letter from Mississippi,” which thoroughly and poignantly details “how the poorest, sickest state got left behind by Obamacare.”

Their account, published in the November/December issue of Politico Magazine and on the Kaiser Health News website, analyzed “Obamacare’s year-long struggle for respectability and viability in the poorest state in the union,” writes Lieberman.

They asked the following question: Can a private system of health insurance and subsidies for buying coverage work in a state with very poor people who have high rates of disease, lack education, and for whom buying insurance is like learning Turkish? “Add to that an uncooperative political infrastructure,” writes Lieberman, “and the answer at this point seems to be no.”

Given that Mississippi suffers from a high incidence of diabetes, heart disease, obesity and the highest mortality rate in the nation, Obamacare barely registered there. In fact, according to one analysis Varney cites, “Mississippi would be the only state in the union where the percentage of uninsured residents has gone up, not down.”

Varney blames many factors on this failure, including “political infighting, an overwhelmed federal agency and a surprise decision from the Supreme Court.” Only about 20 percent of the state’s residents eligible for Obamacare coverage have signed up. The “most significant drag on sign-ups,” Varney writes, “was Mississippi’s decision not to expand Medicaid,” which left some 138,000 low-income residents, most of whom are black, without insurance options.

Varney also points out inequalities that are part of the ACA, such as high deductibles and other high cost-sharing requirements. A 54-year old waitress got a policy for $129, Varney writes, only to discover she first had to pay $6,350 out of pocket. She cancelled the policy.

These articles focus on Mississippi, which also has the highest rate of leg amputations in the country (for African Americans, this number is particularly “startling,” Varney writes) and a high rate of breast cancer deaths despite a low incidence rate. However, many of the problems with health care apply as well to many other states.

Lieberman makes the point that this story is not being told many places. She writes: “Several of the issues Varney details—like inequality, the loss of federal funds for safety-net hospitals, and the continuing political hostility to health insurance for the uninsured—are not unique to Mississippi and merit attention from reporters around the country.”

In my own state of Kansas, for example, where Medicaid is not being expanded, health care is not being addressed adequately.

While politicians play political football with Obamacare, health-care costs continue to rise.

One culprit (of many), according to an article in Pacific Standard (July/August) notes the overuse of CT scans, often done before doing a simple physical exam. When one patient whose problem was already identified objected to having a scan done because of the exorbitant cost, the doctor said, “Why do you care? Your insurance will cover it.”

The trouble is, too many of us don’t care. And those making the decisions seem to care even less about these costs.