Lynn Evans

Contributing Columnist

One of the more consistent questions at the state Capitol when faced with Mississippi's health-related budget requests is: Why are costs going up?

It's not the children. Children are still the least expensive patients to care for, including if the payer is Medicaid. A child insured by Medicaid costs about $2,399 a year, according to the American Academy of Pediatrics. Although children make up the largest category of Mississippi Medicaid beneficiaries at 56 percent, they account for only about 20 percent of Medicaid spending. And that percentage is actually down, not up.

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Most Medicaid spending in Mississippi is for the elderly and disabled. Although they make up only about a third of the Medicaid population, these two groups account for about two-thirds of Medicaid costs.

The very most expensive group for all insurers are the sickest and the most disabled. People who have suffered traumatic brain or spinal cord injuries. People sick with the deadliest forms of cancer or neurological disease. People who require institutional care for life. Medicaid reports on its website that people on its rolls who have intellectual and developmental disabilities cost the program over $36,000 each in 2016.

Another big category of high-cost treatment for Medicaid and other insurers is prescription drugs, including when the pharmaceutical company has escalated the price of the treatment drug basically because it can. We all know the story of EpiPen and its 600 percent price increase. Three months' worth of the drug used to treat Hepatitis C runs between $80,000 and $120,000. The latest drug company to profit big from the misery of its customers is Evizio, which rescues people with opioid overdoses. The price for Evizio has jumped from $690 to more than $4,500 a dose in two years.

One option seized on by some legislators for decreasing Medicaid costs is initiatives promoted as eliminating fraud and abuse. In fact, Mississippi Medicaid's Program Integrity already investigates suspected provider and beneficiary fraud. The number for reporting suspected abuse is 1-800-880-5920. Recipient fraud seems more alternative than actual fact.

Behind the assumption that somehow beneficiary fraud and abuse must be the cause of high Medicaid costs seems to be a disbelief by some legislators that Mississippi could have so many low-income children and adults who qualify for coverage.

The truth is that Mississippi has the highest percentage of children living in poverty in the U.S.: about one in three. Of the approximately 450,000 children on the Medicaid rolls, some 60 percent live below the poverty level.

One in five of all Mississippians live below the poverty line. According to the U.S. Census, the median household income for our state is $39,665 — $14,224 lower than the median for the nation as a whole. For families where the wage earner is under age 25, our median household income is only about $25,000 a year.

In over three-quarters of Mississippi's cities and towns, the average household income is low enough for the children to qualify for Medicaid. Of the 711 jobs listed for Mississippi wage earners by the Bureau of Labor Statistics, 279 or 39 percent have an average wage low enough that the children in a single wage-earner family would qualify for Medicaid.

The truth is Medicaid funding, for which 74 percent of the funds are drawn down as a match from the federal government, underpins Mississippi's ability to provide medical care to its people. Our payer-mix of private insurance and Medicaid, especially for pediatricians and other primary care providers, is heavily dependent on Medicaid. Over half of Mississippi children rely on Medicaid and CHIP for access to health care. Without Medicaid reimbursement, many physicians would not be able to continue practicing medicine, especially in Mississippi's small towns.

The current threat to cut Medicaid state funding by over $120 million, if carried out, would also hit small community hospitals especially hard. Many are already teetering on the brink, looking for ways to reinvent themselves that focus more on preventive health care and disease management than in-patient care.

If the governor were to declare a Medicaid funding emergency, meaning there was not enough money appropriated to Medicaid to cover costs, the hospitals would likely take the first cuts, along with so-called optional services like hospice, EPSDT, and home and community based services.

Insufficient state funds are the root of the problem, resulting from the tax cuts of the past few years. And, there's a puzzling reluctance to find more revenue from increasing the state's tobacco tax, gas tax, or a use tax to tap lost internet sales taxes due.

It should be readily apparent to state leaders that underfunding Medicaid by a combined state and federal match total of almost $480 million would have a catastrophic effect on our state's health care system.

Lynn Evans is a former Jackson School Board member and a contributing columnist.