Will closed hospitals be Gunn's legacy, too?

When Philip Gunn announced this past week that he would be retiring from the Legislature after one more year, several of his political admirers gushed with praise for the Republican House speaker.

He was credited with being a catalyst for Mississippi's economic growth, for a series of business and individual tax cuts, for pro-life legislation that led to the overturning of Roe v. Wade, and for a new state flag to replace a longtime racially offensive one.

But there is another legacy of which neither Gunn nor his admirers should be so proud.

He has been a principal obstacle to Medicaid expansion, which has cost this state about $8 billion of federal funding and counting, left 200,000 to 250,000 of modestly paid Mississippians without insurance, and helped push a growing number of hospitals in this state, including Greenwood Leflore Hospital, to the precipice of closing.

Gunn has dug in his heels against Medicaid expansion only slightly less stubbornly than Tate Reeves, who has been an obstructionist as lieutenant governor and now as governor. They have made it a politically dangerous for any Republican lawmaker to support Medicaid expansion, no matter what the numbers or the research or the experience of other states that have expanded Medicaid have shown.

And why so?

Because they made the political calculation that opposing anything associated with former President Barack Obama or his Democratic successor, Joe Biden, is a winner for them in a state dominated by Republican conservatives — and no amount of reason or financial incentives for this state has convinced them otherwise.

Since the Affordable Care Act, better known as Obamacare, was passed in 2010, there have been at least eight government or private studies done on what the impact of Medicaid expansion would be on Mississippi, according to a recent report from Mississippi Today. All but the earliest study, done before Medicaid expansion took effect, found that expansion would be a net financial plus for Mississippi, thoroughly refuting the Republican opponents' claim that the state couldn't afford putting up one dollar for every nine dollars contributed by the federal government.

Didn't matter to Gunn.

In 2021, in the first months of the Biden administration, the Democratic majorities in Congress tried to entice Mississippi and the other 11 non-expansion states with an even better deal. Not only would the federal government pay for 90% of the claims of the newly insured, it would also reduce for two years the state's share of the cost for those covered by the regular Medicaid program. To Mississippi, that incentive amounts to an estimated $600 million to $700 million.

In other words, Mississippi would make money by expanding Medicaid in the first two years, and after that, it would at least break even, given the additional state tax revenue generated by the infusion of federal dollars.

Gunn still didn't budge.

The continued opposition not only defies economic reason, it has grave consequences for hospitals like ours.

When Medicaid expansion was enacted, the authors of the legislation said the government would largely pay for it by eliminating, or at least severely reducing, the payments the federal government gave to hospitals that treat a disproportionate share of uninsured patients. The rationale was that diverting these so-called DSH payments was reasonable since any state would be out of its mind not to accept what the federal government was offering in their place.

Congress underestimated how mule-headed Mississippi can be.

The stubbornness of Gunn, Reeves and others like them has dealt a double-whammy to Greenwood Leflore Hospital. Not only has it lost out on the additional revenue that Medicaid expansion would bring, it has seen its DSH payments cut from about $6 million a year to less than a half-million.

It would be simplistic to say that Medicaid expansion alone would save Greenwood Leflore Hospital. It could be, though, one significant piece of a solution that would require some or all of the following: higher reimbursements from government and private insurers; crackdowns on managed-care companies that try to deny benefits; cuts in the Medicaid taxes that hospitals pay the state; and, at least in the short term, subsidies from the city and county, which jointly own the hospital.

Gunn shocked expectations by becoming the state's first prominent Republican elected official to call for a new state flag. He needs to pull a similarly dramatic surprise and reverse his position on Medicaid expansion. And it needs to come quickly, or not only is Greenwood's hospital likely to fail, but several others soon after.

Reeves is not going to change positions. That's a given. He's put too much political stock in opposing any expansion of social safety-net programs, although he's more than comfortable doling out corporate welfare.

That means it would take veto-proof majorities in both houses to make Medicaid expansion happen. That's a huge lift, and it becomes impossible without Gunn's backing.

Gunn's retirement announcement suggests he may have cooled on the idea of running for governor. Whether he has or not, he has a chance to make amends for helping to put Mississippi's rural hospitals in the shape they are now. Let's hope he tries.

- Contact Tim Kalich at 662-581-7243 or [email protected].