Diabetes rates in Mississippi have reached crisis proportions. One in eight Mississippians has been diagnosed with diabetes, the second-highest rate in the country. Hundreds of Mississippians die each year from diabetic complications, and hundreds of thousands suffer from pain and costly treatment. At an average annual cost of $13,700 per patient, Mississippians spent $2.74 billion on diabetes-related medical expenses in 2012.
Acknowledging this problem, Governor Phil Bryant unveiled a new public-private diabetes initiative in his third State of the State speech last month. The governor’s office will partner with the University of Mississippi Medical Center (UMMC), North Sunflower Medical Center, GE Healthcare, Intel-GE Care Innovations, and C Spire to use telemedicine to provide care to diabetic patients in the rural Mississippi Delta.
Telemedicine is a promising but not yet proven tactic that uses digital technology to offer healthcare services to people unable to travel to a doctor’s office. The 18-month pilot program will cost $1.6 million and serve 200 patients. Doctors at UMMC will remotely monitor patients’ weight, glucose levels, and blood pressure, and patients will have phone and web-based contact with nurses for management of their disease.
Given the state’s large rural population and high rate of chronic disease, telemedicine is a logical fit for Mississippi. But any positive effects from the Gov. Bryant’s embrace of telemedicine will be swamped by the adverse consequences of his larger healthcare decisions. The governor’s opposition to Medicaid expansion and local nutrition restrictions threaten to decimate rural healthcare access and exacerbate Mississippi’s diabetes and obesity rates.
Medicaid expansion would extend health insurance to upwards of 300,000 currently-uninsured Mississippians. The federal government would pay all of the expansion costs until 2017 and 90 percent in perpetuity. Nevertheless, Gov. Bryant and his allies in the Legislature have chosen to leave adults under the federal poverty line with few healthcare options except for the emergency room.
That decision carries serious implications for the fate of Mississippi’s rural hospitals. Prior to the Affordable Care Act, the federal government would pick up the bill for hospitals that provided treatment to large numbers of uninsured patients, known as “disproportionate share hospitals” (DSH). These reimbursements for uncompensated care kept many of Mississippi’s rural hospitals in the black.
Under a system in which everyone has insurance, however, the need for DSH payments evaporates. The Affordable Care Act reduces federal payments to hospitals under the assumption that Medicaid and subsidized private insurance would pick up the slack. But Gov. Bryant’s rejection of $426 million in federal Medicaid dollars this year leaves hospitals on the hook for the care they provide to patients who have no ability to pay.
The result is cutbacks in healthcare access for much of Mississippi’s population. Reuters recently reported that Hattiesburg’s Forrest General Hospital projects a $2.5 million loss for fiscal year 2014 due to the cuts to federal uncompensated care payments. The Southwest Mississippi Regional Medical Center in McComb cut five doctors from its payroll. They will not be the last.
Of course, the simplest way to treat diabetes is to stop it before it starts, but Gov. Bryant has also worked to create legal barriers against preventative measures. In 2013 he led the charge to pass SB 2687, known as the Anti-Bloomberg Bill in response to former New York City mayor Michael Bloomberg’s restrictions on the size of refillable soda cups in his city. The governor and Legislature took away the power of Mississippi cities and counties to set their own policies reducing portion sizes, requiring menus to publish calorie counts and food sources, and other methods pioneered by Bloomberg to reduce the supply of obesity-causing foods and beverages. Gov. Bryant’s position is akin to taking away a city’s ability to pass a no-smoking ordinance and then promoting a small pilot project to decrease lung cancer.
The governor’s token embrace of the telemedicine initiative cannot offset the damage his other policies have done to diabetes treatment and prevention in Mississippi. Instead of reversing the trend chronic disease, his policies ensure that Mississippi will continue to finish last in national health rankings.