On Wednesday night, Mississippi became the 39th state to confirm a case of COVID-19. Five more presumptive cases have been reported today. Coronavirus took a while to reach Mississippi, but now that it’s here, the priority is containing its spread and treating the people who suffer severe complications.

At the same time, it’s important to consider how the threat posed by the virus has been exacerbated by Mississippi’s preexisting conditions: large numbers of people suffering from chronic illnesses, a high uninsured and underinsured population, and a critical shortage of healthcare providers. Combine that with sharp reductions in public health funding, and you have a formula for disaster.

The good news — insofar as it exists — is that Mississippi’s officials are taking the pandemic seriously, and politicians in Jackson seem to be following the lead of medical professionals. State Health Officer Dr. Thomas Dobbs is coordinating the governmental response to coronavirus from his post at the helm of the Mississippi State Department of Health (MSDH), which holds a top rating in emergency preparedness from the Trust for America’s Health. Dr. Dobbs is well-suited for his role: he’s an expert in infectious diseases who previously served as the state epidemiologist.

However, recent policy choices that have been detrimental to public health in “normal” circumstances have left Mississippians particularly vulnerable in extremis.

Every year since 2014, the state’s leaders have refused to accept more than $1 billion in federal money to expand Medicaid coverage to approximately 130,000 low-income Mississippians. That decision has not only harmed the people who could’ve been insured, but many more whose local clinic or hospital has been forced into bankruptcy as a result. Since Mississippi began rejecting the Medicaid funding, five rural hospitals have closed for financial reasons, while others have pared back services. By comparison, Arkansas — which expanded Medicaid at the first opportunity — has only had one hospital closure during that period.

The Legislature has also cut the health department’s budget deeply in recent years. MSDH’s state appropriation was reduced by 22% from 2016 to 2018, forcing the agency to close county health clinics, eliminate hundreds of jobs, and even jettison some custodial services. While funding has ticked back up, department leaders and health advocates warned that the budget cuts would hamper the state’s ability to respond to an infectious disease outbreak, among other things.

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