This edition of the President’s stew was started shortly after welcoming in 2024. As we are all now aware, January 2nd was opening day of the Mississippi 2024 Legislative session. I had the privilege to serve as Doctor of the Day on January 2nd. As many of you know, I have had that privilege many times, but this was my first for opening day of a session. The day was filled with excitement, swearing in ceremonies, and a lot of family and visitors around the Capitol. There was so many people, one could hardly move within the chambers. My guess is that they will place some limitations on the number of visitors for the ceremonies in the future.
Representative Jason White was officially elected the new Speaker of the House of Representatives and began his tour of office that day. The next order of business was electing a new Speaker Pro Temp, Representative Manly Barton. The Senate leadership remained unchanged. Needless to say, the day was pretty chaotic but exciting for many. The second day was also chaotic but for another reason. Mississippi was one of six states that day to receive a bomb threat at its Capitol. Thankfully the bomb threat was a false alarm and soon the Capitol was back to its normal routine, but still very concerning. Over the next few days, it was business as usual. First order was appointment of committee membership and chairmanships. In the House with leadership changing, there were many changes in committee chairmanships so time will tell what the impact of these changes will deliver.
In case anyone is interested in the current makeup of the chambers, here they are. The Senate is made up of 52 members, 36 Republican and 16 Democrats. There were 5 new Senators. 3 were Democrats and 2 were Republicans. The house is much larger with 122 members making up this body. Its makeup is 79 Republicans, 41 Democrats, and 2 independents. Unlike the Senate, it welcomed several new members to its family. There were 23 new members, 17 Republicans and 6 Democrats.
Because this is a legislative session following an election year, it is 125-days as compared to the traditional 90-day session in other years. With this being the start of that extended post-election session, things got off to a rather slow start. But things are beginning to heat up as we round out February and head to March.
There were two special sessions called within the early days of the legislative session and they centered around economic development projects by the Governor. Your MSMA leadership began the year with early meetings with the Lt. Governor and the new Speaker to share the MSMA focal points for the session. The meetings were encouraging as both leaders continued to talk about healthcare and were very attentive to our priorities. However as with my analogy of the President’s stew, we can stir in many ingredients and seasonings, but the stew doesn’t always come forth with the flavor we desire. In many cases, politics, like the stew, takes constant watching and attention to achieve just the right flavor. Sometimes we have to turn up the heat and sometimes we have to turn down the heat and let things simmer. Cooking, like politics, takes a lot of experience to get things right and sometimes one has to just throw out the pot and start over.
There continues to be a lot of discussion and rhetoric around improving access to care for working Mississippians. However, it is still uncertain as to what improved or expanded healthcare access is going to look like, but given all the rhetoric and signs, something is going to be presented in both the House and the Senate this session. There have been a few hints, but as of this writing, the actual bills have not been presented. Even if a bill is passed in the chambers, we will have to wait to see how it plays out in the Governor’s chamber.
Another of MSMA’s focal points is a carry-over from last session, streamlining the prior authorization process. As we are all keenly aware, legislation was passed last session only to see the Governor veto the bill. Both the House and Senate have already passed legislation this session and it is on the Governor’s desk yet again. We are in a holding pattern to see how the Governor will address this year’s version of the prior authorization bill. Hopefully his concerns have been addressed and it will become a reality this year.
Another MSMA priority is Medicaid presumptive eligibility for pregnant women. This is another process that was addressed early in the session with favorable responses. My hope is that this process will be passed easily. A major emphasis, rightfully so, has been placed on Mississippi’s poor prenatal and perinatal metrics. There is much work to be done in addressing and improving these maternal and perinatal health outcomes, but this is a great first step in ensuring that these moms are eligible for early intervention and continued care until delivery and beyond.
As I’ve traveled the state attending Mix & Mingles and component society meetings, there have been many questions and concerns raised about Medicare Advantage plans. There is no question that CMS is heavily pushing Medicare Advantage plans with advertisement and high inducements to insurance brokers. It is my opinion that there is a fallacy that these plans will save CMS money and in fact may cost CMS more and yield poorer health outcomes. There are several challenges that arise from these plans such as many physicians are not in some of the networks or choosing not to accept Advantage plans. Thus, forcing patients to travel greater distances for care, if in fact they can find someone to care for them. In an NBC news article in the fall, hospital CEOs in six states reported that they repeatedly experienced refusal of payments. This has had serious negative impacts on many hospitals, but more significantly in rural areas which are struggling to keep the doors open at best. There are possibly situations where patients benefit from advantage plans, but my concern is that there are many unforeseen challenges, and that all patients are not receiving full disclosure. I foresee a need to first address the marketing of these plans with more transparency to the patients. Clearly informing them with what they are giving up in turn for what they are getting. Like many of our patients, MSMA leadership has brought many of these concerns before the Commissioner of Insurance.
Recognizing that this session had the making of both uncertainty and promise, MSMA leadership began early discussions with leadership in both the House and Senate. There continues to be promise mixed with uncertainty as we enter our third month of the session. With all the promise for possible expansion of access, there remains a great deal of uncertainty surrounding the many, many scope bills. There are always a few, but this year there is a landslide of bills. The number and variety of bills are massive. So, when you receive a Call to Action, please contact your local senator or representative and ask for them to support the physician lead team, as the most efficient, safe and cost-effective approach to healthcare. There seems to be much confusion within the legislative leaders that if they pass any legislation that expands access to care for working Mississippians, it will require passage of some form of expanded scope. First, we all understand that scope is about practice parameters, not practice locations, nor does it in any way guarantee increased access to primary care. Nor should it have a significant bearing on increasing the number of providers. Although the current process is not perfect, the physician lead team remains the gold standard to safe, cost-effective care.
By the time that you read this article, much of this year’s legislative process will likely be behind us. Keep in mind the need to take every opportunity to communicate with your legislators. If you don’t already have a personal relationship with your legislators, or other state elected officials, volunteering for Capitol Doctor of the day is a great start. Take advantage of this opportunity, not only this year, but every year.
In closing, it remains critical that we all participate in MMPAC. Your voice and your input are critical to the care and safety of our patients and our physician’s futures. I look forward to continuing my travels across the state, meeting with you and your component societies, and hearing your suggestions. If you are not a member of MSMA, become one. If you are a member, find a way to engage and be more active. We need all of us working together.
Best wishes, joy, and peace.
John Mitchell, MD