The Honorable Haley Barbour

As a Katrina-displaced New Orleans physician now practicing in Mississippi, I have yet to acquire a taste for our Mississippi governor, Haley Barbour. Maybe it is his political origins, first as a successful Washington lobbyist and later as chair of the Republican National Committee. Or his history of fundraising for the 2000 Bush campaign and consistent opposition to campaign finance reform. Since I arrived in Mississippi, I have watched as he hastily rewrote gambling regulations in 2005 so casinos on the Katrina-devastated Gulf Coast could relocate from gambling boats onto dry land. It always bothered me that one of Barbour's first post-Katina policy acts was to re-establish gambling, even as thousands remained homeless.

It also bothers me that, as Barbour brags about his effectiveness in bringing the Mississippi Coast back from Katrina, he continues to ignore the needs of the poor. As the casino income on the coast soared to a record $1 billion in 2007, Barbour dragged his feet in providing housing to hurricane victims. By November 2007, a full two years after Katrina, Barbour had spent a paltry $167 million of a $1.7 billion emergency federal housing block grant on storm victims living in poverty.

Yes, that's million, with an m. And this is in Mississippi, where, I can assure you, it is not hard to find poor people.

So, it should not have been surprising to hear Barbour utter these words in his State of the State speech on January 21, 2008, which ironically enough was Martin Luther King day:
 

In this past four years, we’ve made significant progress in saving Medicaid for the nearly 600,000 Mississippians who rely on it. We have enacted reforms because we know it is wrong for a family to work hard at two or three jobs, to raise their kids and pay for their healthcare, and then have to turn around and pay extra taxes so others who are able to work and take care of themselves choose not to but instead get free healthcare at taxpayers’ expense. That’s not right.

Under this Administration, the Division of Medicaid checks people’s eligibility face-to-face, and the Medicaid rolls have decreased to fewer than 600,000. This drop is what you should expect when the number of people employed has increased by more than 50,000.

On Martin Luther King Day, of all days, Barbour stoops to blaming the fiscal problems of the state on people "who are able to work and take care of themselves [but] choose not to."  The mythical welfare queen rises from the grave. To be fair, Barbour goes on to enumerate the fiscal challenges that Mississippi faces with Medicaid funding. There are many. But it is irresponsible to crow over how many people Mississippi has kicked off Medicaid, blaming the ejected for being lazy and gaming the system for free health care.

 
Barbour is right about one thing: He has very efficiently denied Mississippians healthcare. He has trimmed statewide Medicaid enrollment from 785,000 in 2004, to 540,000 by 2006. That loss of 245,000 enrollees far exceeds the modest 50,000 job increase Barbour boasts, which incidentally occurred over the much longer period of 2003-2007. By his own numbers, Barbour is publicly admitting he has stripped 195,000 citizens of health insurance, even given his assumption that every single job added to the state economy carries full health care benefits.

His myth of the Medicaid Queen is not even close to being true. In my medical career I have treated thousands of Medicaid patients, and I have yet to meet one who chose to sit at home to collect those fabulous Medicaid benefits. Not that Medicaid is all that great an insurance anyway, but it, like almost every insurance, makes all its payments directly to doctors and hospitals. Not a dime of Medicaid money is ever paid directly to a patient.

Medicaid money goes into my pocket, my nurse's pocket, my office manager's pocket. It pays the salaries of the cooks and maintenance people at the hospital where I work. In fact, I can't think of a federal program where the money  goes to harder working and more honest, caring people than it does with Medicaid. Here in McComb, MS, we have a six story hospital that employs at least 1,000 people. That hospital, one of the largest employers in Pike county, might not exist without Medicaid.

And for Mississippi, Medicaid is a real bargain. State funding is backed by federal matching dollars, and Mississippi, as America's poorest state, qualifies for the highest matching fund percentage in the nation, 76.29%. For every dollar Mississippi spends on Medicaid, the feds kick in three.

In Governor Barbour's mind, cutting thousands of qualified poor people from the Medicaid rolls and thus foregoing hundreds of millions in matching dollars is good for the state. This is the same governor who in 2007 happily engineered a $296 million tax incentive package to lure a Toyota plant to Tupelo. That plant will eventually employ 2000 people, a considerable number, but nonetheless small compared to the many thousands working in the medical field in the city of Jackson alone. Our own county hospital creates half as many jobs, and cost far less tax money to build.

It takes a special gall to seize the occasion of Martin Luther King Day to accuse the poor of dragging Mississippi down. Barbour, of course, would deny that race has anything to do with his statement, but, to put things kindly, Mississippi doesn't have a civil rights history that easily excuses that interpretation. That he said this on Martin Luther King Day, a day when most politicians walk on racial eggshells, suggests extraordinary insensitivity to the needs of his own constituency.

The Medicaid line item is a huge part of most state budgets, and this is especially true for a poor, medically under-served state like Mississippi. It is true that even with a 3-to-1 match Mississippi is having trouble meeting the needs of its citizens. Barbour owes it to the voters to admit money is tight. But blaming the tight budget on poor people, when Barbour has pursued a policy to maintain the nation's highest grocery tax and among the lowest corporate and cigarette tax rates, is, to borrow Barbour's own words, "not right."

Yet this is the Republican way. Barbour is no different from his Republican brethren, who think 100% of Americans would have health insurance if poor people would only behave responsibly. He would have us believe it is acceptable to give away $296 million to one of the world's richest corporations for 2000 jobs with health insurance, but unseemly to fund health insurance directly.

It is time that conservatives be called on their heath care lie. They have no intention of promising health care for everyone. Their game is Barbour's game -- force people off government assistance, and pretend they are better off for the loss. As long as they are allowed to persist in this fiction, they will succeed in their goal of depriving millions of poor Americans of the one thing everyone deserves -- good health.