INDIANOLA, Miss.—“That's all I have to say about that—I have to go bury the dead,” undertaker Stephen Holland said after listing his grievances with his state's Medicaid politics early one Friday morning in June. Holland is one of a handful of white Democrats left in Mississippi's House of Representatives, and he helped shape the past 20 years of Medicaid history when he chaired the panel with jurisdiction over the program. Reliving that history rattled him.
In conversation, Mississippi Deltans frequently link death and Medicaid. A 26-year-old barber in B.B. King's hometown of Indianola, who asked to be identified as Calvin Klein in case he gets tended to by a doctor who reads Modern Healthcare, sang his mantra: “If you ain't bleeding, you ain't dying, and if you ain't dying, you ain't trying to see the doctor.”
Arguably, this feeling has become fact in the Delta's health crisis. Medicaid is the foundation and structure of its healthcare system, but there are so many gaps for people to fall through that many don't believe in it. If you are not disabled or pregnant, you can't get coverage unless you have a young child or become pregnant. Even then you have to make less than $5,000 per year as part of a family of three. People increasingly don't trust much else about the system, including the hospitals and doctors who run it.
And hospitals and clinics often don't see the illnesses of this impoverished region—consistently rated by the Robert Wood Johnson Foundation as the sickest in the state and one of the sickest in the nation—until they have blown up. HIV and Stage 3 AIDS infection rates are among the highest in the country, according to the National Institutes of Health. The state's health data system also shows the Delta's equally outsize rates of hypertension, heart disease, chronic liver disease, diabetes and preterm births.