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The Mississipi Delta's healthcare blues

Anne Brooks, a nun and a physician, has struggled for years to treat the poor at a run-down clinic in Tutwiler. The nation's new healthcare law could help – but her state is fighting it.

June 03, 2010|By Noam N. Levey, Tribune Washington Bureau

She helped another woman navigate a garbled notification from her Medicare prescription drug provider. On a house call across the bayou, Brooks visited 82-year-old Johnnie Lane, bedridden after suffering a stroke. Brooks held his hand and gently reminded his wife to make sure she was getting enough rest too.

"When you take care of the person, you take care of the family," Brooks explained after giving Lane's wife a long hug and admiring her roses before heading back to the clinic in her aging white Toyota.

Sometimes, Brooks is able to find a hospital to provide charity care to people like David Kitchens, a 61-year-old farmer who has never had health insurance. Kitchens needed surgery to have a lunch-plate sized tumor removed from his chest.

"I was up a creek without a paddle, and drifting away pretty fast," Kitchens said. "They saved me."

Brooks and her team wish they could do more. But they are up against relentless math.

When they see a patient with private insurance from Blue Cross Blue Shield of Mississippi, the clinic can collect $44.80. For an elderly patient with Medicare, the clinic can bill $61.47.

Medicaid, which in some states pays so little that many doctors have stopped taking poor patients, has higher reimbursements in Mississippi, in part because so many providers rely on it. The program pays $121 for a routine office visit, and $124.01 if the patient is under 18.

Brooks' problem is that 4 in 10 of her patients have no insurance at all. The clinic bills them $15 for an office visit but many never pay.

"When someone brings me a basket of squash, I'm happy," Brooks said.

In 2008, Brooks collected $552,572 for delivering medical care, barely a quarter of the clinic's expenses, according to tax records. Most of the difference had to come from grants and donations.

Even then, there isn't enough money to fix the crack in the ceiling above the X-ray machine or wax the linoleum very often, or upgrade the clinic's aging computer system. The clinic has 24 computers, and seven don't have enough memory to run an electronic records system Brooks wants to install.

"I'm hoping for a little help from Uncle Gates for that one," Brooks joked, plotting the pitch she imagines making to Microsoft founder Bill Gates.

More heartbreaking are the no's that Brooks sometimes has to say to patients. When a woman came to the clinic complaining about pain in her left arm and shoulder, the best Brooks could do was recommend rest. A neurological test might have ruled out something serious, but the woman didn't have insurance — nor the $800 — to pay for the specialized exam.

"There are so many people who need to get help, who go through life in pain because they can't get the tests they need," Brooks noted sadly.

Some of these patients are probably eligible for Medicaid, but they have not enrolled — a fact that many advocates say reflects in no small part the extra hurdles the state has erected.

Mississippi is one of eight states that cut its Medicaid rolls between 2004 and 2008, according to enrollment data analyzed for the Kaiser Commission on Medicaid and the Uninsured. In the same period, the number of Mississippi children living in poverty increased.

Enrollment in Medicaid has begun creeping back up more recently. But the governor has said Mississippi cannot afford to insure any more people, even with the extra help from Washington.

"This new law will ultimately force the state to raise taxes, as hundreds of thousands of new people will be added to our Medicaid rolls," Barbour said.

Mississippi will have to find about $429 million over the next decade, a nearly 5% increase in Medicaid spending, according to an estimate by the Urban Institute, a left-leaning Washington-based think tank. But the federal government has agreed to kick in an estimated $9.9 billion over the same period to help Mississippi, enough to allow the state to cut in half the number of poor adults without insurance.

At the Tutwiler Clinic, Brooks said she's doubtful the state's leaders will take advantage of the federal help. "I just know I have to see my patients," Brooks said, as she reminisced about those she has treated, including the town's former physician who rode through the bayous to see patients with a rifle on his saddle to fend off panthers. "It would be nice if someone could figure out a way to pay us for doing it."

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