Drew Hawkins, Gulf States Newsroom | (TNS) KFF Health News

For Roderick Givens, a radiation oncologist, the expansion of Medicaid isn’t just a policy issue. He practices medicine in a rural area in the Mississippi Delta and he sees daily how Medicaid coverage could help his uninsured patients.

“I can’t tell you the number of patients who I see who come in with advanced disease, who have full-time jobs,” Givens said. “They haven’t seen a physician in years. They can’t afford it. They don’t have coverage.”

This spring, the Mississippi Legislature considered but ultimately failed to expand Medicaid, which would have extended coverage to around 200,000 low-income residents. Mississippi is one of 10 states that haven’t expanded Medicaid, the state and federal health insurance program for people with low incomes or disabilities.

Seven of those states are in the South. But as more conservative-leaning states like North Carolina adopt it, the drumbeat of support, as one Southern state lawmaker put it, grows louder.

Advocates for expanding Medicaid say opposition is largely being driven by political polarization, rather than cost concerns.

Givens, who is also chair of the board of trustees for the Mississippi State Medical Association, which supports Medicaid expansion, said the federal government would pay for the vast majority of it and that most Mississippians support it. “Why does that not translate when it comes to policy?” Givens asked. “It’s called the stupidity of politics. Period.”

Givens pointed to Arkansas as a potential model for Mississippi because the state has similar demographics and expansion has been in place there for a decade. “Look at what has worked for them and what needs to be tweaked,” he said. “For me, that’s just common sense.”

In states that have not expanded Medicaid, hundreds of thousands of people fall into the “coverage gap,” meaning they earn too much to qualify for Medicaid but are not eligible for subsidies to help pay for private insurance. Those in the coverage gap also can’t afford premiums and other out-of-pocket expenses on employer-sponsored insurance even if they are eligible.

The coverage gap is not an issue in states that have expanded Medicaid. In those states, a single person making up to 138% of the poverty level, or about $20,000 a year, can get on Medicaid. Someone making more than that can get subsidies for private health insurance.

For the first time in Mississippi, both the state Senate and House of Representatives proposed expanding Medicaid during the legislative session that ended in May. In the end, the efforts fizzled at the last minute.

Had the proposed bills succeeded, some 74,000 Mississippians who are stuck in the coverage gap would have gained access to Medicaid.

The House speaker, Jason White, a Republican who supports expansion, acknowledged the political hurdles. “It’s President Obama’s signature piece of legislation. It’s known as Obamacare,” White said. “So, there are a lot of political dynamics centered around it that probably never allowed it to get off the ground.”

White said this year was different because of increased support from the business community.

“I kidded some of my fellow Republicans. I said, ‘Come for the savings, if you will, and then you can stay for the salvation and the good things that it does to improve people’s lives,’” White said. “If you can’t get there because it’s the right or compassionate thing to do to help these individuals, get there because it makes sense from a business standpoint.”

In neighboring Alabama, politics also thwarted attempts to provide more health care this year. Although the state legislature didn’t vote on any direct expansion bills, there was an attempt to include expansion language in a bill about casino gambling — specifically, a provision to allocate some gambling profits to rural health systems.

Ultimately, the Alabama bill was stripped down, and the funding for rural health was removed.

If Alabama expanded Medicaid, at least 174,000 more people would be covered, according to KFF. But the connection to Obamacare remains a stumbling block in Alabama’s Republican-dominated state legislature.

“Just the partisan nature of this is definitely a problem,” said Regina Wagner, an assistant professor of political science at the University of Alabama. Wagner said that most Alabama voters support expansion and that other states have adopted the programs after mounting public pressure.

“A lot of rural voters are Republicans. And so your own constituents are being hit by this and you’re not addressing it,” she said. “If the pressure gets high enough and sentiment shifts, maybe that’s going to be enough to push them.”

The main disagreement in the Mississippi Legislature revolved around work requirements — recipients would have to show they were working part-time or in school.

White said many of his Republican colleagues view extending health coverage through Medicaid as “some form of welfare, some form of giveaway, some form of expanding government.”

Opponents of Medicaid expansion in Alabama are also concerned about potential impacts on the workforce of what they call free health care.

“If you open up this federal subsidized program for hundreds of thousands of people, then it could actually hurt that labor participation rate, give them another reason not to go to work, to stay at home,” said Justin Bogie, senior director of fiscal policy at the Alabama Policy Institute, a research group that says it is committed to limited government.

The federal Centers for Medicare & Medicaid Services, or CMS, would have to issue a waiver to allow an expansion plan with a work requirement — something the Biden administration hasn’t done for any state.

This spring, Mississippi came close to a compromise bill that included a work requirement, something that needs a CMS waiver. Had the bill passed and CMS denied the waiver, expansion still would not have taken effect, and the state would have had to apply for the waiver from CMS every year, hoping for approval under a future — potentially more conservative — presidential administration.

That’s what happened in Georgia. In 2020, the Trump administration approved a waiver for a work requirement as part of a limited expansion effort. CMS later rescinded the waiver under the Biden administration, leading to a lawsuit. A federal judge ruled in favor of Georgia, reinstating the work requirement provisions.

However, only about 2,300 people are enrolled — which is fewer than half of 1% of the more than 430,000 uninsured Georgia adults who could gain access if Medicaid were fully expanded, according to KFF. The state’s alternative expansion plan has cost taxpayers at least $26 million, according to KFF, with nearly all of it going to administrative and consulting fees, not medical care for low-income residents.

As public support for expansion continues to grow in holdout states, North Carolina, the most recent Southern state to pass Medicaid expansion, may offer a glimpse of the future. Since its adoption last year, more than 600,000 people have become eligible.

“But it still took a long time,” said Robin Rudowitz, a vice president and director of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News. “It took the governor who continually supported expansion, and the legislature finally came to endorse and pass the expansion.”

Rudowitz said the fiscal incentive under the American Rescue Plan Act played a role in moving the needle in North Carolina and could help ignite debate in other holdout states. But ultimately, she said, the reasons the Affordable Care Act was established continue to be the strongest motivators.

“Without expansion, there are more people who are uninsured. Hospitals and other providers are not able to get reimbursement because individuals are uninsured,” Rudowitz said. “Those are the underlying issues that existed pre-ACA and continue to exist, particularly in states that haven’t adopted expansion.”

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This article is from a partnership that includes the Gulf States Newsroom , NPR , and KFF Health News.

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(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Last year, Mary Jane Burgett got a taste of the fun and fame that come with being first through the gate on the first day of the Minnesota State Fair.

It was such an exciting experience that the 7-year-old persuaded her parents, Clayton Burgett and Rose Hume, to once again camp out overnight outside the main gates on Snelling Avenue so she could claim the honor for 2024. The family arrived at 3:10 p.m. Wednesday and pitched a tent.

Mary Jane Burgett, 7, covers her ears as people cheer during the countdown to the opening of gates for the first day of the 2024 Minnesota State Fair in Falcon Heights on Thursday, Aug. 22, 2024. Mary Jane was first through the Snelling Ave. main gates Thursday, along with her parents, father Clayton Burgett, right, and mother Rose Hume. The Minneapolis family was also first through the gates last year. (John Autey / Pioneer Press)

When Minnesota State Fair CEO Renee Alexander rang the Fair’s ceremonial cowbell at 7 a.m. to signal the opening of the Fair, Mary Jane bounded through the gate.

“Bunnies! I’m going to see the bunnies,” she said. “Then it’s the swings or maybe the Ferris wheel.”

First Fair food? “Probably a blueberry waffle,” Hume said. “She loves blueberries.”

The family, who live in Minneapolis, brought a tent, a hammock, two chairs, board games and art supplies for their overnight adventure. “She likes to draw, so we drew a lot,” Clayton Burgett said. “We played rock, paper, scissors for, like, three hours, and tic tac toe for a couple of hours.”

A couple hoping to be first in line came at 4:30 p.m. Wednesday, but Mary Jane, a rising second-grader at St. Anthony Park Elementary School in St. Paul, had already staked her claim. Another person showed up Wednesday night, but also left after realizing they weren’t going to be first, Clayton Burgett said.

Mary Jane “came up with this idea last year after she heard us talking about it,” he said. “She said, ‘Can anybody be first?’ and we said ‘Yes.’ ‘So, we can be first?’ And I said, ‘Yeah,’ and she’s like, ‘Can we?’ And here we are again. It’s just a way to make memories for the kiddo. Hopefully, she’ll remember those three hours of rock, paper, scissors.”

Fairgoers break out the umbrellas and ponchos as the rain began to fall in the afternoon of the first day of the Minnesota State Fair in Falcon Heights on Thursday, Aug., 22, 2024. (John Autey / Pioneer Press)

Is this going to become an annual event? “We don’t know,” he said. “Last night she said, ‘Next year we don’t have to be first.’ She wants to give the title to somebody else. But then she rebutted that like half an hour later and said, ‘Well, what if I want to be first?’ So we might be back next year.”

Said Hume: “It’s a great way to make memories and see some friends. That’s always how it is, too. You see somebody you’ve seen yesterday or someone you haven’t seen in 20 years. That’s always something fun to look forward to.”

Next in line

Next in line were Ginger Johnson, who arrived at 1 a.m., and Jason Hanson, who arrived at 3 a.m. The two befriended each other in 2019 – when Johnson, 63, of Apple Valley, was first in line and Hanson, 52, of Blaine, was second.

“In 2019, I went in memory of my brother Butch, who I lost in January of that year,” Hanson said. “He always wanted me to be one of the first people through the gate of the State Fair because he knows how much I love the Fair. I got here, and I met Ginger, and we’ve been friends ever since. I went all 12 days of the Fair back in 2019.”

Hanson, who grew up in Wilson, Wis., said his father, Phillip Johnson, used to let him and his brother skip a day of school to go to the Fair.

“He would get up early, and we would drive over,” he said. “It’s a way to honor my dad.”

Ginger Johnson said her quest to be first in line was a tribute to her daughter, Luppy Wencel, who died in July 2022 of complications related to diabetes.

“I want to get her in first, so I keep trying,” Johnson said, fingering a locket around her neck containing some of Wencel’s ashes. “It hasn’t happened yet. But next year I’ll be here, so she can be first.”

Fairgoers ride the SkyGlider at the Minnesota State Fair in Falcon Heights on Thursday, Aug. 25, 2016. (John Autey / Pioneer Press)

Something special

There’s something special about being at the Fair before the throngs of people arrive, said Johnson, who plans to make 10 trips to the Fair this year.

“The barns don’t smell. The bathrooms are clean,” she said. “You can see animals. It’s pleasant. There’s no food on the ground. You get the fresh food smells instead of other smells. The lines aren’t as long. And the people are generally happier because it’s the first day, and they haven’t been here for many days, and it’s cooler, and they’re not crabby.”

“The exciting part about being here this early is you get to see the State Fair wake up,” he said. “If you really love the State Fair, like Ginger and I do, it’s just a great experience because you sit here and you see a couple hundred people this early, and then by 1 or 2 in the afternoon, there’s thousands of people here. and you’re, like, ‘Wow.’ It’s just incredible.”

The friends planned to make a breakfast stop at Andy’s Grill before seeing all the other sights.

“They have a great croissant breakfast sandwich that has egg on it, and then you can get ham, bacon or sausage,” Hanson said. “That’s been a tradition of mine for at least five years now.”

‘It’s all perfect’

Next up were the mother-son duo of Misty Leonida and Elias Pearson, who left their house in Inver Grove Heights a little after 4 a.m. and were in line by 4:45 a.m.

“What’s the best thing about being first? Everything’s fresh. It’s all clean. The food tastes great. You know? It’s all perfect. It’s a great day,” Leonida said.

Their first planned stop was to pick up an electric mobility scooter for Leonida and then coffee at the Minnesota Farmers Union Coffee Shop on Dan Patch Avenue. Pearson planned to have a London broil steak sandwich, and Leonida wanted to try a grilled-cheese sandwich with pickles.

“We write down what we’re going to do and what we’re going to eat and check off our list,” she said. “We plan.”

Claire Smalley, of Chicago, planned to make a beeline for the animal barns as soon as she went through the gate. Smalley, who was waiting near the front of the line with her friends Amanda Riley, of Minneapolis, and Rob Ridner, of North St. Paul, attends all 12 days of the Fair.

“We go straight back to the barns for that peace and quiet,” Smalley said. “It’s our favorite place, and we’re just so excited to be here every year. We always cry happy tears. Seeing all the kids bring the animals in, it’s just, like, the perfect kickoff — the perfect way to start it before all the chaos comes, you know?”

Members of the Twins Cities Unicycle club perform during the daily parade at the Minnesota State Fair in Falcon Heights, Friday Aug. 25, 2023. (John Autey / Pioneer Press)

A countdown before opening

Minnesota State Fair Police Chief Ron Knafla treated the early-bird Fair-goers to a special countdown. “Fifteen minutes!” he shouted at 6:45 a.m. “Fifteen minutes!” He continued the countdowns – which were met with huge cheers – at intervals until 7 a.m.

“There’s a lot of positive energy, and we just like to get people fired up and excited to get in here and have a great time,” he said. “The 2-minute warning was the best one. We waited till about 2 minutes to really get the full excitement. They knew it was close. I mean, they’re true Minnesotans, right? Minnesotans love the Fair. Some of these people I see every year at the gate on opening day ready to come in.”

Thom Miller is one of those people. The St. Louis Park resident says getting to the Fair at 6:15 a.m. – 45 minutes before the gates open – means he gets a prime parking spot for free.

“As early as I get here, I’ve never been up front because there are about a dozen people who have been there seemingly overnight or at least from 1 a.m.,” he said.

Usually, there are politicians like U.S. Sen. Amy Klobuchar greeting the early birds, he said, but this week “all the politicians must be in Chicago at the Democratic National Convention.”

Miller met his college friend Tim O’Toole for the first day – a tradition that started 20 years ago, he said.

“It’s kind of fun when you go into some of the buildings, and you’re the very first of the day, and everybody just kind of knowingly looks around, and it’s, like, ‘OK, here we go,’” he said. “Some of the salespeople are still getting their spiels down at their displays. … It’s just like a waking-up time for the Fair that is really fun to witness. You get to chat with everyone, and everybody is in a great mood.”

Miller, who grew up in St. Paul, said he loves everything about the State Fair. He goes three or four times a year and “knows those grounds like the back of my hand,” he said.

“I’ve often thought about why I enjoy it so much,” he said. “It certainly isn’t any particular place, or food, or activity. It’s the event itself. I love Disney World, too, and I’m sure it’s because I am both a very social person and a romantic as well. However, in a different way from Disney World, the fair has a certain ‘Brigadoon’ nature. During 50 weeks of the year, this huge chunk of land in the middle of a major metropolitan area lies in fallow. Then for 12 days, it’s arguably the most lively part of the state, packing people shoulder to shoulder for what is essentially a big party. People stroll around eating, drinking, and playing. Like a party, one sees mostly the old and familiar; the 4H building, the all-you-can-drink milk, but usually a few new things, too. Then at the end of 12 days, the people, the food, the party vanishes again for another year.”

O’Toole couldn’t resist giving Miller a hard time for “being one of those firsters.”

“He has to be one of the first 50 people through the gate on Snelling,” he said. “Why? It’s like some people buy a Corvette. It’s just compensating, you know? It’s a cry for help.”

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Morayo Ogunbayo | (TNS) The Atlanta Journal-Constitution

Worried you might have syphilis but are afraid to go to a clinic? Now you can get tested at home.

The Food and Drug Administration has authorized the first over-the counter antibody test for detecting syphilis in human blood. The move is an effort to stall the recent increase in cases within the United States.

This new test will be available without a prescription and inform the user of their status within 15 minutes, according to the FDA. The test is just an indicator of syphilis antibodies, however. Anyone who tests positive should see their doctor.

Between 2018 and 2022, the Atlanta-based Centers for Disease Control and Prevention reported an 80% increase in syphilis cases within the U.S., moving from 115,000 cases to more than 207,000, a development that had been part of a decades-long trend.

Syphilis, if left untreated, can cause heart damage, brain damage, deafness, blindness and paralysis. If the transmission happens during pregnancy, it can cause a miscarriage, or lifelong or terminal health issues for infants.

“Access to home tests may help increase initial screening for syphilis, including in individuals who may be reluctant to see their health care provider about possible sexually transmitted infection exposure,” Michelle Tarver, M.D., Ph.D., director of the FDA’s Center for Devices and Radiological Health, said in a statement. “This can lead to increased lab testing to confirm diagnosis, which can result in increased treatment and reduction in the spread of infection.”

Today, medical professionals are well-versed in treating syphilis, and typically a penicillin-based treatment is all it takes to recover from this sexually transmitted illness. With increased access to over-the-counter test kits, the hope is fewer Americans will unknowingly spread this disease.

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©2024 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.