On the heels of several major hospitals departing the Mississippi Hospital Association, the organization’s leader is baffled.

The hospitals’ move comes shortly after the association’s political action committee made a $250,000 contribution to Democratic gubernatorial candidate Brandon Presley, an outspoken proponent of Medicaid expansion.

The state’s largest public hospital system, the University of Mississippi Medical Center, announced in a letter on April 28 that it was leaving the MHA. Days later, three more hospitals — Singing River on the coast, Gulfport’s Memorial Hospital and George County Regional in Lucedale — followed suit. 

Forrest General Hospital in Hattiesburg on Monday became the most recent hospital to leave the organization, as first reported by Magnolia Tribune. 

The PAC made the donation – the largest it has ever made – in late April, MHA Executive Director Tim Moore said. 

Forrest General’s termination letter said the departure was fueled by “recent events,” while the other four hospitals cited concerns with MHA leadership. 

Moore said donating to Presley’s campaign was recommended by the MHA’s board of governors, who are administrators of member hospitals elected by MHA members.

“We all have had these discussions for a number of years now that we support candidates that support hospitals, and here is a candidate that is coming very strongly forward with a complete health care agenda,” Moore said. “It was certainly not just … it was not my decision.”

Presley, a Democrat, is running against incumbent Republican Gov. Tate Reeves in the 2023 statewide elections. While Reeves has been an active opponent of Medicaid expansion, Presley has vowed to expand Medicaid if he’s elected governor. 

Moore, who’s led the MHA for nearly 10 years, suspects the donation was a catalyst. The hospitals’ departures have left him in disbelief, he said. 

“There’s nothing else that has changed. Nothing,” he said in an interview with Mississippi Today last week. “Our strategy has not changed.”

Mississippi hospitals as a whole are struggling amid the pandemic, when labor and operating costs skyrocketed. The struggle is most apparent in the state’s rural hospitals — about a third are at risk of closure. 

Experts say Medicaid expansion would bring in millions to Mississippi and insure an additional 200,000 to 300,000 Mississippians. State leaders such as Gov. Tate Reeves, the incumbent candidate, have remained opposed to the policy change, though most Mississippians and lawmakers support it. 

“How can anybody blame the hospital association for committing upfront to somebody that has committed to helping hospitals and patients across the state? How can you condemn that?” Moore said. “I can’t figure it out.”

Multiple requests for comment to George County Regional Hospital went unanswered. Spokespeople for UMMC, Singing River, Forrest and Memorial said that hospital administration had no further comment on their decisions to leave the MHA. 

A connection to Reeves is clear for at least one hospital. 

Memorial’s CEO Kent Nicaud has consistently been one of Reeves’ top donors, leading to an appointment to the state gaming commission earlier this year. Reeves also appointed Nicaud’s wife, Jenny, as an administrative law judge for the Mississippi Workers Compensation Commission in 2021. 

While expansion isn’t a silver bullet, experts agree that it would go a long way to increasing the financial viability of Mississippi’s struggling hospitals. Moore previously said that the state’s hospitals run up about $600 million annually in uncompensated care costs. 

Moore said that it’s difficult to imagine any hospital CEO in Mississippi as an opponent of Medicaid expansion because of the vast financial benefits.

“It is a good policy, a fair one,” Moore said. “It’s good for the state of Mississippi. It’s good for the patients. It’s good for the providers. It’s an economic stimulus. It just goes on and on. And there’s just no logical reason not to be trying to move forward.

“While I’m sitting in this seat, I’m nonpartisan. I’m looking for folks that will support our hospitals and providers to take care of patients.”

Michael Beyer, Presley’s communications director, said Presley was proud to have earned the support of the MHA and if elected, would work to “end Tate Reeves’ hospital crisis.”

“Tate Reeves needs to answer why there is always enough taxpayer money for pet projects for his celebrity friends and personal trainer but never enough to solve his hospital crisis, which has left many rural hospitals across the state scrambling to keep their lights on and 220,000 working Mississippians without healthcare,” Beyer said in a statement.

Shelby Wilcher, Reeves’ press secretary, said the Governor’s office “does not have any comment on MHA’s internal affairs.” 

The MHA, a member of the American Hospital Association, represents the interests of Mississippi’s hospitals and advocates for health care policy change, including Medicaid expansion. They also offer services to member hospitals, like a health information exchange program and educational courses. According to its website, the MHA comprises over 100 hospitals, health care systems and other providers, as well as over 50,000 employees.

While the PAC operates as a separate organization from the MHA, it answers to the same board. And Moore serves on the board, as well as director of both organizations.

Moore said during the nearly 100 years that the MHA has represented the state’s hospitals, hospitals have rotated in and out of the organization, but those departures have not been publicized. 

“Hopefully at some point we can reconcile whatever differences these are with members that have become dissatisfied or whatever has been the confusion, because I will say I’ve been extremely disappointed as to how these were handled,” Moore said. 

Whether or not hospitals are members of the MHA, they reap the benefits of the changes the organization advocates for, he said, but it’s harder to convince state lawmakers to make policy changes when the hospitals are fractured.

“In a state like Mississippi, with small geography and a relatively small population … if you break them up into segments, you have a much more difficult job in trying to unify the industry and come in one voice,” he said. “If you implement another association … they tend to undermine each other.”