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Mississippi rebuilds health earmark empire in post-Cochran era

The state, 34th in population, nonetheless received more than $50 million worth of health-focused earmarks in 2022

Sen. Cindy Hyde-Smith, R-Miss., a Senate appropriator, led the state's efforts to gather health-related earmarks in fiscal 2022.
Sen. Cindy Hyde-Smith, R-Miss., a Senate appropriator, led the state's efforts to gather health-related earmarks in fiscal 2022. (Tom Williams/ CQ Roll Call)

Mississippi, the country’s poorest state and its second unhealthiest, was one of the top recipients of health-focused earmarks in 2022, offering a case study in how lawmakers can finagle billions in extra taxpayer funds for their states’ most pressing needs.

At first glance, it’s not immediately obvious why Mississippi, which ranks 34th in terms of population, scored such a cash haul. But a look behind the scenes offers a lens into the opaque earmarks process, where power is concentrated among a few top lawmakers.

The state was one of seven to receive more than $50 million worth of health-focused earmarks in 2022, according to a recent Government Accountability Office report. Mississippi lawmakers — Republican Sen. Cindy Hyde-Smith in particular — helped the state rake in roughly $55.7 million for projects funded through the Department of Health and Human Services. 

Those funds went to projects like a $7.9 million investment in facilities and equipment for the University of Southern Mississippi. In Hattiesburg, Forrest General Hospital received $7.5 million to build a mental health and addiction services outpatient center. Delta Health System, which is located on the state’s extremely poor border with Arkansas, received $4.2 million for renovations and equipment upgrades. 

Other top states, like New York and California, are home to leaders from both parties in both chambers, while Missouri — which received nearly twice as much in health funding as the next nearest state — is home to retiring Sen. Roy Blunt, the top Republican on the Labor-HHS-Education Appropriations Subcommittee.

Mississippi came in sixth for health funding overall, ahead of West Virginia, the home of two Senate appropriators, Republican Shelley Moore Capito and key Democratic swing vote Joe Manchin III. West Virginia is also the only state with a worse health ranking than Mississippi, according to U.S. News & World Report

Overall, Mississippi ranked ninth in terms of total earmark funds, pulling in $266.7 million.

It’s an impressive haul in the absence of the late Mississippi senator and powerful Republican appropriator Thad Cochran — who retired in 2018 — and with only junior senator Hyde-Smith serving on the Senate Appropriations Committee, where most earmark power is concentrated. The state is losing its only appropriator in the House, Republican Steven M. Palazzo, after he lost his reelection bid amid an ethics scandal. 

GOP Sen. Roger Wicker, who also logged hundreds of millions in earmarks, served on the Appropriations Committee during his time in the House.

Mississippi has a long history of “punching above its weight” in terms of federal funding, said Jonathan Klingler, an assistant professor of politics at the University of Mississippi. With a delegation of six members, the state has outsize representation in appropriations. 

“Looking at the history of Mississippi’s congressional delegation,” he said, “there are more people who have been appropriators than most states over the last 20 or so years.”

With the highest poverty rate in the nation, the state is also one of the least healthy. Mississippi has some of the highest rates of diabetes, heart disease and cancer, to name a few.  

Those disparities bred a historical culture of lawmakers needing to secure federal aid, said Marty Wiseman, former director of Mississippi State University’s John C. Stennis Institute of Government and Community Development.

“They were expected first and foremost to deliver from Washington,” he said. “And if they didn’t, they were threatened with losing.”

At one time in the 1980s, the state had two Democrats  — Sen. John Stennis and Rep. Jamie Whitten — at the helm of both the Senate and House appropriations committees.

In fiscal 2022, both the University of Mississippi and Mississippi State were among the health earmark beneficiaries, with the former receiving $7.3 million for workforce and mental health initiatives and Mississippi State securing nearly $1.7 million for disability services and a physician assistant program.

Appropriators, particularly in the Senate, historically score the largest earmarks. Hyde-Smith serves on the Labor-HHS-Education subcommittee, which boosted her case with health funding in particular. 

Institutional memory helps. Hyde-Smith hired at least three of Cochran’s former staffers, including Brad White, who served as chief of staff to both her and to Cochran before taking his current role as leader of Mississippi’s Department of Transportation. 

Staffers who understand how to navigate the process and know the decision-makers are invaluable, Klingler said.

“Even though there’s presumably been a fair amount of turnover in the last four years in Sen. Hyde-Smith’s office,” he said, “those lessons would still carry through.”

Mississippi is typically one of the top recipients of federal money more broadly, according to Pew Trusts, even during the ban on earmarks. Federal money made up 42 percent of the state’s budget in 2019, compared to 31 percent for the 50-state average. 

Pros and cons

Advocates of earmarks say they grease the gears of Congress and inject more transparency into government spending, with new rules designed to guard against the ethics scandals of the early 2000s.

Earmarks also create an avenue for projects that don’t fit neatly into an existing funding bucket and can open the door for organizations that aren’t regular recipients of agency grants.

But critics argue that the funding is still susceptible to lobbying, and can deprioritize critical projects. Lobbying is usually a tool of wealthier hospital systems and universities that can afford to hire expensive representatives in Washington.

Those lobbying machines “never quite went out of business” during the earmark moratorium, Citizens Against Government Waste President Thomas Schatz said, and their projects are easy to tout to constituents.

“I got more money for health care, I got more money for education,” Schatz said. “It doesn’t matter if it’s being spent effectively.”

It can also be a strain on the agencies, he added, noting that in the past some projects were funded without additional staffing support.

“That’s the problem with earmarks,” he said. “Substituting a member’s judgment for the people that are supposed to decide how that money is being spent.”

One lobbyist who spoke on background said the return of earmarks has supersized the appropriations workload. Organizations can also often seek earmarks without first applying for competitive funding from existing grants.

The money is unequally distributed between lawmakers and in terms of state populations. Mississippi ranked 10th in terms of “pork per capita,” at $90 per state resident, according to CAGW.

Earmarks still repel most Republicans, particularly in the Senate. Wicker and Hyde-Smith were two of just 16 GOP senators to request earmarks for fiscal 2022. 

They can also open up a lawmaker to a challenge from the right.

In 2014, Mississippi’s tea party-backed state Sen. Chris McDaniel nearly unseated Cochran in a vicious primary, basing much of his bid on ending establishment pork barrel spending. McDaniel also ran against Hyde-Smith and Wicker.

Earmarks’ bad reputation still lingers more broadly as well. None of roughly a half dozen recipients contacted by CQ Roll Call would talk about the money they received. Hyde-Smith, Wicker and Palazzo also did not respond to requests for comment. 

Lawmakers have already filed requests for fiscal 2023 earmarks, which will likely be unveiled after leaders strike a deal on the broader government spending bill. 

For now, earmarks are a winning strategy in Mississippi, where the state is competing “eyeball-to-eyeball” with heavy hitters like California and New York, Wiseman said.

“Any list you want to compose, you can look toward the bottom and find Mississippi on the good stuff, or toward the top on the bad stuff,” he said.

“We need the money,” he added.

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