Is Miss. Gov. Haley Barbour’s (R-MS) assault on Medicaid in his state prudent or draconian? The possible ’12 GOP presidential candidate has had his share of recent controversies. His fight to overhaul the state’s Medicaid program may just add to that list. Mississippi is one of the most impoverished states in the country, with an annual poverty rate of just over 20 percent (only the District of Columbia has a higher rate). With that level of penury, healthcare delivery in that state is characterized as extremely disorganized. Socioeconomic status is just but one of the drivers of such poor delivery. Racial and educational disparities thrown in to the mix complicate efforts to even develop plans for targeted acute care. Barbour seems to be drawing quite a dichotomy in the healthcare reform debate, with friends and associates essentially praising him for not wanting to scrap the entitlement in favor of making earnest changes to create a leaner, less federally subsidized delivery system. Detractors fear just another assault on entitlement spending. Indeed, his actions as governor shed some light on his arguments: in the latter part of the 2000s, overall enrollment has dropped, creating a decline in federal outlay to the state. Barbour credited changes in prescription benefits for beneficiaries and dually eligibles as a main reason. Critics and advocates of unfettered access to federal subsidies are hightened in the their rhetoric, blasting the governor for moving ahead to dismantle such a critical program in a state which already has some of the most restrictive standards of means testing in the country. Barbour’s tone of greater state control would rest upon grants from the government to give “flexibility” to Mississippi in running Medicaid. To critics, it’s more state’s rights rhetoric which endangers the care of citizens who need it most; Barbour, they allege, is trying to beat the feds to the finish line before reform could swell the state’s Medicaid rolls anew — come 2014.