“What’s your plan: to watch Rome burn and to let hospitals close?” a Louisiana healthcare expert asked regarding Mississippi’s hospital crisis.

Think about that. State leaders have sat on their hands and watched the state’s hospital crisis build for more than a decade. As the Northeast Mississippi Daily Journal wrote recently, “Nothing has had a larger impact than the loss of federal dollars hospitals use to offset losses from care provided to uninsured patients. That money stared shrinking more than a decade ago with the passage of the Affordable Care Act. It was to be offset by expanding Medicaid coverage to the working poor.”

Mississippi leaders didn’t. And they came up with no alternative plan.

Our leaders seem to have trouble looking ahead, much less effectively planning ahead. For over two decades they have watched PERS finances deteriorate and prison problems mount. More recently, brain drain and rural population loss trends seemed to catch them by surprise.

Now comes another potential crisis. “The population of college-age Americans is about to crash,” reports an article in Vox.com. “It will change higher education forever.”

The problem arises from declining birth rates in America. “The birth rate kept dropping, and we are now starting to see the consequences on campuses everywhere,” said the Vox article. “Classes will shrink, year after year, for most of the next two decades. People in the higher education industry call it ‘the enrollment cliff.’”

Mississippi is not exempt from this demographic trend. Live births have declined by over 18% since 2000. In-state resident enrollment in our universities has now begun to drop. From 2013 to 2021, IHL in-state enrollment fell 14%. While, that was partially offset by out-of-state student increases, overall enrollment is trending down. Note, out-of-state enrollment now accounts for one-third of IHL enrollment.

Mississippi Valley State University announced this month that its enrollment had fallen 9% to its lowest level in decades. “The current enrollment challenges are happening nationally, and as the numbers showed for our eight public institutions here in Mississippi, seven experienced an enrollment decline this fall,” MVSU President Jerryl Briggs told the Greenwood Commonwealth. IHL system enrollment was down 1% this year. It has fallen each year since 2016 for a cumulative decline of 8%.

Notably, from 2016 to 2021 IHL freshman enrollment dropped 23%.

Already having to regularly increase tuition and fees due to declining state support, IHL universities will have trouble dealing with long-term enrollment decreases. While not a crisis yet, except at The Valley, it could become one if the trends of enrollment drops and state support continue. Declining birth rates predict the enrollment trend will.

So, what is the state’s forward looking plan to deal with this? Without one, my old favorite issue will likely raise its head – closing and merging institutions. Since the “let ‘em burn” approach is in vogue for hospitals, universities need to get ready.

“So, if you think you are standing firm, be careful that you don’t fall” – 1 Corinthians 10:12.

Crawford is a syndicated columnist from Jackson.