Mississippi Today
Can a Mississippi governor expand Medicaid on his own? Depends on who you ask.
Editor’s note: Mississippi Today interviewed two Deep South governors about why they chose to champion and pass Medicaid expansion in their states and what the outcomes have been. Those articles will publish on August 24.
Brandon Presley, the Democratic nominee for governor, has at times spoken of expanding Medicaid through executive action without approval of the Republican-controlled Mississippi Legislature should he win the November general election.
“Day 1, I’m going to expand Medicaid so that 220,000 working Mississippians can get access to affordable healthcare,” Presley wrote on social media in July.
At other times, perhaps recognizing the obstacles such a solo effort to expand Medicaid might face, Presley has indicated he would work with the Legislature, which he has said he believes would be amenable to Medicaid expansion.
As nearly half of the state’s rural hospitals are at risk of closing and hospitals across the state are laying off staff or cutting services because of budget problems, Medicaid expansion has become a key campaign issue in 2023.
Forty states and the District of Columbia have expanded Medicaid, a federal opt-in program that provides health care coverage to poor Americans who can’t otherwise afford it themselves. Two of Mississippi’s neighbors, Arkansas and Louisiana, have expanded Medicaid with great success and improved outcomes.
But leaders in Mississippi, the poorest state in America with one of the nation’s highest percentages of uninsured residents, have resisted expansion for more than 10 years — despite the fact that it would bring more than $1 billion per year in new funds to the state and directly help hospitals.
READ MORE: FAQ: What is Medicaid expansion, really?
In some states, such as Louisiana, expansion was done through executive orders instead of by approval of the Legislature. But there are questions about whether a governor in Mississippi could expand Medicaid without legislative approval.
Republican Gov. Tate Reeves, who is seeking reelection and faces Presley in the November general election, has long opposed expanding Medicaid.
The Division of Medicaid, which is under the statutory direction and purview of the governor, takes the position that Medicaid expansion requires legislative approval.
“State law defines who can be eligible for Medicaid in Mississippi. Our understanding is that a governor is not authorized to unilaterally establish a new Medicaid coverage group through an executive order or a federal demonstration waiver,” said Matt Westerfield, a spokesperson for the state’s Division of Medicaid.
State Sen. Kevin Blackwell, R-Southaven, who chairs the Senate’s Medicaid Committee, referred questions about whether a governor could expand Medicaid on his or her own to the Division of Medicaid. His House counterpart, Joey Hood, R-Ackerman, could not be reached for comment.
Former state Rep. Steve Holland, who for years was considered one of the leading authorities in the Legislature on Medicaid issues as the longtime chair of Public Health Committee, said the governor has considerable authority over the Medicaid program. After all, Medicaid is a division within the governor’s office.
Still, Holland said, “We have the most codified Medicaid program in the country. We have put all the eligibility requirements in law … I know Brandon (Presley) as well as anyone. If he is fortunate enough to be elected governor, he is smooth enough and prepared enough to begin immediately to expand Medicaid. And I think he can work with the Legislature to do that.”
READ MORE: Nearly half of rural hospitals at risk of closure in Mississippi, new data shows
The Presley campaign has cited the ability of the Division of Medicaid — hence the governor — to seek a federal waiver to alter the state Medicaid program. A campaign spokesperson said the governor would have authority to seek the waiver under state law, though waivers are granted for only five years and they normally are granted in coordination with the Legislature, which often must provide funding to pay for the waiver.
Holland said state law provides the Division of Medicaid under the governor significant flexibility to seek waivers from the federal government to enact programs that are not codified in state law.
The bottom line is that if there was an effort to expand Medicaid through the waiver program, an appropriation by the Legislature to fund the program most likely still would be needed. But if a governor did expand Medicaid and figure out a way to pay for the program without the Legislature, it likely would result in litigation and be left to the state courts to determine whether it was legal.
Specific sections of state law define who is eligible for Medicaid based on income levels and health issues. In general terms, in Mississippi only poor pregnant women, poor children, the disabled, certain groups of the elderly and some groups who fall into extreme poverty categories and are providing care for family members on Medicaid are eligible for Medicaid coverage.
Most able-bodied people are not eligible for Medicaid in Mississippi.
With Medicaid expansion, those earning up to 138% of the federal poverty level — or about $18,750 annually — would be eligible for coverage. The intent with Medicaid expansion is to provide health care to primarily the working poor who cannot afford private insurance and who are not provided coverage by their employers.
The most clear cut way to expand Medicaid would be for the Legislature to approve a bill to incorporate the new eligibility requirements in state law.
Whether it would be feasible for the Legislature to agree to such a change in state law is the unknown question. If Presley is elected, Mississippians will find out.
At least in the current Legislature, there is a significant appetite to at least consider the merits of expansion. Last legislative session, Mississippi Today surveyed most of the 174 lawmakers and asked them directly if they supported Medicaid expansion.
In response, voting majority in the House said they either supported Medicaid expansion or remained undecided. One vote shy of a voting majority in the Senate said the same.
Just 21 of the House members surveyed, or 18% of the House, said they outright opposed Medicaid expansion. And just 18 of the Senate members surveyed, or 38% of the Senate, said they outright opposed it.
READ MORE: Few Mississippi lawmakers outright oppose Medicaid expansion
Holland, who served in the Legislature until 2020, says he believes Presley could get Medicaid expansion through the Legislature even with a Republican supermajority.
“Tate Reeves and (House Speaker) Philip Gunn were the two blocking it. Period.” said Holland. Gunn is not seeking re-election this year.
“In my final years in the House I had so many Republicans come to me and say expanding Medicaid is the right thing to do,” Holland said.
Another option would be for the Legislature to reauthorize the ballot initiative program that was ruled unconstitutional in 2021 by the state Supreme Court. Through the initiative process, people can gather signatures to bypass the Legislature and place issues directly on the ballot.
When the initiative process was ruled invalid, there was an effort underway to gather the required number of signatures to place Medicaid expansion on the ballot. The Mississippi Hospital Association was one of the sponsors of the Medicaid expansion initiative proposal and had hoped to have enough signatures to place the proposal on the 2022 ballot.
Multiple polls have indicated strong support among Mississippi voters for Medicaid expansion.
So far, legislative efforts to revive the initiative have been unsuccessful.
READ MORE: Mississippi leaving more than $1 billion per year on table by rejecting Medicaid expansion
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1870
Jan. 26, 1870
Virginia was readmitted to the Union after the state passed a new constitution that allowed Black men to vote and ratified the 14th and 15th Amendments. The readmission came five years after Black men first pushed to vote.
A month after the Civil War ended, hundreds of Black men showed up at polling places in Norfolk to vote. Most were turned away, but federal poll workers in one precinct did allow them to cast ballots.
“Some historians think that was the first instance of blacks voting in the South,” The Washington Post wrote. “Even in the North, most places didn’t allow blacks to vote.”
Black men showed up in droves to serve on the constitutional convention. One of them, John Brown, who had been enslaved and had seen his wife and daughter sold, sent out a replica of the ballot with the reminder, “Thou shalt love thy neighbor as thyself.” He won, defeating two white candidates.
Brown joined the 104 delegates, nearly a fourth of them Black men, in drafting the new constitution. That cleared the way not only for Black voting, but for Virginia’s senators and representatives to take their seats in Congress.
But hope of continued progress began to fade by the end of the year when the Legislature began to create its first Jim Crow laws, starting with separate schools for Black and white students. Other Jim Crow laws followed in Virginia and other states to enforce racism on almost every aspect of life, including separate restrooms, separate drinking fountains, separate restaurants, separate seating at movie theaters, separate waiting rooms, separate places in the hospital and when death came, separate cemeteries.
Following Mississippi’s lead, Virginia adopted a new constitution in 1902 that helped to disenfranchise 90% of Black Virginians who voted. States continued to adopt Jim Crow statutes until 1964 when the Civil Rights Act became the law of the land.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
How Jim Barksdale’s $100 million gift 25 years ago changed the course of Mississippi public education
This week marks the 25th anniversary of the landmark contribution of $100 million by Jim Barksdale to improve reading skills in Mississippi.
Standing with state education officials on Jan. 20, 2000, in the old Central High School auditorium in downtown Jackson, Barksdale and his late wife Sally announced their historic gift that would launch the Barksdale Reading Institute, which would create an innovative reading program that would be implemented in public schools across the state.
The contribution, still one of the largest in the state’s history, made headlines across America and the world. Slate Magazine listed the contribution by Barksdale, former head of internet software provider Netscape, as the sixth largest in the nation for 2000. The New York Times, which praised the Barksdales on its editorial page, wrote at the time that the contribution was “thought by authorities to be by far the largest in the field of literacy.”
The $100 million gift not only provided tangible benefits to Mississippi’s schools and children, but it provided a critical symbolic boost to public education in the state.
In a letter to the editor published in The New York Times a couple days after the gift was announced, retired sociology professor Beth Hess of Mountain Lake, N.J, praised the Barksdales but added a telling addendum to her note.
“It is disturbing that the state of Mississippi will be rewarded for its continuing failure to tax its citizens fairly and to allocate enough money to educate students, especially in predominantly Black districts,” Hess wrote. “This should have been a public rather than private responsibility.”
Indeed, this exact point was on the minds of many Mississippians — certainly including the Barksdales — at the time. And given the then-fresh history of segregation of the state’s public schools, how could it not be?
The historic financial commitment made by the Barksdales came less than a quarter of a century from the vote in 1978 to finally remove from the state constitution the provision creating a “separate but equal” system to prevent the integration of the schools.
And it came much less than a quarter of a century from the vote in 1987 to finally remove from the constitution the provision that allowed the Legislature to disband the public schools rather than integrate them. That segregationist provision had been added to the Mississippi Constitution in 1960, with voters in only three of the state’s 82 counties rejecting it: Itawamba and Tishomingo counties in northeast Mississippi and Jackson County on the Gulf Coast.
To say in the year 2000 that there were still Mississippians not enamored with a fully integrated Mississippi public school system would be an understatement.
The history of public education in Mississippi, like the history of the state itself, is marred by racial strife and hate-inspired division that continues even today in some ways.
But on that January day in 2000, Jim Barksdale, a Mississippi native and one of the nation’s leading business executives, showed them and the nation another way forward, proclaiming his commitment “to keeping the main thing the main thing.” And it was clear that he believed the “main thing” was support of an integrated Mississippi public education system.
Barksdale’s brother, Claiborne, who ran the Barksdale Reading Institute that was created with the contribution, said that Jim and Sally Barksdale viewed their action as a $100 million investment in Mississippi and its children, not as a gift. If positive results were not being achieved, the Barksdales were prepared to halt the program and invest their money in other beneficial ways.
The program worked, however, and looking back over these past 25 years since the gift, the results are clear. The historic investment produced historic gains that are now dubbed “The Mississippi Miracle.”
“The state ranks second in its reading scores for children in poverty and seventh for children from households of color,” Claiborne Barksdale wrote this week for Mississippi Today Ideas. “… Tens of thousands of Mississippi children are reading, and reading proficiently, thanks to Jim and Sally’s persistent desire to help them achieve a brighter future. I’d say that’s a pretty damn good return on their investment.”
It could still be argued, as the retired sociology professor did on the New York Times editorial pages in 2000, that Mississippi leaders are not doing enough for public education. But important strides have been made. The state still funds a reading initiative based on the Barksdale model.
While state politicians line up to claim credit for Mississippi’s improved reading scores and “The Mississippi Miracle,” it’s worth remembering that it all started with the Barksdales’ investment 25 years ago.
Editor’s note: Jim and Donna Barksdale are Mississippi Today donors and founding board members. Donors do not in any way influence our newsroom’s editorial decisions. For more on that policy or to view a list of our donors, click here.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1965
Jan. 25, 1965
Annie Lee Cooper — portrayed by Oprah Winfrey in the film “Selma” — had been standing in line for hours outside the Dallas County courthouse in Selma, Alabama, once again attempting to register to vote.
Sheriff Jim Clark and his deputies appeared. The 6-foot Clark had a reputation for racism and violence, carrying a billy club and cattle prod and telling others that the only problem with his job was “all this n—– fuss here of late. … You just have to know how to handle them.” He ordered the activists to leave, despite the fact they were legally entitled to register.
Cooper recalled, “I was just standing there when his deputies told a man with us to move, and when he didn’t, they tried to kick him. That’s when (Clark), and I got into it. I try to be nonviolent, but I just can’t say I wouldn’t do the same thing all over again if they treat me brutish like they did this time.”
Clark began poking her over and over in the neck with his billy club. She finally struck back, knocking him down. Deputies attacked her, beating her with a billy club. They threw her into jail, where she began to sing spirituals.
Cooper had returned to Selma to care for her sick mother three years earlier. She had registered to vote where she lived in Kentucky and Ohio, but when she tried to register, the clerk told her she failed the test. She kept trying and joined SNCC’s first Freedom Day, where she waited with 400 others to register to vote in fall 1963. She was fired from her job and struck with a cattle prod. And after she was jailed in 1965, she never gave up.
The Voting Rights Act passed Congress, and she was able to vote. She lived to be 100, and the city of Selma named a street after her. Winfrey said she decided to portray Cooper because of “what her courage meant to an entire movement. Having people look at you and not see you as a human being — she just got tired of it.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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