Arguably the biggest issue of the 2024 legislative session, Medicaid expansion is likely to come up again next year. But did the historic 2024 session create the momentum needed for it to cross the finish line in 2025, or was it merely a one-off?

The two most influential lawmakers for this issue in the Senate, Lt. Gov. Delbert Hosemann, who oversees the Senate, and Senate Medicaid Chair Kevin Blackwell, both told Mississippi Today they would not consider an expansion plan that didn’t include a work requirement. 

Hosemann, who said he was disappointed with the way expansion died last year, confirmed in an emailed statement that he would push for an expansion bill next session as long as it had a work requirement in it. Blackwell declined to comment whether he would push the issue next year.

A work requirement is more likely to be approved by the federal government this year than last, since President-elect Donald Trump will be in office and approved work requirements in his last term. 

Still, the Trump administration only ever approved work requirements in states that had expansion – as a means of limiting it – and never in states seeking to expand Medicaid for the first time. That means the Senate is banking on the president making an unprecedented move for Mississippi. 

Including a work requirement is a political tactic meant to make expansion more palatable to a Republican majority Legislature led by a governor who has been vehemently opposed to expansion for years, derisively calling it “Obamacare” and “welfare” on social media. 

The bureaucracy of requiring monthly or semi-annual proof of employment ends up being another stressor on low-income people already facing a slew of socioeconomic barriers – as well as a stressor on the state Medicaid system, some experts say. 

Currently, Georgia is the only expanded state with a work requirement, and it remains in litigation with the federal government over the issue. The plan has only covered 4,300 people – despite lawmakers predicting 345,000 people would be eligible – and cost taxpayers $26 million as of last March. More than 90% of that went toward administrative costs. 

“Georgia’s plan has proven to be very profitable for large companies like Deloitte (the primary consultant for Georgia’s project) but has provided health care to almost no one who needs it,” said Joan Alker, Medicaid expert and executive director of Georgetown University’s Center for Children and Families. “It’s been a terrible waste of taxpayer dollars so far.”

Meanwhile, Hosemann and Blackwell’s counterparts in the House chose not to speak to Mississippi Today on the details of the issue ahead of the session, despite being the main drivers of last year’s expansion bill – the first expansion bill authored by Republicans in the history of the Mississippi Legislature, and which garnered more support than any other expansion bill in the last decade. 

Speaker of the House Jason White did not respond to Mississippi Today’s questions about his plans for the session.

White told business leaders at the Mississippi Economic Council’s annual Hobnob event that he would make Medicaid expansion a 2025 legislative priority.

“We trust our elected officials and state agencies to use federal dollars responsibly to invest in critical infrastructure, promote education and workforce training and maintain a balanced regulatory framework that all promote economic development,” White said. “Let’s give our hospitals and health care experts the same opportunity, so that hardworking, low-income Mississippians will benefit.”

House Medicaid Chairwoman Missy McGee told Mississippi Today that it will be a priority for the House Medicaid Committee.

The 2024 House expansion bill included a provision that if federal authorities did not approve the waiver necessary to allow a Mississippi work requirement by a certain deadline, Medicaid would still be fully expanded to people up to 138% of the federal poverty level – about $20,000 for an individual or $43,000 for a family of four. Ultimately, the Senate scratched that provision in conference, and also lowered the income threshold to 99% of the federal poverty level – about $15,000 for an individual or $31,000 for a family of four. The Senate’s plan isn’t considered traditional expansion and wouldn’t qualify for the increased federal match that makes expansion a prudent economic policy for states. 

Since the Affordable Care Act made it possible in 2014, states have had the option to expand Medicaid to cover the working poor. Mississippi is one of only 10 states not to do so. 

Tens of thousands of working Mississippians go without health coverage each year, making too little to afford the high deductibles on the cheapest marketplace insurance plan but too much to qualify for Medicaid under the current stipulations. 

Medicaid eligibility varies from state to state, and Mississippi has one of the strictest income requirements in the nation. Childless adults don’t qualify, and parents must make less than 28% of the federal poverty level, a mere $7,000 annually for a family of three, to qualify. More times than not, that means that working a full-time job counts against an individual – despite anti-expansion critics arguing that Medicaid should only apply to those who work.

Expanding Medicaid would cover adults – including those without children – who make up to 138% of the federal poverty level.

But it would also alleviate an enormous burden that Mississippi hospitals currently shoulder: uncompensated care costs. 

Without health insurance, many Mississippians are forced to let their health conditions deteriorate. That, in conjunction with the fact that the emergency room is the only place health care providers can’t turn patients away for not having money, means that some Mississippians use the emergency room as their only source of primary care. 

The emergency room is also the most expensive place to receive care. When patients can’t pay, hospitals pick up the slack covering their care, and the practice – called uncompensated care – costs hospitals millions. 

That’s why Mississippi Hospital Association’s CEO, Richard Roberson, is again asking the Legislature to consider expansion. 

“The upside for hospitals could be several hundred million dollars,” he said. “Right now, the hospitals continue to see the patients that don’t have any form of insurance, which is financially harmful for hospitals because they’re having to provide that care for which they’re not being paid. But probably the bigger and most important part of that is you’re having people that are showing up in the hospitals for what really amounts to primary care services – and that’s not what hospitals are for.”

Without expansion, he said, it’s “very possible” more rural hospitals will be forced to shut down in the coming years.

Right now, they’re being kept afloat by enhanced Medicaid payments Gov. Tate Reeves passed in the eleventh-hour of his heated 2023 reelection campaign. But Roberson said there’s no guarantee those payments will continue, which makes it hard for hospitals to plan services and staff. 

“We don’t want to rely on a program that’s a one-year program, because that enhanced payment, we’ve got to ask for it every single year,” he said. “And so, as hospitals try to plan for the services they’re going to provide, or as they’re trying to recruit physicians and other staff members, you know you’ve got this for one year … but there are no guarantees.”

Roberson says he’s hopeful going into 2025, given how far expansion got last session. 

“I’m more hopeful than I have been, because we now know what a starting place is – for both the Senate and the House. We now know from that conference report what a meeting of the minds was seven months ago. So, that makes me hopeful that whatever concerns still remain, it’s a shorter path to get to those. We’re not starting from scratch.”

But because many Republicans still oppose expansion, any expansion bill in 2025 will likely need the help of the minority party to achieve a veto-proof majority. Last year, Democrats came under fire for blocking a Medicaid expansion compromise in the final days of the session – despite pushing expansion bills for years to no avail – because they felt that the compromise Republican leaders reached wasn’t expansion at all. 

Getting both chambers and both parties to agree could prove difficult again this year. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

NEW ORLEANS (AP) — A driver wrought carnage on New Orleans’ famed French Quarter early on New Year’s Day, killing 10 people as he rammed a pickup truck into a crowd before being shot to death by police, authorities said.

More than 30 people were injured as Wednesday’s attack turned festive Bourbon Street into macabre mayhem.

Among those killed was 18-year-old Nikyra Cheyenne Dedeaux of Gulfport, NOLA.com reported Wednesday. Her mother said that her daughter wasn’t supposed to be in New Orleans, and that she had sneaked over for the night with her 18-year-old cousin and a friend.

“I just want to see my baby,” her mother Melissa Dedeaux, 40, told NOLA.com. “She was the sweetest person. She would give you anything, anything.”

The FBI is investigating the attack as an act of terrorism. An Islamic State group flag was found in the vehicle.

The FBI identified the driver as Shamsud-Din Jabbar, 42, a U.S. citizen from Texas and said it is working to determine Jabbar’s potential associations and affiliations with terrorist organizations. Authorities are also looking into whether other people may have been involved.

Jabbar was killed by police after he exited the vehicle and opened fire on officers, police said. Two officers were shot and are in stable condition, police said. They were in addition to 33 people injured in the vehicle attack.

A photo circulated among law enforcement officials showed a bearded Jabbar wearing camouflage next to the truck after he was killed. The attack happened around 3:15 a.m. in an area teeming with New Year’s revelers.

Investigators recovered a handgun and an AR-style rifle after the shootout, a law enforcement official said. The official was not authorized to discuss details of the investigation publicly and spoke on condition of anonymity.

The FBI said a potential improvised explosive device was located in the vehicle and other potential explosive devices were also located in the French Quarter.

New Orleans Mayor LaToya Cantrell described the killings as a “terrorist attack.”

New Orleans Police Superintendent Anne Kirkpatrick said the driver was “hell-bent on creating the carnage and the damage that he did.”

“It was very intentional behavior. This man was trying to run over as many people as he could,” Kirkpatrick said.

New Orleans city councilmember Helena Moreno told WWL-TV that after being briefed on the attack, she understands that “there is a potential that other suspects could be involved in this and all hands on deck on determining who these individuals are and finding them.”

The area is a prime New Year’s Eve destination, and tens of thousands of college football fans were in the city for Wednesday night’s Sugar Bowl playoff quarterfinal between Georgia and Notre Dame at the nearby Superdome.

“When I got to work this morning, it was kind of pandemonium everywhere,” Derick Fleming, chief bellhop at a downtown hotel, told The Associated Press. “There were a couple of bodies on the ground covered up. Police were looking for bombs in garbage cans.”

University of Georgia President Jere Morehead said a student was critically injured in the attack and is receiving medical treatment.

Zion Parsons told NOLA.com that he and two friends were leaving a Bourbon Street restaurant when he heard a “commotion” and “banging” and turned his head to see a vehicle barreling onto the pavement toward them. He dodged the vehicle, but it struck one of his friends.

“I yell her name, and I turn my head, and her leg is twisted and contorted above and around her back. And there was just blood,” Parsons said. The 18-year-old said he ran after hearing gunshots shortly thereafter.

“As you’re walking down the street, you can just look and see bodies, just bodies of people, just bleeding, broken bones,” he said. “I just ran until I couldn’t hear nothing no more.”

Bourbon Street has had barriers to prevent vehicle attacks since 2017, but Wednesday’s rampage happened amid a major project to remove and replace the devices, which left the area vulnerable. Work began in November and was expected to be largely wrapped up in time for the Super Bowl in the city in February.

Hours after the attack, several coroner’s office vans were parked on the corner of Bourbon and Canal streets, cordoned off by police tape with crowds of dazed tourists standing around, some trying to navigate their luggage through the labyrinth of blockades.

“We looked out our front door and saw caution tape and dead silence and it’s eerie,” said Tessa Cundiff, an Indiana native who moved to the French Quarter a few years ago. “This is not what we fell in love with, it’s sad.”

Elsewhere, life went on as normal in the city known to some for a motto that translates to “let the good times roll.”

Close to where the truck came to rest, some people were talking about the attack while others dressed in Georgia gear talked football. At a cafe a block away, people crowded in for breakfast as upbeat pop music played. Two blocks away, people drank at a bar, seemingly as if nothing happened.

“We recognize that there are tourists around us, and we urge all to avoid the French Quarter as this is an active investigation,” Louisiana Gov. Jeff Landry said. “We understand the concerns of the community and want to reassure everyone that the safety of the French Quarter and the city of New Orleans remains our top priority.”

President Joe Biden, speaking to reporters in Delaware, said he felt “anger and frustration” over the attack but would refrain from further comment until more is known.

“My heart goes out to the victims and their families who were simply trying to celebrate the holiday,” Biden said in a statement. “There is no justification for violence of any kind, and we will not tolerate any attack on any of our nation’s communities.”

The attack is the latest example of a vehicle being used as a weapon to carry out mass violence, a trend that has alarmed law enforcement officials and that can be difficult to protect against.

A 50-year-old Saudi doctor plowed into a Christmas market teeming with holiday shoppers in the German city of Magdeburg last month, killing four women and a 9-year-old boy.

A man who drove his SUV through a Christmas parade in suburban Milwaukee in 2021 is serving a life sentence after a judge rejected arguments from him and his family that mental illness drove him to do it. Six people were killed.

An Islamic extremist was sentenced last year to 10 life sentences for killing eight people with a truck on a bike path in Manhattan on Halloween in 2017. Also in 2017, a self-proclaimed admirer of Adolf Hitler slammed his car into counterprotesters at a white nationalist rally in Charlottesville, Virginia and is now serving a life sentence.

Stephen Smith, Chevel Johnson and Brett Martel in New Orleans, Jeff Martin in Atlanta, Alanna Durkin Richer and Zeke Miller in Washington and Darlene Superville in New Castle, Delaware, contributed to this report.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Jan. 1, 1960 

Nearly 1,000 Black protesters marched 10 miles through the rain and sleet to the downtown airport in Greenville, South Carolina, to protest its segregation policies and its mistreatment of Jackie Robinson, the first Black player in Major League Baseball. 

Months earlier, Robinson had come to speak at an NAACP banquet, where he encouraged Black Americans. As he left the airport that night, he sat with NAACP leader Gloster Current in the “Whites-only” waiting room at the airport, where Robinson signed autographs. The airport manager ordered them to move to the “Colored” waiting room. They said no. 

When the manager brought a police officer, they responded that they had a legal right to stay where they were and refused to move. After the incident, Robinson complained to the NAACP’s Thurgood Marshall, whose office was already pursuing a case against the airport. In the future, Robinson said, “I hope that we can walk in the airport and sit down and enjoy ourselves.” 

During their march, protesters sang “America the Beautiful” and other songs in what they called their “prayer pilgrimage.” As they arrived at the airport, they were met by a 300-man white mob that included Klansmen. The protesters continued, and 15 of them entered the airport. 

“We will no longer make a pretense of being satisfied with the crumbs of citizenship while others enjoy the whole loaf only by the right of a white-skinned birth,” the Rev. C.D. McCullough of Orangeburg declared. 

The walls of segregation soon fell at both airports.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.