Mississippi Today
Who’s opposed to Mississippi Medicaid expansion and why?
Who’s opposed to Mississippi Medicaid expansion and why?
Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project.Read more about the project by clicking here.
While running for governor in 2019, then-Lt. Gov. Tate Reeves was quizzed at a Capitol Press Corps luncheon whether his opposition to expanding Medicaid coverage to working-poor Mississippians was softening.
"I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I don't know how many ways I can explain this to y'all," Reeves said.
Reeves' fellow Republican House Speaker Philip Gunn has frequently given equally deep and erudite explanations of his steadfast opposition to accepting $1 billion a year in federal money to help the working poor and Mississippi's distressed hospitals.
"From what I know about it, we cannot afford it," Gunn said tersely to questions as the 2021 legislative session ended, obviously not wanting to discuss the issue further.
For more than a decade, despite most other states expanding Medicaid and despite hospitals, doctors, economists and experts saying it would be a net benefit to the poorest, sickest, most uninsured and most federally dependent state in the country, most of Mississippi's top elected leaders have refused the offer.
As some hospitals across the state close their doors and others struggle on the brink of collapse — even as the state budget sees record gains from other federal spending — Mississippi leaders' recalcitrance growingly appears more political than pragmatic.
Reeves and Gunn, who can block expansion from their posts, remain steadfast in their opposition. Republican Lt. Gov. Delbert Hosemann has said he's open to the idea, as are a small but growing number of legislative Republicans. But Hosemann avoids even saying the words "Medicaid expansion" and hasn't pressed his colleagues on full expansion. He has, unsuccessfully, pushed for expanding postpartum Medicaid coverage for mothers.
Q&A: What is Medicaid expansion, really?
Notably, all three top leaders declined interviews or comments for this story. Medicaid expansion hasn't gotten a real hearing with the Legislature in years, even as the federal government has tried to sweeten the deal and counter arguments against expansion.
At times, including recently, some state leaders have said they would instead prefer people to have good jobs that provide private insurance. But this has proved elusive, with Mississippi seeing slow job growth, the lowest median income in the nation and among the highest rates of uninsured people.
Mississippi Today compiled a list of the main arguments against Medicaid expansion that opponents have given over the last decade, with counterpoints from proponents:
We can't afford it/it will tank the state budget
"I don't see Medicaid expansion as something that is beneficial to the state of Mississippi," Gunn said in 2021. "I just don't think the taxpayers can afford it. That is what it boils down to is the taxpayers. It is their money. I just don't have the taxpayers calling saying we want you to raise taxes so we can expand Medicaid."
So far, Medicaid expansion hasn't tanked any states' budgets, nor have any been forced to raise taxes to cover ACA Medicaid expansion.
Numerous studies, including those by Mississippi's state economists, say the state — including government coffers — would see a net economic benefit, including growth in GDP and population and the creation of thousands of jobs.
Studies in Arkansas, Kentucky, Louisiana, Michigan, Montana and Virginia showed the states saw a net reduction of more than 4% in spending on their traditional Medicaid programs after expansion. Louisiana's Medicaid expansion in 2016 brought a 33% reduction in uncompensated care costs for hospitals, including a 55% reduction for rural hospitals.
READ MORE: Here’s what experts say about expanding Medicaid in Mississippi
The federal government will quit paying its share
"For us to enter into an expansion program would be a fools errand," then-Gov. Phil Bryant said in 2014. "I mean, here we would be saying to 300,000 Mississippians, 'We're going to provide Medicaid coverage to you,' and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that."
But the Affordable Care Act, including Medicaid expansion, has survived through three presidents, including Republican Donald Trump who wanted to do away with it, and through multiple congresses, including two under Republican control of both chambers. It has survived numerous court challenges (Mississippi has joined in at least a couple of those).
Mississippi leaders made the same argument to postpone adopting the Medicaid program when it was created in the 1960s. It was one of the last states to do so, in 1969. Arguments that the feds would stop funding it and leave Mississippi in the lurch have proved erroneous, and the Magnolia State has enjoyed the highest rate of federal reimbursement for its existing Medicaid program for many years.
It's subsidizing people who won't work/it's more welfare
"We believe all able-bodied folks ought to get off the couch and go to work," state Agriculture Commissioner Andy Gipson, a longtime former lawmaker, said at the Neshoba County Fair in July, mirroring comments many other leaders have made over years. "This is why we oppose Medicaid expansion."
By its definition, covering people who make up to 138% of poverty level income, Medicaid expansion is aimed at helping the working poor.
"These are people that are working," said Tim Moore, president of the Mississippi Hospital Association. "By definition, to be at 138% above poverty, you have to have income from somewhere. In fact these are people that are often working multiple jobs, but still don't have the discretionary income to afford the high cost of premiums."
"Medicaid expansion is not about putting people on the welfare rolls," state Insurance Commissioner Mike Chaney said last year. "This is about expanding health care availability to the poor, the disabled, the folks that fall through the cracks, that are not able to get on the Affordable Care Act."
READ MORE: How Medicaid expansion could have saved Tim’s leg and changed his life
It would drive up private insurance costs, especially if hospitals help pay for expansion
"If hospitals are going to pay for it, that means that your cost when you go to the hospital is going to go up," Reeves said during a 2019 gubernatorial election debate, referring to Mississippi hospitals offering to pay the state's share of expansion. "If you have private insurance, that means that your insurance rates are going to go up."
Others over the years have warned that expansion in general would drive up private insurance premiums.
But driving down uncompensated care costs for Mississippi hospitals, which has hovered around $600 million a year (lowered temporarily a bit recently because of federal COVID-19 relief money) would allow hospitals to lower prices, Moore said. One recent study said expansion would cut Mississippi hospitals' uncompensated care by an average of $251.6 million a year from 2020-2030. The same study projects private premiums paid each year would also fall by $52.6 million over the same period.
"Treating people with no coverage forces the costs onto everyone else," Moore said. "Plus, if people have coverage, they get care in a more timely, more efficient manner. You have less chronic problems, less higher-cost problems."
As for hospitals paying the state's share of expansion, as MHA proposed with the MS Cares plan in 2019, Moore said that's a moot point now, because Mississippi hospitals are struggling so bad financially now that they couldn't afford to do it.
Medicaid is broken, full of fraud and provides poor health outcomes
When Mississippi lawmakers in 2017 passed an act aimed at preventing fraud in Medicaid and welfare, one concern cited during debate was that there were dead people on Medicaid rolls.
"Are you talking about dead people on the rolls of Medicaid?" one lawmaker asked then-Senate Medicaid Chairman Brice Wiggins, R-Pascagoula. He responded: "I am talking about everybody, yes. It doesn’t matter if it is dead people. It doesn’t matter if it is people double dipping. They need to be following the law.”
Medicaid doesn't provide money to beneficiaries. It provides health care, and money goes to providers. As several lawmakers pointed out at the time, it would be hard for dead people to be receiving health care.
Many, including some state politicians, appear to conflate Medicaid with "welfare." Medicaid is a state-federal health insurance program that, in Mississippi currently, is available only to the disabled, elderly poor people, poor pregnant women and poor children. An able-bodied adult cannot simply be poor and qualify for Medicaid.
Mississippi has been plagued with fraud, corruption or misspending in Medicaid, welfare and other government programs. But this has been mostly committed by politicians, bureaucrats, business people, or large corporations. Beneficiary fraud in all these programs would appear to be a smaller problem.
It is true that Mississippi Medicaid beneficiaries have very poor health outcomes. But given that a large portion of qualifying beneficiaries are very sickly and poor to begin with, this would appear self-fulfilling prophecy. The aim of expansion is to cover the healthier, working poor and provide more preventive care.
"If you start early and provide health care, the outcome is better," Moore said. "If you put off treating a condition, it gets worse. Diabetes is an example. You have an individual that doesn't have health care coverage and they have neuropathy but put off treatment. They get a hole in the foot that gets infected. Then they lose a leg. Or they lose eyesight or have renal failure. Then all of a sudden they have a disability and can't work, and they have to be taken care of. But we could have prevented it, and we could have managed the cost much better."
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1903, W.E.B. Du Bois urged active resistance to racist policies
April 27, 1903

W.E.B. Du Bois, in his book, “The Souls of Black Folk,” called for active resistance to racist policies: “We have no right to sit silently by while the inevitable seeds are sown for a harvest of disaster to our children, black and white.”
He described the tension between being Black and being an American: “One ever feels his twoness, — an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose strength alone keeps it from being torn asunder.”
He criticized Washington’s “Atlanta Compromise” speech. Six years later, Du Bois helped found the NAACP and became the editor of its monthly magazine, The Crisis. He waged protests against the racist silent film “The Birth of a Nation” and against lynchings of Black Americans, detailing the 2,732 lynchings between 1884 and 1914.
In 1921, he decried Harvard University’s decisions to ban Black students from the dormitories as an attempt to renew “the Anglo-Saxon cult, the worship of the Nordic totem, the disenfranchisement of Negro, Jew, Irishman, Italian, Hungarian, Asiatic and South Sea Islander — the world rule of Nordic white through brute force.”
In 1929, he debated Lothrop Stoddard, a proponent of scientific racism, who also happened to belong to the Ku Klux Klan. The Chicago Defender’s front page headline read, “5,000 Cheer W.E.B. DuBois, Laugh at Lothrup Stoddard.”
In 1949, the FBI began to investigate Du Bois as a “suspected Communist,” and he was indicted on trumped-up charges that he had acted as an agent of a foreign state and had failed to register. The government dropped the case after Albert Einstein volunteered to testify as a character witness.
Despite the lack of conviction, the government confiscated his passport for eight years. In 1960, he recovered his passport and traveled to the newly created Republic of Ghana. Three years later, the U.S. government refused to renew his passport, so Du Bois became a citizen of Ghana. He died on Aug. 27, 1963, the eve of the March on Washington.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Mississippi Today
Jim Hood’s opinion provides a roadmap if lawmakers do the unthinkable and can’t pass a budget
On June 30, 2009, Sam Cameron, the then-executive director of the Mississippi Hospital Association, held a news conference in the Capitol rotunda to publicly take his whipping and accept his defeat.
Cameron urged House Democrats, who had sided with the Hospital Association, to accept the demands of Republican Gov. Haley Barbour to place an additional $90 million tax on the state’s hospitals to help fund Medicaid and prevent the very real possibility of the program and indeed much of state government being shut down when the new budget year began in a few hours. The impasse over Medicaid and the hospital tax had stopped all budget negotiations.
Barbour watched from a floor above as Cameron publicly admitted defeat. Cameron’s decision to swallow his pride was based on a simple equation. He told news reporters, scores of lobbyists and health care advocates who had set up camp in the Capitol as midnight on July 1 approached that, while he believed the tax would hurt Mississippi hospitals, not having a Medicaid budget would be much more harmful.
Just as in 2009, the Legislature ended the 2025 regular session earlier this month without a budget agreement and will have to come back in special session to adopt a budget before the new fiscal year begins on July 1. It is unlikely that the current budget rift between the House and Senate will be as dramatic as the 2009 standoff when it appeared only hours before the July 1 deadline that there would be no budget. But who knows what will result from the current standoff? After all, the current standoff in many ways seems to be more about political egos than policy differences on the budget.
The fight centers around multiple factors, including:
- Whether legislation will be passed to allow sports betting outside of casinos.
- Whether the Senate will agree to a massive projects bill to fund local projects throughout the state.
- Whether leaders will overcome hard feelings between the two chambers caused by the House’s hasty final passage of a Senate tax cut bill filled with typos that altered the intent of the bill without giving the Senate an opportunity to fix the mistakes.
- Whether members would work on a weekend at the end of the session. The Senate wanted to, the House did not.
It is difficult to think any of those issues will rise to the ultimate level of preventing the final passage of a budget when push comes to shove.
But who knows? What we do know is that the impasse in 2009 created a guideline of what could happen if a budget is not passed.
It is likely that parts, though not all, of state government will shut down if the Legislature does the unthinkable and does not pass a budget for the new fiscal year beginning July 1.
An official opinion of the office of Attorney General Jim Hood issued in 2009 said if there is no budget passed by the Legislature, those services mandated in the Mississippi Constitution, such as a public education system, will continue.
According to the Hood opinion, other entities, such as the state’s debt, and court and federal mandates, also would be funded. But it is likely that there will not be funds for Medicaid and many other programs, such as transportation and aspects of public safety that are not specifically listed in the Mississippi Constitution.
The Hood opinion reasoned that the Mississippi Constitution is the ultimate law of the state and must be adhered to even in the absence of legislative action. Other states have reached similar conclusions when their legislatures have failed to act, the AG’s opinion said.
As is often pointed out, the opinion of the attorney general does not carry the weight of law. It serves only as a guideline, though Gov. Tate Reeves has relied on the 2009 opinion even though it was written by the staff of Hood, who was Reeves’ opponent in the contentious 2019 gubernatorial campaign.
But if the unthinkable ever occurs and the Legislature goes too far into a new fiscal year without adopting a budget, it most likely will be the courts — moreso than an AG’s opinion — that ultimately determine if and how state government operates.
In 2009 Sam Cameron did not want to see what would happen if a budget was not adopted. It also is likely that current political leaders do not want to see the results of not having a budget passed before July 1 of this year.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Mississippi Today
1964: Mississippi Freedom Democratic Party was formed
April 26, 1964

Civil rights activists started the Mississippi Freedom Democratic Party to challenge the state’s all-white regular delegation to the Democratic National Convention.
The regulars had already adopted this resolution: “We oppose, condemn and deplore the Civil Rights Act of 1964 … We believe in separation of the races in all phases of our society. It is our belief that the separation of the races is necessary for the peace and tranquility of all the people of Mississippi, and the continuing good relationship which has existed over the years.”
In reality, Black Mississippians had been victims of intimidation, harassment and violence for daring to try and vote as well as laws passed to disenfranchise them. As a result, by 1964, only 6% of Black Mississippians were permitted to vote. A year earlier, activists had run a mock election in which thousands of Black Mississippians showed they would vote if given an opportunity.
In August 1964, the Freedom Party decided to challenge the all-white delegation, saying they had been illegally elected in a segregated process and had no intention of supporting President Lyndon B. Johnson in the November election.
The prediction proved true, with white Mississippi Democrats overwhelmingly supporting Republican candidate Barry Goldwater, who opposed the Civil Rights Act. While the activists fell short of replacing the regulars, their courageous stand led to changes in both parties.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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