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Who’s opposed to Mississippi Medicaid expansion and why?

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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

Early voting proposal killed on last day of Mississippi legislative session

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mississippitoday.org – @MSTODAYnews – 2025-04-03 13:02:00

Mississippi will remain one of only three states without no-excuse early voting or no-excuse absentee voting. 

Senate leaders, on the last day of their regular 2025 session, decided not to send a bill to Gov. Tate Reeves that would have expanded pre-Election Day voting options. The governor has been vocally opposed to early voting in Mississippi, and would likely have vetoed the measure.

The House and Senate this week overwhelmingly voted for legislation that established a watered-down version of early voting. The proposal would have required voters to go to a circuit clerk’s office and verify their identity with a photo ID. 

The proposal also listed broad excuses that would have allowed many voters an opportunity to cast early ballots. 

The measure passed the House unanimously and the Senate approved it 42-7. However, Sen. Jeff Tate, a Republican from Meridian who strongly opposes early voting, held the bill on a procedural motion. 

Senate Elections Chairman Jeremy England chose not to dispose of Tate’s motion on Thursday morning, the last day the Senate was in session. This killed the bill and prevented it from going to the governor. 

England, a Republican from Vancleave, told reporters he decided to kill the legislation because he believed some of its language needed tweaking. 

The other reality is that Republican Gov. Tate Reeves strongly opposes early voting proposals and even attacked England on social media for advancing the proposal out of the Senate chamber. 

England said he received word “through some sources” that Reeves would veto the measure.

“I’m not done working on it, though,” England said. 

Although Mississippi does not have no-excuse early voting or no-excuse absentee voting, it does have absentee voting. 

To vote by absentee, a voter must meet one of around a dozen legal excuses, such as temporarily living outside of their county or being over 65. Mississippi law doesn’t allow people to vote by absentee purely out of convenience or choice. 

Several conservative states, such as Texas, Louisiana, Arkansas and Florida, have an in-person early voting system. The Republican National Committee in 2023 urged Republican voters to cast an early ballot in states that have early voting procedures. 

Yet some Republican leaders in Mississippi have ardently opposed early voting legislation over concerns that it undermines election security. 

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

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Mississippi Legislature approves DEI ban after heated debate

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mississippitoday.org – @MSTODAYnews – 2025-04-02 16:34:00

Mississippi lawmakers have reached an agreement to ban diversity, equity and inclusion programs and a list of “divisive concepts” from public schools across the state education system, following the lead of numerous other Republican-controlled states and President Donald Trump’s administration.  

House and Senate lawmakers approved a compromise bill in votes on Tuesday and Wednesday. It will likely head to Republican Gov. Tate Reeves for his signature after it clears a procedural motion.

The agreement between the Republican-dominated chambers followed hours of heated debate in which Democrats, almost all of whom are Black, excoriated the legislation as a setback in the long struggle to make Mississippi a fairer place for minorities. They also said the bill could bog universities down with costly legal fights and erode academic freedom.

Democratic Rep. Bryant Clark, who seldom addresses the entire House chamber from the podium during debates, rose to speak out against the bill on Tuesday. He is the son of the late Robert Clark, the first Black Mississippian elected to the state Legislature since the 1800s and the first Black Mississippian to serve as speaker pro tempore and preside over the House chamber since Reconstruction.

“We are better than this, and all of you know that we don’t need this with Mississippi history,” Clark said. “We should be the ones that say, ‘listen, we may be from Mississippi, we may have a dark past, but you know what, we’re going to be the first to stand up this time and say there is nothing wrong with DEI.'”

Legislative Republicans argued that the measure — which will apply to all public schools from the K-12 level through universities — will elevate merit in education and remove a list of so-called “divisive concepts” from academic settings. More broadly, conservative critics of DEI say the programs divide people into categories of victims and oppressors and infuse left-wing ideology into campus life.

“We are a diverse state. Nowhere in here are we trying to wipe that out,” said Republican Sen. Tyler McCaughn, one of the bill’s authors. “We’re just trying to change the focus back to that of excellence.”

The House and Senate initially passed proposals that differed in who they would impact, what activities they would regulate and how they aim to reshape the inner workings of the state’s education system. Some House leaders wanted the bill to be “semi-vague” in its language and wanted to create a process for withholding state funds based on complaints that almost anyone could lodge. The Senate wanted to pair a DEI ban with a task force to study inefficiencies in the higher education system, a provision the upper chamber later agreed to scrap.

The concepts that will be rooted out from curricula include the idea that gender identity can be a “subjective sense of self, disconnected from biological reality.” The move reflects another effort to align with the Trump administration, which has declared via executive order that there are only two sexes.

The House and Senate disagreed on how to enforce the measure but ultimately settled on an agreement that would empower students, parents of minor students, faculty members and contractors to sue schools for violating the law.

People could only sue after they go through an internal campus review process and a 25-day period when schools could fix the alleged violation. Republican Rep. Joey Hood, one of the House negotiators, said that was a compromise between the chambers. The House wanted to make it possible for almost anyone to file lawsuits over the DEI ban, while Senate negotiators initially bristled at the idea of fast-tracking internal campus disputes to the legal system.   

The House ultimately held firm in its position to create a private cause of action, or the right to sue, but it agreed to give schools the ability to conduct an investigative process and potentially resolve the alleged violation before letting people sue in chancery courts.

“You have to go through the administrative process,” said Republican Sen. Nicole Boyd, one of the bill’s lead authors. “Because the whole idea is that, if there is a violation, the school needs to cure the violation. That’s what the purpose is. It’s not to create litigation, it’s to cure violations.” 

If people disagree with the findings from that process, they could also ask the attorney general’s office to sue on their behalf.

Under the new law, Mississippi could withhold state funds from schools that don’t comply. Schools would be required to compile reports on all complaints filed in response to the new law.

Trump promised in his 2024 campaign to eliminate DEI in the federal government. One of the first executive orders he signed did that. Some Mississippi lawmakers introduced bills in the 2024 session to restrict DEI, but the proposals never made it out of committee. With the national headwinds at their backs and several other laws in Republican-led states to use as models, Mississippi lawmakers made plans to introduce anti-DEI legislation.

The policy debate also unfolded amid the early stages of a potential Republican primary matchup in the 2027 governor’s race between State Auditor Shad White and Lt. Gov. Delbert Hosemann. White, who has been one of the state’s loudest advocates for banning DEI, had branded Hosemann in the months before the 2025 session “DEI Delbert,” claiming the Senate leader has stood in the way of DEI restrictions passing the Legislature. 

During the first Senate floor debate over the chamber’s DEI legislation during this year’s legislative session, Hosemann seemed to be conscious of these political attacks. He walked over to staff members and asked how many people were watching the debate live on YouTube. 

As the DEI debate cleared one of its final hurdles Wednesday afternoon, the House and Senate remained at loggerheads over the state budget amid Republican infighting. It appeared likely the Legislature would end its session Wednesday or Thursday without passing a $7 billion budget to fund state agencies, potentially threatening a government shutdown.

“It is my understanding that we don’t have a budget and will likely leave here without a budget. But this piece of legislation …which I don’t think remedies any of Mississippi’s issues, this has become one of the top priorities that we had to get done,” said Democratic Sen. Rod Hickman. “I just want to say, if we put that much work into everything else we did, Mississippi might be a much better place.”

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

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Mississippi Today

House gives Senate 5 p.m. deadline to come to table, or legislative session ends with no state budget

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mississippitoday.org – @MSTODAYnews – 2025-04-02 16:13:00

The House on Wednesday attempted one final time to revive negotiations between it and the Senate over passing a state budget.

Otherwise, the two Republican-led chambers will likely end their session without funding government services for the next fiscal year and potentially jeopardize state agencies.

The House on Wednesday unanimously passed a measure to extend the legislative session and revive budget bills that had died on legislative deadlines last weekend. 

House Speaker Jason White said he did not have any prior commitment that the Senate would agree to the proposal, but he wanted to extend one last offer to pass the budget. White, a Republican from West, said if he did not hear from the Senate by 5 p.m. on Wednesday, his chamber would end its regular session. 

“The ball is in their court,” White said of the Senate. “Every indication has been that they would not agree to extend the deadlines for purposes of doing the budget. I don’t know why that is. We did it last year, and we’ve done it most years.” 

But it did not appear likely Wednesday afternoon that the Senate would comply.

The Mississippi Legislature has not left Jackson without setting at least most of the state budget since 2009, when then Gov. Haley Barbour had to force them back to set one to avoid a government shutdown.

The House measure to extend the session is now before the Senate for consideration. To pass, it would require a two-thirds majority vote of senators. But that might prove impossible. Numerous senators on both sides of the aisle vowed to vote against extending the current session, and Lt. Gov. Delbert Hosemann who oversees the chamber said such an extension likely couldn’t pass. 

Senate leadership seemed surprised at the news that the House passed the resolution to negotiate a budget, and several senators earlier on Wednesday made passing references to ending the session without passing a budget. 

“We’ll look at it after it passes the full House,” Senate President Pro Tempore Dean Kirby said. 

The House and Senate, each having a Republican supermajority, have fought over many issues since the legislative session began early January.

But the battle over a tax overhaul plan, including elimination of the state individual income tax, appeared to cause a major rift. Lawmakers did pass a tax overhaul, which the governor has signed into law, but Senate leaders cried foul over how it passed, with the House seizing on typos in the Senate’s proposal that accidentally resembled the House’s more aggressive elimination plan.

The Senate had urged caution in eliminating the income tax, and had economic growth triggers that would have likely phased in the elimination over many years. But the typos essentially negated the triggers, and the House and governor ran with it.

The two chambers have also recently fought over the budget. White said he communicated directly with Senate leaders that the House would stand firm on not passing a budget late in the session. 

But Senate leaders said they had trouble getting the House to meet with them to haggle out the final budget. 

On the normally scheduled “conference weekend” with a deadline to agree to a budget last Saturday, the House did not show, taking the weekend off. This angered Hosemann and the Senate. All the budget bills died, requiring a vote to extend the session, or the governor forcing them into a special session.

If the Legislature ends its regular session without adopting a budget, the only option to fund state agencies before their budgets expire on June 30 is for Gov. Tate Reeves to call lawmakers back into a special session later. 

“There really isn’t any other option (than the governor calling a special session),” Lt. Gov. Delbert Hosemann previously said. 

If Reeves calls a special session, he gets to set the Legislature’s agenda. A special session call gives an otherwise constitutionally weak Mississippi governor more power over the Legislature. 

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

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