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Medicaid Expansion
in Mississippi

Mac Gordon

Donuts on Cake

Second-term Gov. Tate Reeves experienced a close call only to emerge victorious once again in the fight over expanding a healthcare program that would have benefited a large group of Mississippi’s low-income and disabled citizens and struggling rural hospitals.

Despite on-again, off-again appearances that Mississippi might finally shed an image of not caring about the health and prosperity of all of its citizens by providing them a measure of healthcare insurance, that image lives on following failure by the 2024 Legislature to enact expansion of the federal-state Medicaid program.

If expansion had been approved by lawmakers and signed by Reeves, more than 200,000 medically-vulnerable state residents would’ve reaped healthcare benefits previously unattainable. Most of the costs would have been borne by the federal government with an initial cash injection into state coffers of about $1 billion.

The state already had left several billions untouched due to previous spurning of expansion in recent years.

Hospitals of all sizes across Mississippi, particularly those soaked with the high costs of uncompensated care, would also have benefited from the expansion move, including some that likely will be forced into closure. A few hospital boards have delayed those gut wrenching decisions pending legislative action—or inaction.

Reeves has been fighting off the program’s expansion since taking office in 2020. He was reelected in November and never hesitated to say he didn’t believe the state could afford full Medicaid coverage.

Mississippi re-mains one of 10 states failing to accept the federal government’s invitation to include more citizens on the program’s rolls. Others include Alabama, Florida, Georgia, Kansas, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. All but two have Republican governors. Kansas and Wisconsin have Democrats in charge.

Republican chief executives across the fruited plain have generally maintained a recalcitrance to expand by claiming it was too costly or inefficient; or they couldn’t trust the federal government; or they were pathologically opposed to a federally-influenced healthcare system.

When expansion was allowed following passage of the 2010 federal Affordable Healthcare Act (often derided by Republicans as “Obamacare”), the decision to expand was chiefly left up to state governors. However, legislatures could approve expansion if they could get a bill past a governor, say, by overriding a veto, if necessary.

That’s what seemed to be in the offing this year in Jackson as both chambers of the Legislature early-on passed expansion bills with stout-enough votes to override a Reeves veto, if it came to that.

It would take a scorecard the size of the capitol building to have kept up with all of the possibilities of expansion that cropped up as lawmakers hashed out bills in committees and then on the respective chamber floors. One idea or another would seemingly garner approval of most of the representatives and senators, but would fall out of favor almost overnight.

Reeves played a large hand in all of that minutiae, calling the lawmakers over to the Governor’s Mansion for late-day counseling sessions, which apparently worked to help derail any positive action.

The apparent largest obstacle to final approval of expansion is attaching a recipient’s work requirement to benefits received. Both chambers flirted with it but even such a practical-sounding plan didn’t produce an okay. Several states have enacted a work provision that proved unworkable, however.

To their credit, state lawmakers did expand a Medicaid law section to allow low-income women to receive earlier prenatal care in a state with America’s highest rate of infant mortality. Score one for sensibleness and life itself.

Rest assured that Medicaid expansion advocates won’t loiter preparing another pitch at full expansion, despite Reeves’ shutout record thus far.

---Mac Gordon is a native of McComb. He is a retired newspaperman. He can be reached at

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