Medicaid expansion proposal advances through Republican-led Mississippi House, will go to Senate

JACKSON, ma’am. — Mississippi’s Republican-led House on Wednesday passed a bill that would expand Medicaid benefits to hundreds of thousands of residents in one of the poorest states in the U.S. — a milestone after state leaders refused to consider the policy for years.

The bill’s passage was greeted with applause in the House chamber on a bipartisan vote of 98-20. It now heads to the Senate, where its fate remains uncertain as lawmakers are expected to pass a competing proposal that could serve as a basis for further negotiations.

The move follows years of opposition from Republicans, including Gov. Tate Reeves, to the expansion allowed under the Affordable Care Act, a 2010 federal health care overhaul signed by then-President Barack Obama. The bill’s Republican sponsor, Missy McGee, said lawmakers had a “moral obligation” to put aside ideology to improve Mississippi’s poor health outcomes.

“It is a subject that must transcend politics and economics. Because at its core, it is about the well-being and dignity of every Mississippian,” McGee said. “Sometimes it’s okay to do the right thing because it’s the right thing.”

Mississippi has the highest number of preventable deaths in the US. The country’s top health official has said the country is at the bottom of almost every health care indicator and at the top of every inequality. Hospitals are struggling to stay open. The state also has one of the lowest labor force participation rates in the country. Expansion advocates have said the policy could help improve these conditions.

Opponents of the Medicaid expansion say the program would increase dependence on the government, increase wait times for health care and turn people away from private insurance. In a social media post Wednesday before the vote, Reeves echoed those criticisms and tied the bill to the goals of prominent Democrats.

“Representative McGee keeps saying over and over again that her bill is for working people,” Reeves said. “The truth is this: Her bill, which passed the House committee yesterday, is outright Obamacare Medicaid Expansion.”

The proposal would expand eligibility for Medicaid, a health insurance program that covers low-income people. Those at 138% of the federal poverty level, or $20,120 a year for a single person, would qualify under the proposal. Mississippi has a population of about 3 million and its Medicaid program covered 754,585 people in January. McGee said the benefits could be extended to about 200,000 people.

House of Representatives Jason White’s ascension to the top position this year helped pave the way for consideration of Medicaid expansion. He said the House is sending the Senate a “conservative plan.” Central to securing Republican votes in the House of Representatives was a provision requiring people to work at least 20 hours a week to qualify for the expanded benefits.

Of the 10 states that have not expanded Medicaid, only Georgia has managed to attach a work requirement to a partial expansion of benefits. The Biden administration has rescinded waivers from work requirements, arguing that people should not face barriers to getting health care. If that happens with Mississippi’s Medicaid policy, the state could still move forward with its expansion.

In a statement Wednesday, a CMS spokesperson said Medicaid work requirements are a barrier to coverage but would not preclude granting a waiver.

“We are concerned about the risks of significant coverage loss and harm to individuals associated with linking Medicaid eligibility to employment,” the spokesperson said in a written statement. “CMS reviews each demonstration proposal on a case-by-case basis to determine whether its goals align with those of Medicaid.”

During a committee hearing Wednesday, McGee touted a financial incentive for Medicaid expansion provided by Congress in the American Rescue Plan. The bonus helped pass Medicaid expansion in North Carolina. In Mississippi, the incentives and other cost offsets, such as higher tax revenues, could fund the program for about four years, McGee said.

House Democratic Leader Robert Johnson said he was stunned by the lopsided vote in favor of the bill. The result brought back memories of when Mississippi voted in 2020 to remove the Confederate battle emblem from the state flag.

“The last time I felt this good, I cried because we changed the Mississippi state flag,” Johnson said. “Today is a great day for working Mississippians.”

If lawmakers vote to expand Medicaid, Reeves will likely veto the bill. Lawmakers could override his veto with a two-thirds majority of both the House of Representatives and the Senate. White suggested Reeves, a “reasonable, business-minded governor,” might change his mind.

“It is in the most uncomfortable times that we get our best grades,” White said. “And that’s when we move our state forward.”


Michael Goldberg is a staff member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.