By Sid Salter
Columnist
While not an absolute, it’s been my experience that political change comes slowly in Mississippi
– as slowly as molasses on a cold biscuit.
That’s my take on the disappointing failure of Mississippi lawmakers to reach a consensus on a
plan to expand Medicaid coverage to our state’s working poor. The working poor are those
fellow Mississippians with jobs who don’t make enough money to afford health insurance.
All of us who pay federal taxes in Mississippi are already paying for expanded Medicaid in 40
other states and providing healthcare opportunities for the citizens of those states. But not here,
not for our own people.
But one thing is certain, the Mississippi Legislature in 2024 saw and heard an effective
demonstration of the depth and breadth of public support for an expanded Medicaid program that
provides a path to health care for working Mississippians.
And it would be disingenuous to suggest that likewise state lawmakers saw and heard that there
is also broad-based taxpayer support for some form of work requirement in that expanded
program. The disappointment of the 2024 regular session is that the Legislature came so close to
getting it right before negotiations got stuck in the political mire.
A decade ago, Medicaid expansion in Mississippi was politically dead on arrival at every level in
this red state – including the Governor’s Mansion, the House and the Senate. All one had to do to
see the shadow of the political Grim Reaper was whisper the word “Obamacare.”
But as time passed, COVID struck, and inflation followed. Rural hospitals continued to struggle
and some shuttered. The lack of availability of rural healthcare is a real danger.
Donald Trump was elected president and his policy change on implementing work requirements
for expanded Medicaid programs impacted the political logjam as red states began to find ways
to make Medicaid expansion politically palatable.
Trump’s policy change on work requirements for Medicaid expansion was more than a policy
change. It was political white smoke coming from the White House giving Republican state
legislators permission of a sort to seriously kick the tires and hold meaningful discussions about
Medicaid expansion.
When current President Joe Biden was elected, his administration rejected the work requirement
changes Trump had put in place and Republican state lawmakers in non-expansion states again
faced roadblocks in trying to implement Medicaid changes.
But early in the 2024 Mississippi legislative session, new House Speaker Jason White led the
Mississippi House by a margin of 98-20 to pass legislation that would have expanded Medicaid
benefits to individuals aged 19 to 64 who earn no more than 138% of the federal poverty level.
The bill contains a work requirement – which everyone knew the feds under Biden were likely to
disapprove – but even so, the bill expanded Medicaid coverage in Mississippi for four years
before a legislative repealer kicked in.

That action came even after White’s predecessor, former House Speaker Philip Gunn, had
consistently opposed any expansion of the Medicaid program.
The initial reaction from the State Senate was mixed, but the two sides were negotiating. Late in
the game, Senate negotiators offered a plan whereby a person who makes less than 138% of the
federal poverty level must work 100 hours a month to receive expanded Medicaid. If federal
officials denied the work requirement, the state could reapply later if CMS switched stances and
approved another state’s work requirement, but there would be no access to expanded care
without federal approval.
The House countered with a voter referendum offer, but by that point, negotiations turned
contentious. That’s where the plan died for this year.
After the measure died, Lt. Gov. Delbert Hosemann suggested that the outcome of the 2024
presidential election may determine the fate of Medicaid expansion in Mississippi. It well might.
The Medicaid fight also reminded voters that they can no longer impact public policy through
the referendum process without legislative permission. Lawmakers will hear about both issues
from their constituents moving forward.
The proposed referendum would have asked: “Should Mississippi expand Medicaid? If so,
should the expansion include a work requirement?”
It would seem most Mississippi voters would answer “yes” to both questions – which
complicates finding a legislative solution.
Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.