By Sid Salter
The 2024 regular session of the Mississippi Legislature ended with a failure to reach consensus
between Senate and House conferees on an effort to expand the state’s Medicaid program. That
after Senate and House leaders engaged in a good faith debate of Medicaid expansion for the first
time since former President Barack Obama’s administration implemented the program.
In 2010, the Patient Protection and Affordable Care Act or “Obamacare” was enacted by
Congress – then the biggest public policy overhaul and coverage expansion of public healthcare
since the 1965 enactment of the Medicare and Medicaid programs. Today, Mississippi remains
one of 10 states that has not adopted some form of Medicaid expansion to draw down additional
federal funds to pay for health care for the working poor.
The 10 states include Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina,
Tennessee, Texas, Wisconsin and Wyoming. The failed 2024 Mississippi Medicaid expansion
effort would have expanded Medicaid coverage to about 200,000 people who earned up to 138%
of the federal poverty level, or $20,120 annually for one person.
Facing deadlines in the waning hours of the 2024 session, legislative conferees simply could not
achieve a compromise on the question of applying a work requirement to Mississippi’s proposed
Medicaid expansion plan.
During the first administration of President Donald Trump, the federal government authorized
work requirements for Medicaid expansion – and in doing so offered red states like Mississippi
that had resisted Medicaid expansion a politically palatable means to do so. The work
requirements also served as a natural limit to the costs of the program.
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.
The 2024 efforts to expand Medicaid coverage to cover the working poor was ultimately
logjammed on that reality. 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.
The 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. House Speaker Jason White and Lt. Gov. Delbert Hosemann shared the desire to
expand Medicaid to take care of Mississippians who were already members of the workforce but
who didn’t make enough money to afford insurance coverage. There was broad-based taxpayer
support for some form of work requirement in that expanded program.

Both Hosemann and White have in recent months reiterated their desire to expand Medicaid for
the working poor in Mississippi. With Trump winning the presidential election and the GOP
taking control of both the Senate and the House on Capitol Hill, the incoming Trump
administration has several options that could impact Medicaid expansion efforts in Mississippi
and across the nation.
First, the new Trump administration could restore the work requirements for Medicaid that were
in place during his first term. With a solid GOP majority in the Mississippi Legislature, which
would clear the expansion logjam from the 2024 session. That seems a likely outcome, but
certainly not a sure thing.
Second, the Trump administration could decide to launch an effort to dismantle the ACA
altogether and replace it with the “something better” that Trump referenced but failed to provide
details of in his presidential debate with Vice President Kamala Harris. That outcome is less
likely but not without the bounds of possibility.
Finally, Trump and the GOP congressional majority could allow the Biden-era ACA subsidies to
expire as scheduled in 2025, implement general Medicaid budget cuts during budget
reconciliation (including marketing and outreach funds) and place additional restrictions on
Medicaid eligibility. Those actions would reduce the Medicaid rolls.
Regardless the paths the second Trump administration chooses Mississippi’s Medicaid expansion
leaders in Jackson will pay close attention to what Congress and the White House are saying and
doing about Medicaid expansion in Washington.
Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.