Apr 11, 2024 - Health

Why a deep-red state could be on the verge of expanding Medicaid

an illustration of a health plus shaped like an open lock

Illustration: Tiffany Herring/Axios

Mississippi, one of the country's poorest and least healthy states, could soon become the next to expand Medicaid.

Why it matters: It's one of several GOP-dominated states that have seriously discussed Medicaid expansion this year, a sign that opposition to the Affordable Care Act coverage program may be softening among some holdouts 10 years after it became available.

  • A new House speaker who strongly backs expansion and growing fears that the state's rural hospitals can't survive without it have kept up momentum in Mississippi's legislature this year.
  • As many as 200,000 low-income adults could gain coverage if lawmakers clinch a deal in the closing weeks of the Mississippi session.

State of play: Mississippi's House and Senate this week began hashing out differences between two very different plans passed by each chamber.

  • The House bill is the traditional ACA expansion, extending coverage to adults earning 138% of the federal poverty level, or about $21,000.
  • The Senate's version, which leaders have dubbed "lite" expansion, covers people earning up to the poverty line and wouldn't bring in the more generous federal support available for full expansion.
  • Both plans include a work requirement, but only the House version would still allow expansion to take effect without it. The Biden administration opposes work rules, but former President Trump could revive them in a second term.

Zoom out: State lawmakers in Alabama and Georgia gave serious consideration to Medicaid expansion this year, though they ultimately dropped it. Kansas' Gov. Laura Kelly, a Democrat, is trying again to expand Medicaid, but the GOP-run legislature remains opposed.

  • Shuttering rural hospitals and an acknowledgement that the ACA is unlikely to be repealed have made Republicans more willing to take a closer look at expansion, Politico reported earlier this year.
  • The fact that the extra federal funding from the ACA expansion could lift state budgets as pandemic aid dries up has also piqued states' interest, said Joan Alker, executive director of the Georgetown University Center on Children and Families.

Zoom in: Mississippi's expansion effort has advanced further than other states this year largely because new House Speaker Jason White has made it a priority. Lt. Gov. Delbert Hosemann, who presides over the Senate, has also pushed the issue.

  • "We see an unhealthy population that's uncovered. And we see this as the best way" to insure them, White told Mississippi Today this week.
  • "I just think it's time for us to realize that there's not something else coming down the pipe."

The state's crumbling health infrastructure has also made expansion more urgent, said Democratic state Sen. Rod Hickman. More than 40% of the state's 74 rural hospitals are at risk of closing, a report last summer found.

  • "The dire need of our hospital systems and the state finally recognizing that Medicaid expansion could assist in those issues is what has kind of brought that to the forefront," he told Axios.

Yes, but: Republican Gov. Tate Reeves has reportedly pledged to oppose any Medicaid expansion deal that may emerge before the legislature adjourns in early May, so lawmakers would likely need a veto-proof majority to approve an expansion.

  • Austin Barbour, a Republican strategist who works in Mississippi politics, said he expects lawmakers will reach a deal.
  • But if they don't, "I know this will be an issue that'll pop right back up next session," he said.
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