No Republican lawmaker in the Mississippi House or Senate voted in favor of Medicaid expansion when legislative Democrats forced votes on the issue during the recently completed 2023 session.

But those votes do not necessarily mean the state's Republican-controlled Legislature opposes opting into the policy that would provide health coverage for hundreds of thousands of poor, working Mississippians and revive rural hospitals that have been struggling to stay open.

Only a handful of lawmakers in both the House and Senate say they outright oppose Medicaid expansion, according to a Mississippi Today survey of legislators conducted during the 2023 legislative session.

Just 21 of the House members surveyed, or 18% of the House, said they outright opposed Medicaid expansion. And just 18 of the Senate members surveyed, or 38% of the Senate, said they outright opposed it.

In the House, 67 members — a voting majority — said they either supported Medicaid expansion or were undecided. Mississippi Today could not get answers from 32 representatives.

And in the Senate, 25 members — one vote shy of a voting majority — said they either supported Medicaid expansion or were undecided. Mississippi Today could not get answers from nine senators.

But among the lawmakers who said they opposed expansion or asked to be labeled as “undecided,” several went on to add that they were actually open to some version of expansion.

Several lawmakers who said they opposed expansion said they supported policies similar to those passed in states such as Arkansas, Kentucky or Indiana — all states that have passed versions of Medicaid expansion.

Sen. Kevin Blackwell, a Republican from DeSoto County who chairs the Senate Medicaid Committee, was among those. Other key legislative leaders fell in this camp.

“I am open to considering something like Indiana has done,” said Rep. Trey Lamar, a Republican from Senatobia, after asking to be labeled “undecided.”

“I'm against it other than I would consider something like in Kentucky or Indiana, where everyone's got skin in the game,” said Rep. Kevin Horan, a Republican from Grenada who asked to be labeled “no.”

Mississippi is one of just 10 states that have resisted Medicaid expansion. Economists say the policy would bring $1.5 billion in new revenue annually while creating jobs, helping bolster the budgets of struggling hospitals and providing up to 300,000 poor, working Mississippians with health coverage.

The years-long resistance to expansion has come most directly from Republican leaders — namely Gov. Tate Reeves and House Speaker Philip Gunn — who have likened the policy to socialism. Republican Lt. Gov. Delbert Hosemann, who presides over the Senate, has in the past indicated support for some version of expansion but hasn't earnestly pushed legislation since he was elected in 2020.

And as poor Mississippians struggle to afford basic health care and dozens of the state's rural hospitals struggle to keep their doors open, Mississippi voters appear resolutely behind expansion. An April poll from Mississippi Today/Siena College showed that 66% of Mississippians support Medicaid expansion. An earlier survey in January showed 80% of Mississippians favored expansion.

Several rank-and-file Republican lawmakers polled by Mississippi Today said they were open to expansion, and some shared they believed there was a greater willingness among Republicans to pass expansion than in previous years. All 57 Democratic lawmakers support expansion.

Still, there was no serious push by Republicans in the 2023 session to even debate expansion, let alone vote on it.

“I think people are a little more open-minded about it than they were,” said Rep. William Tracy Arnold, a Republican from Booneville who supports Medicaid expansion. “We have a substantial amount of revenue now. We have to help save our struggling hospitals, and this would not only be giving hospitals more funding, it would help the struggling, tax-paying citizen.”

“Years ago when I first ran, I was totally opposed to Medicaid expansion,” said Rep. Mark Tullos, a Republican from Raleigh. “But I've looked at it further, and looked at what Arkansas did, and I would support something similar to what Arkansas has, with coverage for low income working people. Being from rural Mississippi, hospitals play a large role in our community. For rural Mississippi we are going to have to do something.”

“I'm for giving the working people of Mississippi health coverage,” said Rep. Sam Creekmore, a Republican from New Albany. “I'm for giving the working people health coverage. It would save lives. It would keep people working and prevent medical issues down the road.”

“I am for health insurance for our working people in Mississippi,” said Rep. Jerry Turner, a Republican from Baldwyn. “I'm for a program that would have everybody have skin in the game.”

Dozens of other Republicans asked to be marked as “undecided” in Mississippi Today's expansion database. Some of those indicated they were waiting on leadership to present some options, and others said they wouldn't speak to any theoretical policy change without first seeing a bill.

“We need to have the conversation,” said Sen. Bart Williams, a Republican from Starkville. “We have a hospital crisis and we need to listen to any and all ideas.”

“Without knowing what a bill looks like, it is hard to say. But we have to do something to help our rural hospitals,” said Rep. Jon Lancaster, a Republican from Houston. “But I am concerned about the federal strings.”

“We need to have discussions about it,” said Rep. Nick Bain, a Republican from Corinth. “There are good parts to it and not so good.”

“The devil is in the details, where the money is coming from,” said Sen. Walter Michel, a Republican from Ridgeland. “I do want to help the hospitals, but I would have to see the bill.”

Still, several Republicans remain firmly opposed to expansion. And many of those opposed declined to expound on why they are opposed.

But Rep. Dana Criswell, R-Olive Branch, said: “It's bad insurance, so there's no reason to keep expanding it.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.