In 2013, then-state Rep. Andy Gipson, R-Braxton, said he opposed Mississippi expanding Medicaid because there was no guarantee the federal government would continue to pay for the program.

“Knowing that the federal government may pay for a portion of it for the next two or three years is not enough comfort for me to go ahead and say, ‘You know, let's expand this and take on the whole program,'” the Associated Press quoted Gipson as saying in 2013. “Certainly, we don't have the funds to do that.”

More than 10 years after Gipson made those comments, he still opposes Medicaid expansion, and the federal government continues to pay for the bulk of the program for the 40 states — excluding Mississippi — and D.C. that have expanded Medicaid.

Importantly, there is no serious conversation of discontinuing Medicaid expansion, which provides health insurance for primarily the working poor, individuals earning a little more than $20,000 annually.

At that same meeting in 2013, Gibson said he was for people obtaining health insurance by getting “good-paying jobs,” not by signing up for Medicaid.

Ten years later Mississippi continues to be last in the nation in terms of per capita income and among the bottom 10 states in terms of the percentage of people with employer-sponsored health insurance, according to statistics from the Kaiser Family Foundation. And any gains in the number of Mississippians with private health insurance can be credited primarily to the health insurance exchange created by the federal Affordable Care Act, not because of more well-paying jobs.

At the recently completed political speeches at the Neshoba County Fair, Gipson said he still is opposed to Medicaid expansion and is counting on those jobs to provide health care coverage for working Mississippians.

“I am against Medicaid expansion. I always have been,” said Gipson, who is now the statewide elected commissioner of agriculture and commerce. “We need people having jobs to get insurance that way.”

Gov. Tate Reeves, who is campaigning for his second term as governor, also endorsed the concept of people obtaining health insurance by having well-paying jobs instead of by expanding Medicaid.

“My view is the best way to do that is get more people with more and better high paying jobs which will allow them to have private insurance,” the governor said.

At the Neshoba Fair last week, none of the Republican statewide officials who spoke endorsed Medicaid expansion as a way to reduce the number of people without health insurance and as a way to provide a needed source of revenue for the state's struggling hospitals, many of which are in danger of closing and many of which have had staff reductions in recent weeks.

“I think it is a little late on Medicaid expansion,” said state Insurance Commissioner Mike Chaney.

“The match is not there that we used to have, and I don't think the Legislature has the appetite to do anything,” Chaney added.

READ MORE: Q&A: What is Medicaid expansion, really?

When Medicaid expansion was enacted in 2014, the federal government paid 100% of the costs for two years. The portion paid by the federal government was stair-stepped down to 90% in 2020, which is what the federal match is now. But the federal government still offers a financial incentive for those 10 states that have not opted into the program. The financial incentive to expand Medicaid would equate to more than $600 million to Mississippi over a two-year period.

Chaney said his office is working to sign up people for the health care exchange which also is part of the same Affordable Care Act that resulted in Medicaid expansion. Through the exchange, people can sign up for private insurance where the federal government will help with the costs based on the income level of those signing up. Some people who qualify for Medicaid expansion do not qualify for the health insurance exchange, leaving a coverage gap in states that have not expanded Medicaid.

Secretary of State Michael Watson, said, “I am not in favor of Medicaid expansion, but I will say this – I think there is a number of issues out there that legislative leaders have perhaps been a little bit fearful of addressing because it is such an important topic.”

Watson said he created a task force to look at possible health care solutions in Mississippi. He said hospitals in states that have expanded Medicaid are having financial difficulties like those in Mississippi. Watson said he does not believe Medicaid expansion is “the silver bullet” for Mississippi hospitals, and that he will continue to work with others on possible solutions for the health care woes facing the state.

Treasurer David McRae said, “Being at the state treasury, I don't have a position. I am waiting to see what the Legislature comes up with” and try to determine it is in the best interest of the state of Mississippi.

Attorney General Lynn Fitch said she does not support Medicaid expansion, but “If the law changes, I will certainly be supporting the law that is passed by the Legislature.”

During the 2023 session, Mississippi Today polled legislators on their position on Medicaid expansion. Only a handful said they outright opposed Medicaid expansion with a majority refusing to provide an answer or saying they wanted to see more information or had not decided their position on the issue that could bring more than a billion dollars annually in federal funds to the state.

Lt. Gov. Delbert Hosemann has said in the past he is willing to look at the issue of Medicaid expansion, though, during the past four years the Senate where he presides did not take any action on the issue.

Auditor Shad White missed the Neshoba County Fair because of a military commitment and was not available to offer a Medicaid expansion response.

All of the statewide officials are running for re-election this year.

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

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