As clergy, physicians and business leaders have for weeks rallied at the state Capitol to expand Medicaid coverage to the working poor, observers can often spot the same conservative lawmaker listening attentively on the sidelines. 

Sen. Chad McMahan, a Republican from Guntown, hasn't attended the events as a participant, a supporter or an opponent of the rallies. Rather, he goes because he wants to listen to the debate or because his constituents are there. 

In fact, McMahan has been a quiet, yet constant supporter of Medicaid expansion, or Medicaid reform as he calls it. He believes the policy can give rural hospitals like North Mississippi Medical Center in his hometown of Tupelo a major boost and create a healthier population. 

The three-term lawmaker is widely known for telling reporters that his main duty at the Capitol is to vote how the majority of the people in his district want him to vote. But he also openly shares his childhood story that he believes gives him a unique perspective on how steep medical debt can crush hard-working Mississippians. 

When McMahan was in the ninth grade, he suffered an injury and had to be treated at the local emergency room. When the $20,000 bill came due for the medical services, though, there was a major snag: McMahan's family had no health insurance. 

“That doesn't sound like a lot of money today, but in 1986, $20,000 would buy two top-of-the-line Chevrolet pickups,” McMahan said. “Today, it won't even buy a piece of a Chevrolet pickup truck.” 

The legislator's father owned a cabinet-making business in north Mississippi, and his mother did clerical work. But the medical debt forced them to make tough decisions that thousands of Mississippians still face today. 

It was impossible for the McMahan family to pay the bill in one swoop. Instead, they set up a payment plan with the hospital to pay the bill off over several years. 

“It put a lot of stress and anxiety on my family,” McMahan recalled. “I saw my mom and dad having to decide at the dinner table whether they were going to pay a mortgage, buy groceries or pay the hospital bill that month.” 

READ MORE: Medicaid expansion negotiators still far apart after first public meeting

Roughly 74,000 Mississippians don't make enough money to afford insurance, yet make too much money to qualify for Medicaid and find themselves in positions similar to the one the McMahan family was in decades ago.

But the state Legislature has a chance this year to address this issue because for the first time since the federal Affordable Care Act became law, it's considering expanding Medicaid to the working poor as the ACA envisioned. 

The House and Senate this week are locked in negotiations on a final expansion bill after the two chambers passed vastly different proposals. 

The House's initial plan aimed to expand health care coverage to upwards of 200,000 Mississippians, and accept $1 billion a year in federal money to cover it, as most other states have done.

The Senate, on the other hand, wanted a more restrictive program, to expand Medicaid to cover around 40,000 people, turn down the federal money, and require proof that recipients are working at least 30 hours a week. 

The negotiators met publicly for the first time on Tuesday, but the six lawmakers remained far apart from a final deal. The Senate simply asked the House to agree to its initial plan. But the House offered a compromise “hybrid” model that uses public and private options to implement expansion. 

McMahan said he personally supports the House's effort to expand to the full 138% of the federal poverty level, or an individual who makes $20,782 annually. But he also supports the Senate's effort to have an ironclad work requirement for the recipients. 

While McMahan has compassion for uninsured people he doesn't think fiscally conservative Republicans should agree to expansion legislation that leaves out a work requirement or sets up a process for people to remain on the system indefinitely. 

“I'm proud that I live in a country where there is a safety net to catch people and help people, but I'm not for turning the safety net into a hammock,” McMahan said. 

The Senate negotiators were noncommittal on the hybrid compromise. House Medicaid Chairwoman Missy McGee scheduled a second conference committee meeting for Thursday afternoon. 

McMahan applauded the House and Senate leaders for trying to come to a resolution on expansion, especially after the policy has been a nonstarter for the last 10 years at the Capitol.

He doesn't think it's his job to convince his Senate colleagues to change their minds. But he does want people who remain unabashedly opposed to the policy to listen to the stories of people across the state who still can't afford basic health care. 

“I see the people who are out there,” McMahan said. “A lot of construction workers, a lot of fast food employees. I see the people who are working every day getting up and going to work who have never taken a hand out in life for anything who are not covered by health insurance.”

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