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The evening before a Senate committee was scheduled to vote on a Medicaid expansion bill, Gov. Tate Reeves invited about 20 Republican senators over to the Governor's Mansion for a frank conversation.

The second-term Republican governor, who has blocked expansion for more than a decade, privately told the senators on March 26 they should vote against the bill and reminded them that he would veto anything lawmakers sent to his desk this year. More specifically, Reeves told the group that he had problems with the exceptions the Senate bill would make to the work requirement. If you're going to pass an expansion plan, he told them, it should unequivocally require that Medicaid recipients hold jobs.

The following day, a Senate committee ignored Reeves' request and approved the original bill with the work requirement exceptions. On March 28, when the bill came up for a vote on the Senate floor, one of Reeves' closest Senate GOP allies, Sen. Joey Fillingane, R-Sumrall, introduced two amendments: one that would force struggling mothers to work to receive Medicaid benefits, and another to force people with disabilities to work to receive Medicaid benefits. But the Reeves-proxied amendments failed, and the original bill passed with support from more than two-thirds of the chamber.

READ MORE: Senate passes Medicaid expansion ‘lite' with veto-proof majority

Several of the governor's staffers, phones glued to their hands, scurried around the Capitol shortly after the vote. They'd lost yet another battle in the war their boss has waged.

Reeves lost real ground in his opposition to Medicaid expansion last week, unable to exert his influence even in the Senate, the friendly chamber that likely serves as his best shot at winning. Every tactic he's employed has been thwarted, and he's running low on political capital. And he apparently knows it.

“This week was not a great week in our fight to beat Obamacare Medicaid Expansion,” Reeves acknowledged in a long social media post on Saturday. The post named and thanked the 16 Senate Republican “patriots” who voted no. Most of those no-voters were at the Mansion earlier in the week.

Medicaid expansion would provide health insurance to about 200,000 working Mississippians — many of whom have never been able to otherwise afford it in the nation's poorest and unhealthiest state. Passing the policy, as 40 other states including many GOP-controlled ones have done, would provide a jolt of life to small towns and the rural hospitals that are keeping those towns alive. It could bring more than $1 billion annually in additional federal money to the state, freeing up hundreds of millions that could be spent on anything state leaders want, not just on health care.

But Reeves overlooks the health and economic benefits of the program simply because, he argues, it is an expansion of welfare. Never mind the fact that countless studies show most people who would take advantage of the health care program would be employed, or that both proposals in the GOP-led Legislature this year would require those people to work. The governor has also failed to mention the fact that Georgia's Medicaid program, which does include a work requirement as the state battles the federal government in court, is a dismal failure, costing Peach State taxpayers millions of dollars to administer a restricted program that is serving few people.

READ MORE: Mississippi lawmakers look to other states' Medicaid expansions. Is Georgia worth copying?

When the governor told the group of Republican senators last week that he wanted them to remove some of those work requirement exceptions, it may not have been about the work requirement at all. Reeves knows better than anyone that the federal government has rejected 13 states' previous efforts to place stringent work requirements to their expansion plans.

The Senate bill, as passed last week, is not exactly loved by advocates of greater health care access. In fact, Mississippi would still not be considered an expansion state if it's passed into law because it doesn't draw down a greater federal dollar match and it insures much fewer people than traditional expansion would.

And, importantly, the Senate bill would not allow any expansion program to go into effect unless the work requirement is accepted by the federal government — a poison pill that would temporarily delay or permanently prohibit any potential expansion program from going into effect. Looking at the recent history in other states, the governor's lobbying against the Senate bill the past few days appears pretty simple: If he can't stop the Legislature from passing some version of Medicaid expansion, he should try to get them to put strict work requirements in the bill because it likely won't be approved by the feds anyways.

READ MORE: Gov. Roy Cooper, the most recent state leader to expand Medicaid, has advice for Mississippi lawmakers

Now the Senate plan goes back to the House, which earlier this session passed a real-deal Medicaid expansion plan that would insure tens of thousands more people and draw down hundreds of millions of dollars more than the Senate plan would. The House plan also included a work requirement, though it would allow a Medicaid expansion program to go into effect even if the federal government doesn't approve the work provision.

With such different proposals from each side of the Capitol, Medicaid expansion in Mississippi is still far from a sure thing.

We can expect bitter disagreement between House and Senate leaders in the coming days as leaders from both chambers begin meeting to try to hammer out their differences and come to an agreement. And whatever potential expansion plan comes out of those meetings would still have to garner a substantial vote on both the House and Senate floors to pass.

Reeves, meanwhile, is working with all his might to block it now. And if nothing else, his last gasp would be his veto stamp, which would require yet another legislative vote against him. 

But with the governor seemingly losing more ground with his fellow Republicans with each passing week, perhaps the most critical question remaining is: Does Reeves have enough political firepower to stop this?

READ MORE: Hospitals, business leaders suffering FOT — Fear of Tate — on Medicaid expansion

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