MISSISSIPPI – Mississippi, one of the states that has not expanded Medicaid, faces severe long-term consequences from the coverage gap on rural health care outcomes. This issue is particularly critical in a state with some of the nation’s highest rates of poverty, chronic disease and poor health outcomes.

According to The Kaiser Family Foundation, there are approximately 2,000 individuals per primary care physician in Mississippi, double the recommendation estimated in a report from Annals of Family Medicine. Increased access to primary care providers is linked to improved health outcomes.  

“Its original intent was not to be this mass health insurance, government-run health insurance,” said Starla Brown, the Mississippi state director for Americans for Prosperity. 

Medicaid expansion has been a contentious issue across the United States, especially under the Affordable Care Act, and in southern states like Mississippi. While some argue it increases access to health care for low-income individuals, others, including Republican Gov. Tate Reeves and Brown, raise concerns about its long-term economic sustainability, effects on state budgets, and potential impacts on the health care system.

Brown and Reeves advocate for alternatives that prioritize market-driven solutions and fiscal responsibility, while proponents emphasize the immediate need to address healthcare disparities in a state with some of the nation’s poorest health outcomes. 

Opposition to Medicaid expansion  

Starla Brown’s perspective 

Brown opposes Medicaid expansion because of what she calls its unintended consequences. She also questions its effectiveness in addressing systemic health care issues.  

Brown argues Medicaid was never intended to be a primary insurance provider for able-bodied people but a temporary solution for those in need. According to Brown, expanding Medicaid would  strain federal and state funding, potentially costing taxpayers more money, emphasizing expansion is  more of an economic issue than a health care one. 

“I think it’s important to just really think about and take pause, as a state to say, ‘Can we actually afford this?’” said Brown. “We always want to review cutting spending, but a lot of these expansions have derailed, and now states are looking at, even what services they can actually continue to provide under Medicaid.” 

Governor Tate Reeves’ perspective 

Gov. Reeves is most recently opposed to expansion, though a plan he proposed in 2024 would have made the move more profitable for hospitals, according to Mississippi Today. Following that move, however, the governor made an argument to not expand Medicaid, according to SunHerald. 

According to Brown, Reeves now argues it would impose an unsustainable financial burden on the state, and despite pressure from health care groups and some lawmakers, he maintains expansion would lead to higher costs, forcing cuts to other essential services, such as education and infrastructure.  

RHCJC staffers asked the governor’s office for an interview to talk through Reeve’s 2024 proposal and what prompted his change in perspective, but their office did not respond to emails or calls. 

Richard Daughdrill, administrator at Greene County Hospital, explained, “It’s my understanding that money from the federal government is time limited, and they would only pay for it for five years. Once you start an entitlement, you can’t take it back.” 

Reeves points to the federal government’s role in funding expansion, warning reliance on federal contributions creates uncertainty. For example, if federal funding decreases in the future, the state would be left to fill the budget gaps, which could result in higher taxes or significant program cuts. 

Alternatives to expansion 

Americans for Prosperity in Mississippi works to advocate for health care policies and legislative changes. Its mission is to “work at every level of government to ensure the legislative process works in the best interest of the people, by removing laws that stifle opportunity and encouraging principled policies that ensure everyone has an opportunity to live a life of meaning. 

The group points to a  “Personal Option” in health care, as an alternative for Medicaid expansion. The plan, which aims to make a series of federal and state reforms, claims it would  provide affordable, high-quality, and personalized health care. The basics cover expanded telehealth options, reducing prescription costs and rolling back rules on health savings accounts.

 A series of federal proposals have surfaced to address specifics, such as the CHOICE Arrangement Act (H.R.3799) from Representative Kevin Hern, which would allow workers to use tax-free money from their employer to buy portable health insurance that could stay with them from job to job.

In Mississippi, AFP is targeting Certificate of Need regulations, pushing for lawmakers to repeal what the organization claims are laws that impede access to quality health care – the opposite of what they were enacted to do. 

AFP reports seven out of 10 voters prefer Personal Option to public programs or Medicare for All, which is a proposal for a national health insurance program.  

“We hope, as Americans for Prosperity, that we can look at a series of reforms under the Personal Option, whether it’s at the federal or state level, things like Certificate of Need,” Brown said. Brown says 69% of voters want less government control of their healthcare and 61%of voters favor more competition. 

“We hope that we can enact these laws in the legislation. When you add it all together, the outcome can be more access, more affordable healthcare for all,” Brown said. 

Polls of the people 

According to Cygnal, an international polling analytics firm, in February 2024 nearly 55% of Republican primary voters support Medicaid expansion to cover individuals who earn less than the poverty line. Research released in October 2024 from a global data and business intelligence platform, Statista, shows 18% of Mississippians lived below the poverty line in 2023. 

Cygnal research highlights 50% of Republican primary voters also hold a favorable opinion of Medicaid, with less than a third of voters holding an unfavorable opinion, and almost 60% believe health care is unaffordable in the state. 

Economic impact 

Examples of Medicaid expansion can be seen in Ohio and Arkansas, where it reduced the uninsured rate and improved access to care. The two states expanded on Jan. 1, 2014. The Center on Budget and Policy Priorities reports people who gained coverage are healthier and more financially secure, while long-standing racial inequities in health outcomes, coverage, and access to care have shrunk.  

Both Reeves and Brown argue expansion might discourage work and limit economic mobility. They contend that by expanding eligibility to those earning up to 138% of the federal poverty level, beneficiaries may opt to remain in lower income brackets in order to retain coverage rather than pursuing full-time employment or private insurance options. 

According to Brown, Medicaid’s bureaucratic reimbursement process means doctors and clinics, often locally owned, receive less money than they would from private health plans. Gov. Reeves supports this perspective, calling for solutions that help Mississippians achieve self-sufficiency through employment and private insurance access. 

“Mississippi has the lowest unemployment rate in our state’s history. We need more people in the workforce, so, adding 300,000 able-bodied Mississippians to the welfare rolls I would argue is a bad idea, ” he said.