Elections have consequences, the winning side has often boasted.
Donald Trump’s victory and return to the White House could have major consequences on health care — specifically on Medicaid expansion — in Mississippi.
In theory, Trump’s election should make it easier to finally enact Medicaid expansion in the state to provide health insurance for the working poor.
During the 2024 Mississippi legislative session, efforts to pass Medicaid expansion were unsuccessful, in part because of an insistence by some Republican leaders that to qualify for Medicaid expansion, a person, should be working in most instances.
The work requirement created an impasse in the Mississippi Legislature because the administration of President Joe Biden was not approving work requirements to be eligible for Medicaid expansion. So Medicaid expansion ultimately died because some supporters of expansion believed that mandating the work requirement was a type of poison pill — in essence, lawmakers could say they voted for Medicaid expansion, but in reality did not pass a bill that would expand health care options for poor people.
But there is a general belief that the Donald Trump administration will approve work requirements and might even try to demand them in the 40 states that already have expanded Medicaid.
With Trump poised to reclaim the White House this January, it is likely that the people who supported Medicaid expansion but opposed the work requirement in the 2024 Mississippi legislative session will acquiesce in the 2025 session and accept the aforementioned work requirement.
After all, it seems that Medicaid expansion with a work requirement would be better than no Medicaid expansion at all.
Based on that assumption, it seems likely that a bill to expand Medicaid to provide health care to poor, working Mississippians will sail through the Legislature during the quickly approaching 2025 session.
But there still may be obstacles.
One big potential obstacle is Gov. Tate Reeves. The second term Republican governor has been adamant in his opposition to Medicaid expansion throughout his lengthy political career.
During the upcoming 2025 session, the question will be: Can Medicaid expansion, presumably with a work requirement, make it through the legislative process with the two-thirds majority needed to override a potential gubernatorial veto?
Even if the Legislature is able to ascertain the two-thirds majority needed in each chamber and override a possible gubernatorial veto, there could be the potential of Reeves still working to prevent Medicaid from being expanded in Mississippi.
Will the governor personally lobby the Trump administration to not approve the work requirement and reject the Mississippi Medicaid expansion plan?
Richard Roberson, chief executive officer of the Mississippi Hospital Association, points out that in 2020 before COVID-19 hit, the Trump administration in its first term had proposed a kind of Medicaid expansion program that would include work requirements. Roberson said that proposal – the Healthy Adult Opportunity waiver – might not work in many of the 40 states that already have Medicaid expansion, but “would align very closely” to the Medicaid expansion program with work requirements that was offered but eventually shot down during the 2024 Mississippi legislative session.
If nothing else, Trump has been inconsistent in his health care proposals. He has campaigned at times on repealing the Patient Protection and Affordable Care Act, which includes the Medicaid expansion program, and even tried to kill it during his first time. At other times, he has said he would not try again to repeal the ACA.
It is not clear what the Trump policy toward Medicaid will be during his second term and whether Congress will block portions or all of his plan. Remember, in his first term he could not get a repeal of the ACA, including Medicaid expansion, through a Republican Senate. That could be the case this time with a few Republican senators appearing poised to oppose some of his proposals.
There has been speculation that Trump will try to reduce the amount of money going to the states for Medicaid. Such a proposal, if successful, could impact what Mississippi does on Medicaid expansion.
At any rate, there will be many question marks concerning health care as the Mississippi Legislature’s 2025 session begins.
Those potential answers are consequences, in large part, of the most recent presidential election.
Will those consequences result in improvements to Mississippi’s already dire health care outcomes or make those outcomes worse?
After all, behind those consequences are people whose lives can hang in the balance.
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