No one more deeply understands the fraught politics of pushing Medicaid expansion in a red state than North Carolina Gov. Roy Cooper.

When the Democrat moved to expand Medicaid in 2017, the state’s legislative Republicans sued him in federal court to block him. Their years-long opposition to expansion, much like the sustained GOP blockade here in Mississippi, was rooted in little more than blind politics.

The expansion program, of course, runs through the Affordable Care Act, perhaps the biggest legacy of President Barack Obama. The all-too-familiar logic of North Carolina’s Republicans in opposing Cooper’s expansion effort: Obamacare is bad, Republican power is good.

Unsuccessful at first, Cooper got to work. He traveled his state to listen to constituents, and for years he led a coordinated pro-expansion effort. He pieced together a bipartisan coalition that became too powerful for the GOP lawmakers to ignore. Business leaders lobbied, health professionals pleaded, religious leaders prayed.

At long last, in 2023, North Carolina became the 40th and most recent state to expand Medicaid. An overwhelming majority of legislative Republicans — yes, even most of the loudest earlier opponents — ultimately voted yea.

“That was one of the greatest days of my life,” Cooper told me in an interview on Tuesday. “It was a day that changed so many lives, and the people of North Carolina are better off today for it in every way.”

Cooper has been following the high-profile debate of Medicaid expansion in the Mississippi Capitol this year. Here in Jackson, House Republicans overwhelmingly passed an expansion proposal on Feb. 29. But Senate Republicans are stalling and proposing their own plan — one that is so watered down and ineffectual that Mississippi wouldn’t be considered an expansion state if it passes.

As major deadlines approach and the politics heat up, expansion in Mississippi is still far from reality.

The North Carolina governor said he noticed a recent tweet from Republican Gov. Tate Reeves using yet another one of those tired “Obama is bad” lines.

“It’s really quite sad, isn’t it?” Cooper asked me rhetorically.

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

Truthfully, Mississippi Republicans have little reason to care what Cooper has to say. But before you write off his words, know this: Two different times, North Carolinians elected Cooper on the same ballot that Republican Donald Trump won. Let that sink in: A majority of North Carolina voters elected a Democratic governor while casting votes for Trump on the same ballot. He’s clearly trusted and respected by many Republican voters in his state. Few politicians in America could claim that level of crossover support these days.

His popularity, many in the Tar Heel State believe, got Medicaid expanded and will provide health care coverage to an estimated 600,000 North Carolinians.

So when I got a few minutes with the political savant this week, I couldn’t help but ask: What would he say to Mississippi lawmakers as they’re considering expansion?

“Listen to your constituents instead of the partisan rhetoric,” Cooper responded. “You’ll hear from small business owners that they’re having a hard time affording health insurance for their employees. You’ll hear from rural county commissioners and local government officials that their rural hospitals are in danger of closing. You’ll hear from local law enforcement officers that they’re spending a lot of time dealing with people who are mentally ill or have substance use disorder. If you listen to doctors and health care providers, they’ll tell you they’re having a difficult time treating indigent patients. And if you talk to people who are working hard, making a living and just can’t afford health insurance, they’ll tell you this is a great deal for Mississippi.”

Did you catch that? Cooper doesn’t care if Mississippi lawmakers listen to him; he just wants them to listen to their constituents. Considering the vast support for expansion among Mississippi health care leaders, business leaders and voters of all party affiliations, that fundamental political concept has clearly been shelved here in recent weeks.

READ MORE: Senate Medicaid expansion plan shows generosity to the poor — but mostly in other states

North Carolina expansion went into effect in December 2023, so it’s still early days. But what are the effects so far?

“Already we’re seeing thousands of prescriptions being filled, so obviously there were a lot of people who were not getting the regular preventative drugs that they should have,” Cooper said, which one could easily take as a nod toward Mississippians being consistently ranked the unhealthiest populous in the nation.

He continued: “And look, this will help the private sector. It’s one of the reasons we had a number of local chambers of commerce endorse Medicaid expansion. When you have indigent patients who get treated and providers can’t recover the money, they go to the private sector. Studies have been overwhelming in showing that Medicaid expansion can help control private health care costs.”

There’s logic in that answer that mirrors the numerous studies showing expansion in Mississippi would have similar effects. But in this Mississippi debate, logic has too often taken a backseat to pure, unadulterated politics. This is, perhaps, where we could use Cooper’s unique perspective most.

So I ask: Many so-called conservatives in Mississippi are making this exclusively about politics, arguing simply that expansion is not conservative enough. Knowing what you know on the other side of this fight, what would you say to them?

“It saves people money, so it’s conservative. It saves businesses money, so it’s conservative. It saves lives, so it’s conservative,” he said. “… It’s been hard to find people in North Carolina who are against it after we passed it. And it was an overwhelming majority of legislators from both parties who supported this at the end of the day.”

Mississippi lawmakers can listen to Cooper or not. But the guy has been down the very road they find themselves on right now. And the stakes for so many Mississippians couldn’t be higher.

READ MORE: Senate Republicans should know: This is literally life-or-death.

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