After years of partisan fear and loathing and failed attempts in the Legislature, health care and racial justice advocates want Mississippi voters to force the issue and expand Medicaid at the ballot box.

A nonprofit incorporated by the president of the Mississippi Hospital Association and others has filed preliminary paperwork to start ballot Initiative 76, which would put Medicaid expansion in the state constitution, draw down billions of dollars in federal funds and provide health care to potentially hundreds of thousands of working, low-income, uninsured Mississippians.

Mississippi is one of just 12 states that has refused to expand Medicaid, leaving hundreds of thousands of citizens without the ability to afford health care coverage and rejecting at least $1 billion per year in federal funds.

“Hospitals and our working poor across the state of Mississippi cannot keep waiting,” MHA President Tim Moore told Mississippi Today on Monday. “There’s all the federal money we are leaving in D.C., our taxpayer dollars that we need to bring back to help our citizens. We do that with everything else, accept federal help, but for some reason not with this.

“It’s time to let the Mississippi voters decide.”

The planning stages of the ballot initiative signals a broad coalition may be on board with the effort. Corey Wiggins, the executive director of the Mississippi State Conference of the NAACP, has worked closely with Moore and others on launching the initiative.

“Medicaid expansion, which would provide healthcare to over 200,000 Mississippians and bring over a billion dollars in federal funds home to our state, is an issue we’ve encouraged legislators to pass for years,” Wiggins told Mississippi Today.

Moore, Hattiesburg pediatrician Dr. John Gaudet and public health executive and advocate Nakeitra Burse incorporated the Healthcare for Mississippi nonprofit and filed the initial paperwork to try to put the issue before voters. On March 31, the Mississippi secretary of state published an initial ballot title and summary in the Clarion Ledger public notice section. Now, those involved would have to collect about 106,000 signatures of registered voters to put the issue before voters, likely in the 2022 midterm elections.

Moore said the Mississippi Hospital Association will vote on Friday whether to join in the initiative push — very likely given the association’s long-running advocacy of expansion to help save financially ailing hospitals across the state and help the uninsured working poor in the poorest state in the nation. Moore said he hopes numerous other groups that have supported expansion will promptly get on board with the initiative drive.

Many health advocates have pushed for Mississippi to expand Medicaid under the federal Affordable Care Act and draw down billions in federal dollars to a state already heavily reliant on federal spending. The COVID-19 pandemic, in particular, has highlighted health care disparities in the state, which is home to one of the highest percentages of uninsured residents in the nation. Congress further incentivized Mississippi to expand Medicaid in its latest stimulus package, upping the federal match to the 12 states that have resisted expansion.

But state GOP leaders, starting with former Gov. Phil Bryant, have opposed the move, saying they don’t want to help expand “Obamacare” and that they don’t trust the federal government to keep footing the bill, eventually leaving state taxpayers on the hook.

Meanwhile, hospitals — especially smaller rural ones — say they are awash in red ink from providing millions of dollars of care each year to uninsured and unhealthy people in Mississippi.

Current Republican Gov. Tate Reeves has remained steadfastly opposed to expanding Medicaid, as has Republican House Speaker Philip Gunn. Republican Lt. Gov. Delbert Hosemann has said he’s open to discussion on the issue — including last week as the legislature ended its annual session — but expansion has been a nonstarter despite vigorous lobbying efforts by MHA and others.

Just last week, Gunn reiterated his opposition.

“I am not open to Medicaid expansion,” Gunn said. “We cannot afford it, and there are numerous other reasons … Taxpayers cannot afford it.”

Reeves’ office did not immediately respond to a request for comment on Monday.

“Hospitals have tried to work very closely with the state leadership since 2013,” Moore said. “And we have just not been able to move things in that direction. At some point in time you just have to make a decision to move along another avenue.”

Mississippi voters last election took matters in hand on another long-running health care issue, overwhelmingly approving a medical marijuana program by enshrining it in the state constitution. Moore said he believes Medicaid expansion is likewise popular with Mississippi voters.

“If you look at just outside, public polling, you’ve seen numbers approaching 60% just with likely Republican voters,” Moore said.

Moore said the ballot initiative language, if successful, will likely be broad approval of expansion, not a long, detailed directive like medical marijuana, which brought some criticism that it tied state leaders hands in creating an effective, regulated program.

“Health care shouldn’t be in the constitution,” Moore said. “Neither should medical marijuana. That’s not what it’s for. It should have been taken up and dealt with in the Mississippi Legislature. But they did not do that. They didn’t handle it, and so you have to take the next step and put it before voters.”

After Healthcare for Mississippi filed its initial paperwork for the initiative, the state attorney general’s office drafted an initial title and ballot summary for Initiative 76. The group can challenge the wording of the title, which it is doing, Moore and Wiggins said.

The AG’s title draft says “Should Mississippi amend its constitution to require expansion of Medicaid eligibility for people between the ages of 18 and 65?” Moore said this is misleading, and “has no mention of low incomes or working poor.”

Mississippi is one of 12 states that has not expanded Medicaid to provide health coverage for people making up to 133% of the federal poverty level, or about $17,600 a year for an individual. Estimates vary from about 170,000 to 400,000 on how many Mississippians would qualify, with GOP leaders claiming the larger number.

The state would pay 10% of the cost — estimates range from about $75 million to more than $150 million a year — and the feds would cover the rest, estimated at $1 billion a year. The Mississippi Hospital Association has pitched a plan to lawmakers that the state share could be paid by taxes on hospitals and fees paid by the new Medicaid enrollees.

But the American Rescue Plan recently passed by Congress would provide further incentives for states that expand Medicaid, dropping the state’s share of the cost further.

“For a number of years, the federal government has been offering us a $1 million a day to take care of sick people,” Sen. Hob Bryan, D-Amory, chair of Senate Public Health recently said. “Now they are offering $1 million a day to take that other $1 million a day. You can’t make this stuff up.”

Mississippi hospitals are footing the bill for uninsured Mississippians, including about $600 million in uncompensated care in 2019, with costs steadily rising. Advocates of Medicaid expansion say it would not only help save Mississippi’s rural hospitals — many of which have either gone under or teeter on the brink of bankruptcy — but create thousands of jobs and help the state’s economy.

“It’s encouraging to see the conversations around improved access to healthcare in Mississippi,” said Dan Jones, vice chancellor and dean emeritus at the University of Mississippi Medical Center. “Under current conditions, many hardworking Mississippians in jobs without health insurance coverage could gain access to health care only afforded through health insurance coverage. And this can be accomplished in a way to gain substantial economic benefit for our state.”

While supportive of any effort to expand health care in Mississippi, Jones said he believes the best way forward is through lobbying lawmakers, not the ballot initiative process.

“While I appreciate the effort by some to proceed with a ballot initiative regarding Medicaid reform, in my opinion, working directly with our legislative leaders and members is the ideal way to accomplish the goal of increased healthcare access,” he said. “Our legislature changed our state flag when many thought it an impossible political process. I’m confident the same spirit of moving Mississippi and Mississippians forward can result in improved health care access.”

READ MORE: Mississippi missed out on $7 billion when it did not expand Medicaid. Will that figure jump to $20 billion?

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