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Senate Medicaid Chairman Kevin Blackwell on Friday afternoon said the Senate will hold firm on asking House leaders to agree on a final Medicaid expansion plan that requires recipients to prove they are working at least 30 hours a week.

That’s a stance likely to delay or kill Mississippi’s efforts to provide health coverage to about 200,000 people, as the federal government has refused to approve such work requirements for Medicaid expansion.

“We’re pretty solid on that,” said Blackwell, a Republican from Southaven.

And despite offering a “compromise” to the House that he and two other Senate negotiators agreed to, Blackwell expressed doubt it could garner enough votes in the GOP supermajority Senate.

His remarks come after he and two other Senate negotiators sent House leaders a “hybrid” expansion proposal on Friday morning that would expand coverage to people earning up to 138% of the federal poverty level, or about $20,000 a year. The proposal would use traditional Medicaid for the poorest and subsidized private insurance on the federal exchange for those making from 100% to 138% of poverty level — a compromise House leaders had previously pitched.

House leaders had asked the Senate on Tuesday if they would be receptive to a hybrid expansion model, and the Senate negotiators were noncommittal. Now, Blackwell is agreeing to the House’s hybrid suggestion with a strict work requirement.

“They asked for (a hybrid plan), and we felt obliged to try and accommodate them,” Blackwell said of the House negotiators. 

The movement by Senate leaders to cover those earning up to 138% of the federal poverty level is a major step toward an agreement on a Medicaid expansion program as 40 other states have done to cover primarily the working poor.

But it’s unclear if the Senate even has the necessary votes to pass its own proposal on the Senate floor, much less with a veto-proof two-thirds vote needed to override a threatened veto from Republican Gov. Tate Reeves. 

Blackwell said “only three senators,” meaning the three Senate negotiators, had viewed the counter-proposal. The DeSoto County lawmaker also said he had not tried to convince his Senate colleagues to vote for the plan and had left that job up to the lieutenant governor’s office. 

House leaders are reviewing the Senate’s counteroffer, but had not publicly responded to it by late Friday. Lawmakers are expected to meet through the weekend in the final days of this year’s legislative session.

House leaders have said they, too, want work requirements for expanded Medicaid coverage. But the federal Centers for Medicare & Medicaid Services under the Biden administration have denied waivers for states to implement work requirements.  The House’s proposal called for seeking a waiver, but expanding the coverage whether or not one is granted.

In the House’s original plan, it contained a 20-hour per week work requirement for recipients, but if CMS denied the work requirement waiver, it would have still gone into effect. 

A potential avenue for compromise is for the chambers to include, as North Carolina did, a  “trigger law,” of sorts, to mandate that if the federal government ever changed its policy on allowing states to implement a work requirement, Mississippi would move immediately to adopt one. 

If CMS denies the work requirement waiver, the Senate’s plan directs Attorney General Lynn Fitch’s office to file a federal suit to appeal the denial. 

Senate leaders have said that despite CMS refusing to approve work requirements for Medicaid coverage, they hold out hope that the agency might be so pleased that longtime holdout Mississippi is expanding the program that it makes an exception. Beyond that, they hope the state could prevail in a lawsuit against the federal government filed in the conservative 5^th Circuit federal court to force approval of work requirements.

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Senate leaders have agreed to expand Medicaid coverage to people earning up to 138% of the federal poverty level or about $20,000 annually as is allowed under federal law.

The movement by Senate leaders to cover those earning up to 138% of the federal poverty level is a major step in finally reaching agreement to adopt a Medicaid expansion program as 40 other states have done to cover primarily the working poor.

The House passed a bill earlier this session to cover those earning up to 138% of the federal poverty level. It is estimated the House bill would cover at least 200,000 Mississippians. The Senate, on the other hand, passed legislation to cover those earning less than 100% of the federal poverty level or about $15,000 per year. Senate leaders estimated their plan would have covered about 40,000 people.

During open negotiations earlier this week, House Medicaid Chair Missy McGee, R-Hattiesburg, urged her Senate colleagues to agree to expand Medicaid coverage that would result in drawing down maximum federal funds.

On Friday, Lt. Gov. Delbert Hosemann, who presides over the Senate, announced his leadership team was agreeing to cover those earning up to 138% of the federal poverty level.

Earlier this week, McGee offered a compromise where those earning less than 100% of the federal poverty level would be covered through traditional Medicaid. But those earning between 100% and 138% would be covered through private insurance policies through the federal marketplace exchange.

But the cost of those policies would be paid through state funds and federal Medicaid funds. The federal government pays 90% of the cost for those covered through Medicaid expansion, estimated to be about $1 billion a year for Mississippi. In addition, the federal government is providing incentives to expand Medicaid for the 10 states that have not. Those incentives would provide about $700 million additional funds to Mississippi over a two year period.

The original Senate plan would not have been considered ACA Medicaid expansion and would not have qualified for the increased federal funding.

In a news release, the Senate leaders said they would be willing to cover people earning up to 138% of the federal poverty level using the private insurance policies to cover those earning between 100% and 138%.

While the Senate’s willingness to provide Medicaid coverage to those up to 138% of the federal poverty level is a major step, there are still issues to be resolved as the session nears an end before Medicaid expansion is a reality in Mississippi.

Senate officials said they are still insistent that the expansion plan include a stringent work requirement and monitoring system for those covered through expansion. The Senate proposal would instruct the state Attorney General to file a lawsuit to try to overturn the federal government’s expected denial of the work requirement.

A news release from Hosemann’s office said a work requirement is “a non-negotiable element.” Under the Senate offer, Medicaid would not be expanded until the work requirement is approved either through the federal Medicaid officials or through the federal courts.

House leaders said they also want a work requirement, and included one in the original House proposal. However, should the federal government deny it — as expected — the program would still go into effect — a pragmatic move, House leaders said.

In the news release, Hosemann added, “We are hopeful a compromise is on the horizon. When people are healthy, they are working, raising their families, and contributing to their communities. Access to healthcare is a critical component of economic and workforce development efforts in Mississippi—and reforming healthcare is the right thing to do.”

The work requirement is one obstacle that must be resolved. In addition, Gov. Tate Reeves has said he would veto any bill expanding Medicaid. It would take a two-thirds vote by both chambers to override a veto. The House is expected to easily muster more than a two-thirds vote. But Reeves has been lobbying Senators hard against expansion, and the vote there is less assured.

Under current law, Medicaid in Mississippi covers the disabled, poor children and poor pregnant women, certain primarily caregivers living in extreme poverty and certain segments of the elderly population.

The Senate, when it delivered its compromise offer, also called for the House to reconsider its initial plan, which had passed the Senate by a two-thirds margin.

Senate leaders also called for the House to consider changes to the state’s original Medicaid program that the Senate had proposed earlier in the session. These changes include making it easier for severely disabled children to receive Medicaid coverage and preserving changes made last year to the hospital tax which provides additional federal money for hospitals.

Mississippi Today reporter Taylor Vance contributed to this story.

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National studies and experts in Medicaid expansion states refute concerns voiced in Mississippi’s legislative conference committee that costs to the state would exceed projections.

Among those dispelling that fear are experts and a former governor in Kentucky – one state Mississippi conferee and Senate Medicaid Chairman Kevin Blackwell referred to as an example of where expansion has been expensive.

One study in the National Bureau of Economic Research that analyzed state budget data over an eight-year period found that changes in state spending were “modest and non-significant” after Medicaid expansion, and “state projections (of cost) in the aggregate were reasonably accurate, with expansion states projecting average Medicaid spending from 2014-2018 within 2 percent of the actual amounts, and in fact overestimating Medicaid spending in most years.”

Senate negotiators on Tuesday said they fear more people than estimated would enroll in Medicaid under expansion, and that this would result in higher-than-estimated costs to the state. 

House Medicaid Chairwoman Missy McGee, R-Hattiesburg, reiterated that multiple studies – including one done this month on expansion’s potential impact in Mississippi by a nonpartisan research organization – found that traditional expansion would result in savings to the state, not increased costs.

The study found that traditional expansion – insuring those making up to 138% of the federal poverty level or about $20,000 annually for an individual – would cost the state nothing in the first four years of implementation, and roughly $3 million the following year. It would stimulate the economy, putting about $1.2 billion into circulation that the state would not see otherwise and creating 11,000 new jobs in Mississippi, in addition to providing health insurance for poor working people and cutting acute care hospitals’ uncompensated care costs by $164 to 191 million annually.

While Medicaid enrollment after expansion could exceed projections, that possibility was taken into account by Hilltop’s report, which estimated 95% of enrollees would be newly eligible. According to the study, about 200,000 Mississippians would enroll in Medicaid post-expansion. 

Sen. Brice Wiggins, R-Pascagoula, said he believes the Senate’s original plan is a pragmatic proposal that offers savings – “whereas 44 other states have not been that,” he said, referencing the 40 – not 44 – expansion states. The original Senate plan covers fewer people than the House plan, includes a stringent work requirement unlikely to be approved by the federal government, and doesn’t qualify for increased federal funding.

Blackwell also made a similar comment, asking his House counterpart “Have any of (the states) – I guess how many exceeded the number of population they estimated at onset? I think 40.”

Blackwell later offhandedly told a reporter he heard from a fellow lawmaker in Kentucky expansion had been expensive.

Asked what their sources were regarding their statements about Medicaid expansion costs, Wiggins referred questions to fellow conferee Sen. Nicole Boyd, R-Oxford, who declined to comment. Blackwell said he was unable to provide any sources because they “are still working on the bill” and suggested the reporter read an opinion piece by a conservative columnist whose past views have aligned with those of Gov. Tate Reeves, a Medicaid expansion opponent. 

Dr. Ben Sommers, a health economist and primary care physician based in Boston, is the author of the National Bureau of Economic Research study that found minimal changes in state spending in expansion states. He shared three additional publications with Mississippi Today that show there is no evidence of expansion negatively impacting state budgets.  

“There’s a difference between saying that enrollment was higher than expected and that the state budget impact was worse than expected. More people enrolling than projected doesn’t mean that states lost money … expansion states were able to bring in 90% federal funding which often replaced things like behavioral health and uncompensated care spending that the state was previously paying for with 100% state dollars,” Sommers told Mississippi Today.

Morgan Henderson, one of the authors on the Hilltop report, echoed Sommers. And even with a lower matching rate from the federal government in current years, Henderson, who has a PhD in economics, believes the costs to states are still offset by other benefits.  

“Higher enrollment than expected in the expansion group can lead to higher costs than expected, but this relationship likely won’t be one-for-one. More new enrollees can also mean more cost offsets – such as premium tax revenue and other state tax revenue due to the increased economic activity in the state – which significantly mitigate the costs of expansion,” he told Mississippi Today.

Experts and a former governor in Kentucky – one state Blackwell referred to as an example of where expansion has been costly – said that Sommers’ and Henderson’s characterizations are accurate for what their state experienced post-expansion. 

A study published by the University of Louisville Commonwealth Institute of Kentucky found that while Kentucky did experience an increase in its Medicaid budget, the increase has been offset by other benefits, such as savings in general state funds “related to care for vulnerable groups who were ineligible for Medicaid prior to expansion.” 

Expansion funneled $2.9 billion into the state’s health care system within the first two years, which reduced costs of charity care and collections for medical debts, the study said.

Even if the number of enrollees is higher than originally estimated, that doesn’t necessarily bode poorly for the state’s budget, Sommers said. On top of the 90% federal match and the increased federal incentives for newly expanded states, the leftover portion the state is responsible for under expansion is mitigated by increased tax revenue, reduced uncompensated care costs to hospitals, and other program cost offsets, Sommers explained.

While the state does put up a small amount of money for each new enrollee under expansion, it is less expensive than the amount of money the state pays pre-expansion to cover uninsured individuals who seek care in emergency rooms and inpatient hospital settings – the most expensive places to receive care and often the only option for uninsured people.

Mississippi hospitals incur around $600 million in uncompensated care annually. Kentucky’s hospitals saw a 64% decrease in uncompensated care costs from 2013 to 2017, according to the Center on Budget and Policy Priorities. 

“Everybody’s got heartburn over people ‘getting something they don’t deserve,’” Dr. Dustin Gentry, a rural physician from Louisville, Mississippi, and self-described conservative, said. “But they’re getting it anyway. They go to the ER, they get free care, they don’t pay for it, but that doesn’t bother anybody. But if they get Medicaid, which will actually pay the hospitals for the work they do, all of a sudden everybody’s got heartburn.”

One report estimates that nearly half of all Mississippi’s rural hospitals are at risk of closure.

And while the original House and the Senate plans both cover those in the coverage gap – those making too much to qualify for Medicaid currently but too little to afford private insurance plans – the House proposal would draw down $1 billion federal dollars the original Senate plan would not, since it is not considered true “expansion” according to the Affordable Care Act. That means the state would have to shell out more money, receiving its typical 77% federal match instead of 90%, and would not qualify for the additional funds that would make expansion free to the state for the first four years under the House plan. 

In the last 10 years, as 40 states have chosen to expand Medicaid to cover the working poor, the poorest and sickest state has held out. 

After leaving House conferees alone at the negotiating table Thursday afternoon, the Senate announced its own compromise plan Friday morning. The option extends coverage to those making up to 138% of the federal poverty level and draws down the maximum amount of federal dollars available.

Lawmakers have until Monday to pass a final bill, according to current deadlines.

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A chicken processing company and a staffing agency that allowed a teenager to clean machines at a Hattiesburg plant, leading to his death, have landed on a national list of unsafe and reckless employers. 

The National Council for Occupational Safety and Health assembled its “Dirty Dozen” list compiled through nominations and released its report Thursday during Workers’ Memorial Week. 

“These are unsafe and reckless employers, risking the lives of workers and communities by failing to eliminate known, preventable hazards – and in at least one case, actively lobbying against better protections for workers,” the report states.

More than half of the companies included on the list have locations in Mississippi. 

Marc-Jac Poultry and Onin Staffing 

Onin Staffing hired 16-year-old Duvan Perez and placed him at the Mar-Jac Poultry plant in Hattiesburg. The night of July 14, 2023, he died after being pulled into a deboning machine. 

Federal law prohibits children from working in dangerous conditions such as meat processing plants, especially because of the machinery. In January, OSHA cited Mar-Jac for 17 violations relating to the teenager’s death and proposed over $212,000 in penalties. 

Mar-Jac said it relied on Onin to verify employees’ age, qualifications and training, and Onin denied being Duvan’s employer, according to court records. An attorney for Mar-Jac told NBC News the teenager used identification of a 32-year-old man to get the job. 

In February, Duvan’s mother filed a wrongful death lawsuit against Mar-Jac and Onin in the Forrest County Circuit Court. Responding to the complaint, both companies denied most of the allegations. 

“The plaintiff’s decedent’s negligence was the sole and/or proximate contributing cause of plaintiff’s injuries,” Mar-Jac states in its response to the complaint. 

Since 2020, two other workers have died at the Hattiesburg poultry plant, and workers have suffered amputations and other injuries, according to court records. 

To date, OSHA has cited Mar-Jac nearly 40 times for violations in the past decade, according to agency records. 

Tyson Foods

The company has operations across the country, including two plants in Carthage and Ceres, as well as hatcheries, feed mills, truck stops and other offices across Mississippi. 

The report said six workers have died since 2019 and over 140 have been injured from ammonia leaks, none of them in Mississippi. The gas is often used to refrigerate meat, and according to the Centers for Disease Control and Prevention, exposure to the gas in high doses can be fatal. 

The report also said the company is under investigation for child labor violations, assigning children to work in dangerous high-risk jobs, which is illegal. 

In the past decade, OSHA has issued over 300 citations against Tyson, according to agency records. 

When asked about what it takes to get companies with a poor history of worker safety to protect employees, Jessica Martinez, co-executive director of COSH, said change is needed from all fronts, including having government agencies like Occupational Health and Safety Administration conduct routine inspections. 

She said workers are too fearful to complain. “They need these jobs for survival. Workers are fearful of losing their jobs,” she said.

Uber and Lyft

Nationwide, over 80 drivers for the rideshare apps have been killed on the job since 2017, according to Gig Workers Rising. The report says this is a sign that drivers are pressured to accept unsafe riders. 

Internal documents have shown 24,000 “alleged assaults and threats of assault” against Uber drivers, and workers of color and immigrants experience most of the danger, according to the report. 

JC Muhammad, a Lyft driver and organizer with the Chicago Gig Alliance, was physically assaulted by a passenger, and said the companies need a complete overhaul in how they protect drivers, including verification of passenger identification. 

In his situation, another person, allegedly the mother of the passenger, called for the ride. There was no verification for the person, and the passenger did not have an ID. Muhammad said he had no way to report what happened to police because he lacked the necessary information.

“We’ve had drivers robbed, assaulted, shot at,” he said during a Thursday press conference. “There are no protections, no protocols.”

In Mississippi, several drivers have been injured, including a woman grabbed by a drunk passenger in Ocean Springs in 2019; a man assaulted by his passenger in Oxford in 2021 and a woman driver shot in the head by a passenger in Gulfport in 2023. 

Two other companies included in the report are Waffle House and Walmart, which were cited for inadequate security to protect workers and customers and a lack of worker protections. Both have locations in Mississippi and have had incidents occur here, including shootings and fights. 

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Former Mississippi Today reporter Isabelle Taft has been named as a 2024 Livingston Award finalist in the local reporting division for her investigation into Mississippi’s practice of jailing people who have not been charged with a crime and are in need of mental health treatment.

The award recognizes the best reporting by young journalists.

“Committed to Jail,” a 2023 Mississippi Today and ProPublica investigation, revealed that Mississippi counties jail hundreds of people without criminal charges every year, for days or weeks at a time, solely because they may need mental health treatment — a practice that has resulted in 14 deaths since 2006 and is unique in scope in the United States. Taft was named as a finalist along with ProPublica counterparts Agnel Philip and Mollie Simon.

Mississippi Today found that in just 19 of the state’s 82 counties, people were jailed without charges more than 2,000 times over four years. Taft spoke with 14 Mississippians about their experiences in jail and learned that people detained for being sick are generally treated the same as people accused of crimes. She obtained Mississippi Bureau of Investigation reports on jail deaths and pored over lawsuits and news clips to identify 15 people who died after being jailed during this process since 2006, (including the most recent death in January, after the original series was published). And she surveyed behavioral health officials and disability rights advocates in all 50 states to show that Mississippi stands alone.

Taft was selected from thousands of applicants as a 2024-2025 fellow at The New York Times beginning this summer. She will cover national news.

The winner will be announced in June.

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Senate leaders did not attend a second conference committee meeting with their House counterparts on Thursday to try and compromise on a final bill to expand Medicaid coverage to poor Mississippians. 

House Medicaid Chairwoman Missy McGee, a Republican from Hattiesburg, said she was disappointed the three Senate negotiators didn’t attend the meeting because she expected to hear an update on where the chamber stood on reaching a compromise.

“Those of you who are looking for information, so are we,” McGee said. “Just know the House stands ready to negotiate this very important issue. We are here at the Capitol, and we’re hoping that we’ll be able to have some conversations later today and later in the final days of the session. Thank you for coming and sorry to have wasted your time.” 

Senate Medicaid Chairman Kevin Blackwell, a Republican from Southaven who is one of the Senate negotiators, did not answer questions from reporters about the conference committee as he walked out of a separate Senate committee meeting. But he said the Senate was “working on a compromise.” 

After the meeting, McGee told reporters she notified Blackwell on Wednesday that she was scheduling the second conference meeting for Thursday, but she was not sure if the senators would attend or not. 

“I was hoping we were able to meet again, even if it was briefly,” McGee said. “I didn’t hear anything from the Senate yesterday, so I was hoping we would be able to discuss today.” 

The House and Senate are in negotiations on a final expansion bill because the two chambers earlier in the session passed vastly different proposals. 

The House’s initial plan aimed to expand health care coverage to upwards of 200,000 Mississippians, and accept $1 billion a year in federal money to cover it, as most other states have done.

The Senate, on the other hand, wanted a more restrictive program, to expand Medicaid to cover around 40,000 people, turn down the federal money, and require proof that recipients are working at least 30 hours a week. 

The negotiators met publicly for the first time on Tuesday, but the six lawmakers remained far apart from a final deal. 

The Senate simply asked the House to agree to its initial plan. But the House offered a compromise “hybrid” model that uses public and private insurance options to implement expansion. The Senate negotiators on Tuesday were mostly noncommittal on the hybrid compromise.

House leaders, such as Republican Rep. Sam Creekmore IV of New Albany, have said they are willing to compromise on a final plan with the Senate, but they want an agreement that covers people up to 138% of the federal poverty level to receive the full 90% matching rate from the federal government.

“Here we are with a chance to receive 90 cents on the dollar if we give 10 cents, and that’s it,” Creekmore said. “I don’t know of a business who would not take that. Yet we’re going to turn that down? On the House side, we’re not willing to turn that down.” 

Lawmakers face a Monday deadline to file an initial compromise plan on Medicaid expansion, though that deadline could be suspended if two-thirds of the legislators in both chambers agree to suspend the deadline. 

House Speaker Jason White, a Republican from West, told reporters he wished the Senate negotiators would have attended the Thursday meeting, but he’s still optimistic the two chambers can agree on a final deal.

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Boxing in sanctioned matches in a ring donated by rapper Jay-Z. Throwing and catching a football in the yard. Facing off in table tennis matches.  

Sports teams have come to Missisisppi’s prison system, giving incarcerated people a creative way to stay active, change attitudes, build sportsmanship and help in their rehabilitation, corrections officials said. 

“We encourage our inmates to be involved in sports activities as it battles idleness in prison. We have created many different teams to allow them to get out of their dorms and participate in being active”, Commissioner Burl Cain said in a Wednesday news release. 

Research has found that prison sports programs have social, mental and physical benefits, and participation in sports can help lessen detrimental health impacts people experience through incarceration. 

But the bipartisan chairs of the Legislature’s corrections committees are questioning why incarcerated people have been allowed to participate in boxing, which they say could create a violent environment and put the state on the hook for the boxers’ medical care if they are injured.

House Corrections Chair Rep. Becky Currie, R-Brookhaven, and Senate Corrections Chair Juan Barnett, D-Heidelberg, said there are better uses of MDOC’s budget than a sport as harmful as boxing. 

They would rather see the department focus on a number of other efforts, including drug and alcohol treatment, job training and housing placements to prepare people to leave prison and not return.

“We have to make sure we’re not teaching them to box,” said Currie, who is serving her first session as chair of the committee. “… This is not where we need to spend our time and our money.”

Barnett said incarcerated people should have access to recreation and time out in the yard, and he sees how supporters can see rehabilitative value in boxing and other sports teams. But those are less of a priority compared to MDOC’s main role: to correct people, he said.

Boxing programs exist around the country in state and federal prisons, including in Louisiana. 

The Angola State Penitentiary, where Cain served as warden, has a team. Henry Montgomery, who founded the program as an inmate, helped form the boxing teams there. Montgomery was released from prison in 2021 at the age of 75. His case led to the U.S. Supreme Court decision that all states were required to retroactively apply the ban on mandatory death-in-prison sentences for juveniles that it announced in its earlier Miller v. Alabama ruling. 

In the news release, MDOC said the boxing team members are required to take drug tests and have a pre-match physical. 

During the matches, medical staff and ringside trainers are present along with referees, timekeepers and official judges. Mississippi Athletic Commission Chairman Randy Phillips has helped with boxing training and is ensuring that MDOC’s safety equipment meets standards, according to the news release. 

Parchman’s first boxing match was in November against incarcerated boxers who traveled to the Mississippi State Penitentiary at Parchman from the Central Mississippi Correctional Facility, according to MDOC. Creation of a boxing program at CMCF has been cited as a reason why the women were relocated from the 1A-Yard to unit 720 in 2022. 

A pamphlet shared with Mississippi Today showcases a March 28 “Fight for the Title” event hosted at Parchman. Listed were the 22 members of the boxing team, 14 of whom fought in matches that day. 

Tangya Allen-Elliott attended both boxing events to support her nephew, Carlos Allen, who coaches the boxing team. She said the March event had a good atmosphere and the matches seemed professional and safe. 

Allen, 35, was appointed as the boxing team coach because of his leadership, Allen-Elliott said. Prior to incarceration, he played sports, refereed and coached. 

He has been in the state prison system for three years and at Parchman for over a year, his aunt said. Allen was sentenced to over 100 years for drug trafficking, sale of fentanyl and possession of other drugs. Additionally, he was sentenced as a habitual offender, meaning he is not eligible for parole.

Being part of the boxing team has helped her nephew have a positive impact on others and mentor younger men – all of which give him hope in prison. 

She said the sport is a great opportunity for the men, and she hopes it can serve as a guide for other states, such as Alabama, where she lives.

“They’re on the right track,” Allen-Elliot said about boxing in Mississippi prisons. 

“I had never seen a prison do something to this impact.” 

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As clergy, physicians and business leaders have for weeks rallied at the state Capitol to expand Medicaid coverage to the working poor, observers can often spot the same conservative lawmaker listening attentively on the sidelines. 

Sen. Chad McMahan, a Republican from Guntown, hasn’t attended the events as a participant, a supporter or an opponent of the rallies. Rather, he goes because he wants to listen to the debate or because his constituents are there. 

In fact, McMahan has been a quiet, yet constant supporter of Medicaid expansion, or Medicaid reform as he calls it. He believes the policy can give rural hospitals like North Mississippi Medical Center in his hometown of Tupelo a major boost and create a healthier population. 

The three-term lawmaker is widely known for telling reporters that his main duty at the Capitol is to vote how the majority of the people in his district want him to vote. But he also openly shares his childhood story that he believes gives him a unique perspective on how steep medical debt can crush hard-working Mississippians. 

When McMahan was in the ninth grade, he suffered an injury and had to be treated at the local emergency room. When the $20,000 bill came due for the medical services, though, there was a major snag: McMahan’s family had no health insurance. 

“That doesn’t sound like a lot of money today, but in 1986, $20,000 would buy two top-of-the-line Chevrolet pickups,” McMahan said. “Today, it won’t even buy a piece of a Chevrolet pickup truck.” 

The legislator’s father owned a cabinet-making business in north Mississippi, and his mother did clerical work. But the medical debt forced them to make tough decisions that thousands of Mississippians still face today. 

It was impossible for the McMahan family to pay the bill in one swoop. Instead, they set up a payment plan with the hospital to pay the bill off over several years. 

“It put a lot of stress and anxiety on my family,” McMahan recalled. “I saw my mom and dad having to decide at the dinner table whether they were going to pay a mortgage, buy groceries or pay the hospital bill that month.” 

READ MORE: Medicaid expansion negotiators still far apart after first public meeting

Roughly 74,000 Mississippians don’t make enough money to afford insurance, yet make too much money to qualify for Medicaid and find themselves in positions similar to the one the McMahan family was in decades ago.

But the state Legislature has a chance this year to address this issue because for the first time since the federal Affordable Care Act became law, it’s considering expanding Medicaid to the working poor as the ACA envisioned. 

The House and Senate this week are locked in negotiations on a final expansion bill after the two chambers passed vastly different proposals. 

The House’s initial plan aimed to expand health care coverage to upwards of 200,000 Mississippians, and accept $1 billion a year in federal money to cover it, as most other states have done.

The Senate, on the other hand, wanted a more restrictive program, to expand Medicaid to cover around 40,000 people, turn down the federal money, and require proof that recipients are working at least 30 hours a week. 

The negotiators met publicly for the first time on Tuesday, but the six lawmakers remained far apart from a final deal. The Senate simply asked the House to agree to its initial plan. But the House offered a compromise “hybrid” model that uses public and private options to implement expansion. 

McMahan said he personally supports the House’s effort to expand to the full 138% of the federal poverty level, or an individual who makes $20,782 annually. But he also supports the Senate’s effort to have an ironclad work requirement for the recipients. 

While McMahan has compassion for uninsured people he doesn’t think fiscally conservative Republicans should agree to expansion legislation that leaves out a work requirement or sets up a process for people to remain on the system indefinitely. 

“I’m proud that I live in a country where there is a safety net to catch people and help people, but I’m not for turning the safety net into a hammock,” McMahan said. 

The Senate negotiators were noncommittal on the hybrid compromise. House Medicaid Chairwoman Missy McGee scheduled a second conference committee meeting for Thursday afternoon. 

McMahan applauded the House and Senate leaders for trying to come to a resolution on expansion, especially after the policy has been a nonstarter for the last 10 years at the Capitol.

He doesn’t think it’s his job to convince his Senate colleagues to change their minds. But he does want people who remain unabashedly opposed to the policy to listen to the stories of people across the state who still can’t afford basic health care. 

“I see the people who are out there,” McMahan said. “A lot of construction workers, a lot of fast food employees. I see the people who are working every day getting up and going to work who have never taken a hand out in life for anything who are not covered by health insurance.”

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