The U.S. Supreme Court this week eliminated one of the reasons cited by Mississippi Republican leaders for not expanding Medicaid.

The nation’s highest court rejected, in a 7-2 decision, a lawsuit asking that the Patient Protection and Affordable Care Act — better known as Obamacare — be struck down. It was the third such lawsuit rejected by the Supreme Court in recent months. The lawsuit was filed by Texas and joined by 17 other Republican-led states, including by former Gov. Phil Bryant on behalf of Mississippi.

A key provision in the Affordable Care Act is the expansion of Medicaid to provide health care coverage to primarily the working poor. The lawsuit rejected Thursday by the U.S. Supreme Court asked that the entire law, including the expansion of Medicaid, be tossed out.

One of the reasons state leaders, such as Gov. Tate Reeves, has used for not expanding Medicaid is that there was no assurance, they claimed because of the lawsuits, that the program would remain in place. They argued that if they expanded Medicaid in Mississippi and the program was dropped by the federal government, the state would be left responsible for providing health insurance to up to 300,000 Mississippians or dropping their coverage.

Twelve states, including Mississippi, have not expanded Medicaid. While state leaders have cited the possibility of the federal government or the courts eliminating a program that 38 states participate in, the primary reason Mississippi leaders said they do not want to expand Medicaid is because it will mean additional costs to the state.

“I am not open to Medicaid expansion,” Republican House Speaker Philip Gunn said at the end of the 2021 session in April. “… I don’t see Medicaid expansion as something that is beneficial to the state of Mississippi. I just don’t think the taxpayers can afford it. That is what it boils down to is the taxpayers. It is their money. I just don’t have taxpayers calling saying we want you to raise taxes so we can expand Medicaid.”

The federal government pays 90% of the costs for Medicaid expansion. Medicaid expansion proponents have argued that in addition to the 90% match, the influx of federal money — estimated at $1 billion per year — would be an economic boon to the state.

Plus, the American Rescue Plan, approved by Congress earlier this year and signed into law by President Joe Biden, offers additional financial incentive for the holdout states to expand Medicaid. It has been estimated that the incentive would be more than $600 million for Mississippi over a two-year period.

The lawsuit was essentially rejected by the U.S. Supreme Court this week because the majority said the states could not prove any harm from the Affordable Care Act.

If the Supreme Court had ruled in favor of the Texas lawsuit, that could have placed health care coverage in jeopardy for 31 million Americans and could have placed in jeopardy coverage of pre-existing conditions for millions more.

The Texas lawsuit said among the reasons the law should be rejected is that in recent years under former President Donald Trump, the mandate that people had to purchase insurance was dropped. They claimed in earlier Supreme Court rulings the individual mandate was cited as a tax and with that tax removed the law was unconstitutional.

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