STARKVILLE ­– The 2024 regular session of the Mississippi Legislature ended with a failure to reach consensus between Senate and House conferees on an effort to expand the state’s Medicaid program. That after Senate and House leaders engaged in a good faith debate of Medicaid expansion for the first time since former President Barack Obama’s administration implemented the program.

In 2010, the Patient Protection and Affordable Care Act or “Obamacare” was enacted by Congress – then the biggest public policy overhaul and coverage expansion of public healthcare since the 1965 enactment of the Medicare and Medicaid programs. Today, Mississippi remains one of 10 states that has not adopted some form of Medicaid expansion to draw down additional federal funds to pay for health care for the working poor.

The 10 states include Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. The failed 2024 Mississippi Medicaid expansion effort would have expanded Medicaid coverage to about 200,000 people who earned up to 138% of the federal poverty level, or $20,120 annually for one person.

Facing deadlines in the waning hours of the 2024 session, legislative conferees simply could not achieve a compromise on the question of applying a work requirement to Mississippi’s proposed Medicaid expansion plan.

During the first administration of President Donald Trump, the federal government authorized work requirements for Medicaid expansion – and in doing so offered red states like Mississippi that had resisted Medicaid expansion a politically palatable means to do so. The work requirements also served as a natural limit to the costs of the program.

When current President Joe Biden was elected, his administration rejected the work requirement changes Trump had put in place and Republican state lawmakers in non-expansion states again faced roadblocks in trying to implement Medicaid changes.

The 2024 efforts to expand Medicaid coverage to cover the working poor was ultimately logjammed on that reality. The working poor are those fellow Mississippians with jobs who don’t make enough money to afford health insurance.

All of us who pay federal taxes in Mississippi are already paying for expanded Medicaid in 40 other states and providing healthcare opportunities for the citizens of those states. But not here, not for our own people.

The Legislature in 2024 saw and heard an effective demonstration of the depth and breadth of public support for an expanded Medicaid program that provides a path to health care for working Mississippians. House Speaker Jason White and Lt. Gov. Delbert Hosemann shared the desire to expand Medicaid to take care of Mississippians who were already members of the workforce but who didn’t make enough money to afford insurance coverage. There was broad-based taxpayer support for some form of work requirement in that expanded program.

Both Hosemann and White have in recent months reiterated their desire to expand Medicaid for the working poor in Mississippi. With Trump winning the presidential election and the GOP taking control of both the Senate and the House on Capitol Hill, the incoming Trump administration has several options that could impact Medicaid expansion efforts in Mississippi and across the nation.

First, the new Trump administration could restore the work requirements for Medicaid that were in place during his first term. With a solid GOP majority in the Mississippi Legislature, which would clear the expansion logjam from the 2024 session, that seems a likely outcome, but certainly not a sure thing.

Second, the Trump administration could decide to launch an effort to dismantle the ACA altogether and replace it with the “something better” that Trump referenced but failed to provide details of in his presidential debate with Vice President Kamala Harris. That outcome is less likely but not without the bounds of possibility.

Finally, Trump and the GOP congressional majority could allow the Biden-era ACA subsidies to expire as scheduled in 2025, implement general Medicaid budget cuts during budget reconciliation (including marketing and outreach funds) and place additional restrictions on Medicaid eligibility. Those actions would reduce the Medicaid rolls.

Regardless the paths the second Trump administration chooses, Mississippi’s Medicaid expansion leaders in Jackson will pay close attention to what Congress and the White House are saying and doing about Medicaid expansion in Washington.

Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.