Two weeks after announcing his bid for governor, Lt. Gov. Tate Reeves again rejected the idea that he would support Medicaid expansion, a hard line stance that may put him out of step with not only many Mississippians but also some members of his own party.

Speaking at a Stennis Institute press club luncheon on Monday, Reeves said he would reject any form of Medicaid expansion in Mississippi, even in the face of reports that Gov. Phil Bryant and other top Mississippi Republicans had begun examining ways to roll out a limited form of the health insurance program.

“I will remain opposed to any call for Obamacare expansion, no matter what other name or what other form you want to call it,” Reeves said. “I am opposed to Obamacare expansion in Mississippi because it is not in the best interest of Mississippi taxpayers.”

A majority of Mississippi taxpayers, however, have warmed to the idea of Medicaid expansion, some form of which has been rolled out in all but 14 states since the Affordable Care Act’s implementation in 2013. Sixty percent of Mississippians now say they would support expanding Medicaid in Mississippi, according to a Millsaps/Chism Strategies poll released last week.

When pressed for specifics on his stance on Monday, Reeves refused to answer the question and left the podium.

But hours after Reeves spoke on Monday, Medicaid Executive Director Drew Snyder admitted during a House appropriations subcommittee meeting that his agency had recently looked at ways of expanding Medicaid in Mississippi.

“I will tell you we have been looking at—are there some mechanisms. We hear from hospitals that the higher uninsured population is causing problems, so I think it is a fair conversation to think about what’s out there to lower the number of (uninsured), without getting into this big debate,” Snyder said.

“But CMS just put out some guidance on changing some of their policies with 1332s,” he said, referring to federal waivers states can use to change parts of their Medicaid policy, such as eligibility.

Until recently, the mantle of Medicaid expansion in Mississippi had been taken up almost solely by Democrats. Jim Hood, considered the Democratic Party’s front runner for governor in 2019, led the announcement of his gubernatorial candidacy in October with a call for expansion. And thirteen of the 14 states that have yet to expand Medicaid have Republican governors. The other, North Carolina, has a Republican-controlled legislature.

But over the last few months, some top Republicans have publicly and privately expressed interest in the idea. Mississippi Today reported in December that Bryant, who has been a vocal opponent of the Affordable Care Act and even sued the federal government over its constitutionality, was quietly working with his staff to explore ways of bringing one of the law’s central tenets, Medicaid expansion, to this state.

Asked about Snyder’s and Reeves’s comments on Monday, a spokesperson for the governor said Bryant was not planning to push the issue with the legislature this year.

“Gov. Bryant doesn’t have Medicaid expansion on his legislative agenda, and he doesn’t foresee that occurring this year,” said Knox Graham, a spokesman for the governor.

While most states that expanded Medicaid did so through legislative action, seven other states expanded their state Medicaid program by executive order, using what’s known as a Section 1115 waiver. These waivers let the federal government approve experimental, pilot, or demonstration projects that the agency believes are likely to promote Medicaid’s objectives. As governor, Bryant sits atop Mississippi’s Division of Medicaid and could order the agency to apply for a waiver.

If he did, he would likely have support from some of Mississippi’s top Republicans. Last week, Secretary of State Delbert Hosemann told Tupelo’s Daily Journal that he would support a limited form of Medicaid expansion, tied to work requirements, that is similar to what states like Arkansas and Indiana have approved.

Rep. Robert Foster, R-Hernando, who is running for governor as a conservative to the right of Reeves, has said publicly that he supports a limited form of expansion.

“What I do support and what we do have to take into serious consideration is looking at waivers in an innovative way of bringing health care affordable to the working class Mississippians that are left out right now,” Foster said, announcing his bid for governor last week. 

Rep. Tracy Arnold, R-Booneville, who initially asked Snyder about expansion in Monday’s appropriations hearing, told Mississippi Today he was interested in expansion geared towards “the working poor.”

“There might even be a cost savings to it for the state,” Arnold said.

Many of the Republicans who do support expansion have said the amount of federal dollars the program would bring to the state—approximately $1 billion per year, according to a 2012 report from the Institutions of Higher Learning—is hard to ignore.

In the last five months, four of Mississippi’s rural hospitals have declared bankruptcy. Since 2010, five hospitals in Mississippi have shut their doors. Nationally studies have linked hospital closures to states’ decisions against expanding Medicaid.

But not all Republicans are open to the idea. House Public Health Chairman Sam Mims, R-McComb, oversaw Monday’s appropriations meeting and told Mississippi Today that he hadn’t been a part of any talks about Medicaid expansion.

“I’m not in favor of expanding Medicaid and I have not heard any discussions of expanding Medicaid,” Mims said.

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.