Sen. Cindy Hyde-Smith greets supporters during a 2018 campaign event.

Health care, which Democratic challenger Mike Espy has described as his top issue, is the focus of Republican U.S. Sen. Cindy Hyde-Smith’s second campaign ad in advance of the Nov. 3 general election.

“As your United States senator, I’ve made it a priority to improve access to quality health care for all Mississippians,” Hyde-Smith said in the 30-second TV ad released Wednesday.

Espy has for weeks focused on health care during the campaign, saying he wanted to be known as the health care senator for Mississippi.

“This is the No. 1 issue for the Espy campaign. It is the No. 1 issue in Mississippi,” Espy said.

Various polls have highlighted the importance of improved health care affordability and access for Mississippians with a Chism Strategies/Millsaps College poll in January, finding 70% of Mississippians were concerned about being able to afford health care. And the COVID-19 pandemic has heightened the importance of the issue.

READ MORE: “Cindy Hyde-Smith is holding us back”: Mississippians rip senator in new Mike Espy ad.

At the center of the health care issue is the future of the Patient Protection and Affordable Care Act, often referred to as Obamacare. Hyde-Smith, a close ally of President Donald Trump, supports the president’s efforts to eliminate the Affordable Care Act. Trump’s administration will be asking the U.S. Supreme Court to overturn the signature law on Nov. 10 — one week after the election.

In Mississippi, an estimated 600,000 people with pre-existing conditions, according to the Kaiser Family Foundation, are guaranteed health care coverage because of the ACA, and an estimated 100,000 received coverage through the ACA exchange, with a large percentage of those insured receiving federal subsidies to help pay for the insurance.

In addition, Espy has supported the state expanding Medicaid, as is allowed under the ACA, to provide health care coverage to between 200,000 and 300,000 primarily working Mississippians who are in jobs that do not provide employer-sponsored insurance.

Mississippi is among 12 states that have not expanded Medicaid, refusing to provide the 10% match that states are required to provide for the expansion. If elected, Espy said he will work with the governor and the state Legislature to try to convince them to opt into the program in which the federal government pays 90% of the cost of the health care coverage. If unsuccessful with that pitch, Espy said he will work in the U.S. Congress to try to get the federal government to waive the 10% match for Mississippi.

Espy’s support of expanding Medicaid is shared by several prominent Republicans in Mississippi, including Lt. Gov. Delbert Hosemann.

Hyde-Smith has not taken a position on the issue of Medicaid expansion, saying it is for state officials, not Mississippi’s federal officials to decide.

Asked about what would happen to people with pre-existing conditions should the ACA be repealed, Hyde-Smith campaign spokesperson Justin Brasell recently said, “President Trump has repeatedly stated that he will ensure that individuals with pre-existing conditions will continue to be covered regardless of the outcome of the litigation. Sen. Hyde-Smith agrees with the president that ensuring continued protection for these individuals is important and so does Senate Republican leadership.”

Thus far, the proposals made by Senate Republicans to cover pre-existing conditions in absence of the ACA have been met with skepticism by many health care advocates. The non-profit Kaiser Family Foundation, for instance, points out some Senate Republicans’ plans have prevented the exclusion of pre-existing conditions coverage from insurance policies, but do not provide financial supplements to make the plans affordable. In short, the insurance companies might be able to charge more for people based on their pre-existing condition and might even allow higher premiums for women than for men, according to the KFF analysis.

In Tuesday’s presidential debate, the president was asked about his plan to replace the ACA. He said he had a plan, but did not offer specifics other than to say it would be better than the ACA.

In Hyde-Smith’s new campaign advertisement, Hyde-Smith said, “I’ve worked to bring more support for rural hospitals.” At least six of the state’s rural hospitals have closed in recent years, with other Mississippi hospitals facing bankruptcy and possible closure, according to a January article from the Mississippi Rural Health Care Association.

The Mississippi Hospital Association has presented a plan to expand Medicaid, which hospital officials said would help the state’s hospitals, but it has been rejected by state leaders.

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Bobby Harrison, Mississippi Today’s senior capitol reporter, covers politics, government and the Mississippi State Legislature. He also writes a weekly news analysis which is co-published in newspapers statewide. A native of Laurel, Bobby joined our team June 2018 after working for the North Mississippi Daily Journal in Tupelo since 1984. He is president of the Mississippi Capitol Press Corps Association and works with the Mississippi State University Stennis Institute to organize press luncheons. Bobby has a bachelor's in American Studies from the University of Southern Mississippi and has received multiple awards from the Mississippi Press Association, including the Bill Minor Best Investigative/In-depth Reporting and Best Commentary Column.