North view of the state Capitol in Jackson, Friday, June 17, 2022.

Southern politicians have a long history of opposing efforts to provide government-sponsored health care for their constituents.

In 1947, President Harry Truman proposed legislation that essentially would provide universal health care paid through fees and taxes. Remember, health care options for working people in those days were even more dire than now with fewer people having employer-based health insurance.

Truman’s proposal was killed in part by Southern Democrats in the U.S. House and Senate. Nobel Prize-winning economist Paul Krugman wrote in his book, “The Conscience of a Liberal,” that Southern politicians opposed the plan of the Democratic president because they feared that it would lead to a government mandate to integrate hospitals.

“Keeping Black people out of white hospitals was more important to Southern politicians than providing poor whites with the means to get medical treatment,” Krugman wrote.

Southern politicians, as it turns out, are still not crazy about government-sponsored health insurance.

A quick glance at a map of the states that have and have not expanded Medicaid is startling. Of the 11 states that have not expanded Medicaid, eight (if Texas is included) are Southern states.

The map of the non-expansion states, a matter of fact, looks a lot like the footprint of the collegiate Southeastern Conference sports league with the exception of Louisiana, Arkansas, Kentucky and Missouri. Those four states have expanded Medicaid. Granted, most would say that Missouri is not a Southern state, but it is in the SEC.

At any rate, it is the SEC states, led by Southern politicians, now Republican Southern politicians, who are again resisting efforts to expand government-sponsored health care to help their poor constituents.

No longer, of course, are hospitals segregated. They were integrated in the 1960s, according to Krugman, when another government-sponsored program was enacted: Medicare, which provides health care to the elderly.

While it has been established by various studies that the largest percentage of people who would benefit from Medicaid expansion are people of color, it is important to point out that there are many white citizens who also would benefit.

Medicaid expansion, as is allowed as part of the Patient Protection and Affordable Care Act, provides health insurance for primarily the working poor — for people earning up to 138% of the federal poverty level, or $18,754 per year for an individual. In Mississippi, the traditional Medicaid program covers, generally speaking, poor pregnant women, poor children, certain groups of poor retirees and the disabled, but not the working poor.

The federal government pays the bulk of the health care costs for those on Medicaid expansion. When Southern politicians express their opposition to Medicaid expansion, they often simply proclaim they “are against Obamacare” as if that is enough reason to oppose it.

“I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I don’t know how many ways I can explain this to y’all,” Republican Gov. Tate Reeves said in response to reporters’ questions.

When the nation’s only Black president — Barack Obama — passed through Congress in 2010 the Affordable Care Act, almost all Republicans were opposed to “Obamacare.” But now solid Republican states like Montana, North Dakota, Utah and Idaho have embraced Medicaid expansion. In Republican-controlled South Dakota, voters just approved a ballot initiative to adopt Medicaid expansion. For the most part, it is just Southern politicians eschewing Medicaid expansion.

John Bell Williams also was against expanding health care when he served in the U.S. House representing Mississippi. As a congressman, he voted against Democratic President Lyndon Johnson’s plan to enact a Medicaid program for a small population of the underprivileged.

But as governor, Williams later called a special session in 1969 and urged the Legislature to opt into the Medicaid program.

In a speech to the Legislature, Williams said, “Let us not delude ourselves into the false notion that we can — or will — evade the burden of caring for these unfortunate people. Our society, through the instrument of government, has always shouldered this responsibility, and I am sure it always will.”

Williams went on to say the state could not afford to turn down a federal health care program that would require the state to provide only 20% of the matching funds. He spoke of the economic impact it would have on the state.

“The simple fact is that someone pays for health services, and we must decide, who will do it and how,” he explained.

The special session lasted from July 22 to Oct. 11. In the end, the Mississippi Legislature opted into the program, proving that Southern politicians did not always oppose improving health care for their poor constituents.

Whether that will happen with Medicaid expansion remains to be seen.


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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.