Gov. Tate Reeves speaks during Mississippi Economic Council's 2023 Hobnob at the Mississippi Coliseum in Jackson, Miss., Thursday, Oct. 26, 2023. Credit: Eric J. Shelton/Mississippi Today

Gov. Tate Reeves, the state’s most powerful opponent of Medicaid expansion, repeated a familiar claim at Wednesday night’s gubernatorial debate: that the program wouldn’t save the state’s failing hospitals.

But health care experts say that was always clear, that the governor’s argument is missing an understanding of the challenges facing the state’s health care system and that expansion, by potentially insuring about a quarter million Mississippians, would allow hospitals to get paid something for the care they provide to uninsured patients versus getting paid nothing.

The first and only debate between Reeves and Democratic challenger Brandon Presley ahead of the Nov. 7 election opened Wednesday night with questions about Medicaid expansion, which has remained a title issue of the campaign cycle.

Mississippi is one of just 10 states that have not expanded Medicaid. Though most Mississippians support the policy, the governor has remained steadfast in his opposition.

READ MORE: FAQ: What is Medicaid expansion, really?

“Medicaid is not the best policy for rural hospitals, but you don’t have to look very far to prove that,” Reeves said at the debate, before citing data from the Center for Healthcare Quality and Payment Reform’s rural hospital report about Louisiana and Arkansas, two Southern states that have expanded Medicaid.

The center’s most recent version of the report, which was updated last month, shows that Louisiana and Arkansas still have high rates of rural hospitals at risk of closure — 42% and 43%, respectively.

According to the report, 42% of Mississippi’s rural hospitals are at risk of closure.

“Guess what? The difference is… Louisiana and Arkansas have expanded Medicaid,” Reeves continued. “Mississippi has not. (Medicaid expansion) is not the financial windfall that Brandon Presley would have you believe.”

READ MORE: Brandon Presley again vows to expand Medicaid as Gov. Tate Reeves reiterates opposition

The heart of Reeves’ argument misses some major points, experts said.

“To say that other states that expanded have had the same problems is a very true statement,” said Ryan Kelly, executive director of the Mississippi Rural Health Association. “But would they be worse off without (Medicaid expansion) in the current environment? Yes, I think they would be.”

According to the center’s report, the average percentage of rural hospitals at risk of closure in non-expansion states is over 37%, while the percentage in expansion states is much lower at 26%.

“What [Reeves is] saying is true,” said Harold Miller, leader of the Center for Healthcare Quality and Payment Reform. “Those are the numbers.”

However, expansion is about more than just “saving” hospitals, Miller said — it’s about insuring vulnerable people, allowing them to receive regular health care.

While emergency rooms cannot turn down patients regardless of their insurance status, doctor’s offices can, preventing people from receiving preventative and other non-urgent forms of health care.

Somewhere between 200,000 and 300,000 Mississippians would be affected by Medicaid expansion, according to projections. The policy would potentially bring in billions within its first few years of implementation in Mississippi, an influx of cash that the state needs. Just minutes later during the same debate, Reeves touched on Mississippi’s economy, and the “competitive disadvantage” the state’s up against when it comes to economic development.

Miller said hospitals in states that have expanded Medicaid do have greater losses on Medicaid services — Medicaid typically reimburses hospitals at lower rates than commercial insurance for health care services.

Reeves used that argument during the debate.

“The unintended consequence of expanding Medicaid to 300,000 Mississippians is moving individuals off of private insurance,” he said. “That’s bad for rural hospitals as well, because the fact is that when you move them from private insurance, the reimbursement rates… are actually lower when they go on Medicaid.”

But that’s better than not getting paid at all, according to Kelly.

Hospitals report losing about $600 million on uncompensated care annually, or services provided to people who aren’t insured. That number would reduce drastically if Medicaid was expanded.

Experts agree that the hospital crisis, while heightened by the COVID-19 pandemic, has been caused by a multitude of factors. In the same vein, it won’t be solved by one policy.

Kelly cited all of the other challenges hospitals are up against, including timely insurance reimbursements and rising health care costs, but he conceded that expansion would aid hospitals’ uncompensated care losses, an issue that’s fueling the crisis.

“You’re going to have a real hard time finding someone who would say hospitals would be better off without Medicaid expansion,” Kelly said.

READ MORE: ‘It is a moral obligation’: Faith leaders, advocates, doctors cite Christianity as reason to expand Medicaid

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Devna Bose, a Neshoba County native, covers community health. She is a 2019 graduate of the University of Mississippi, where she studied print journalism and was a member of the Sally McDonnell Barksdale Honors College. Before joining Mississippi Today, Devna reported on education at Chalkbeat Newark and at the Post and Courier’s Education Lab, and on race and social justice at the Charlotte Observer. Her work has appeared in the Hechinger Report, the Star-Ledger and the Associated Press, and she has appeared on WNYC to discuss her reporting. Devna has been awarded for her coverage of K-12 education in the Carolinas.