‘This Is Not an Entitlement Program’: Ballot Initiative Seeks to Expand Medicaid Coverage

Mississippi Hospital Association President and CEO Tim Moore and others established Healthcare for Mississippi, a nonprofit that proposes to bypass the State Legislature and expand Medicaid coverage through Ballot Initiative 76. File photo by Aliyah Veal

Mississippi Hospital Association President and CEO Tim Moore and others established Healthcare for Mississippi, a nonprofit that proposes to bypass the State Legislature and expand Medicaid coverage through Ballot Initiative 76. File photo by Aliyah Veal

Hundreds of thousands of Mississippians could receive expanded Medicaid coverage from a newly created ballot initiative. Recently incorporated nonprofit Healthcare for Mississippi filed Ballot Initiative 76, which would expand Medicaid coverage to those under 138% of the federal poverty limit.

Mississippians face the worst or near-worst health outcomes of any state in the nation. Mississippi State Department of Health data show these outcomes are even worse for those vulnerable populations and those who have been historically marginalized in the state.

”The result is a disproportionate burden of disease and illness that is borne by racial and ethnic minority populations and the rural and urban poor,” MSDH says on its website. “Health disparities not only affect the groups facing health inequities, but limit overall improvements in quality of care, the health status for the broader population, and results in unnecessary costs.”

State Entirely Resistant to Expansion

Medicaid provides health-care coverage to a wide variety of Americans, mostly those with low incomes or various health conditions demanding increased care. In 2010, the Affordable Care Act expanded Medicaid to cover all Americans living at or below 138% of the federal poverty level—in 2021, just over $30,000 for a family of three.

But a 2012 Supreme Court case, National Federation of Independent Business v. Sebelius, struck down the portion of the act that mandated that states accept the Medicaid expansion or lose funding for the program entirely. The State of Mississippi has remained entirely resistant to expansion ever since and is one of only 12 remaining states that have failed to expand the program to its poorest citizens.

First reported by Mississippi Today, under the new initiative Mississippi would become eligible for an addition $1 billion per year under the Affordable Care Act, while the recently passed American Rescue Plan would allot even more federal funding.


Mississippi has rejected Medicaid expansion and the accompanying federal funds since 2012. Data source Kaiser Family Foundation

In a Tuesday interview, Mississippi Hospital Association President and CEO Tim Moore detailed why he says the initiative is necessary.

“Our small hospitals, our large hospitals, our universities have all worked tirelessly to take care of friends, neighbors, family, whoever comes through the door that was faced with COVID or non-COVID illness, they were taken care of,” Moore said.

“On top of that, the Biden administration is offering a super incentive for the first two years to expand Medicaid. It's those things coming together, along with the fact that Mississippi is the poorest most unhealthy state in the country. You’ve almost got a perfect storm of saying ‘golly, we need to do this!’”

Under the Affordable Care Act, Mississippi would only be billed for 10% of the total cost and would now pay an even smaller percentage under the American Rescue Plan.

“Not an Entitlement Program”

Moore expressed his frustration with the Legislature’s failure to include Medicaid expansion in this latest session.

“We as an association have been supportive of expanding health care for the last 10 years and have been very vocal about that and felt like that we're now at a point that we'd given the legislature ample time to address the issue and they have still not done so,” Moore said.

“This needs to be fixed, but yet that didn't happen in the session. So one would have to think … they’re just not going to do it, period. So if that's the case, then it really pushes you to the point of saying ‘OK, let’s just take it to the people, let the people decide.’”

The State has rejected more than $7 billion in federal funding since 2014 by refusing Medicaid expansion. “My position has not changed. I am opposed to expanding Medicaid in Mississippi,” Gov. Tate Reeves said in a March 11 press conference.

Medicaid expansion has received weak support at best from State leadership, with Lt. Gov. Delbert Hosemann as the most supportive of considering available options.

“This is not an entitlement program,” Moore said. “It is an insurance program. For those individuals that make too much money to qualify for Medicaid and they don't make enough money to be able to buy commercial insurance, whether that's on an exchange or not.”

Membership in Healthcare for Mississippi is still coalescing as of the time of writing while a press release is anticipated. Initiative 76 will need 106,000 petition signatures before it can move to inclusion in an incoming ballot.

Send story tips to Reporting Fellow Julian Mills at [email protected].


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