Medicaid expansion foe wins GOP primary, sets up November clash on an issue with deep implications for the criminal legal system.

The prospect that Mississippi will expand Medicaid to cover more low-income residents suffered a blow on Tuesday when Lieutenant Governor Tate Reeves won the GOP nomination for governor. 

Reeves is staunchly opposed to expanding Medicaid as provided under the Affordable Care Act, and he ran ads attacking his Republican opponent Bill Waller for supporting the idea. “Bill Waller would expand Obamacare in our state,” said one ad. “Three hundred thousand more people on welfare.”

Tate Reeves (Tate Reeves/Facebook)

An estimated 300,000 Mississippians are in a coverage gap due to the state’s refusal to expand Medicaid. They are ineligible for public insurance under current rules and yet too poor to qualify for government subsidies to purchase a private plan.

Reeves next faces Attorney General Jim Hood, the Democratic nominee who unlike Reeves favors expanding Medicaid. “That’s insane for us not to take care of those folks, and keep those hospitals open,” he told the Clarion Ledger. 
Mississippi has one of the country’s highest rates of uninsured residents, alongside other states that have not expanded Medicaid. Having a minimum wage job is enough to make one too wealthy to qualify for Medicaid under the current rules, according to Mississippi Today. Poor access to healthcare is also furthering a dire crisis in the state’s rural hospitals. A report published by the Mississippi Center for Justice in 2015 documents that poor areas with a higher share of uninsured residents are also facing a severe shortage of medical providers, which impedes everyone’s access to treatment whether or not they have insurance.
“Mississippi is at the bottom of the pile when it comes to issues of need for access to quality healthcare,” Jennifer Riley Collins, the former executive director of the ACLU of Mississippi and the Democratic nominee for attorney general this year, told the Appeal: Political Report last week. “Citizens of the state of Mississippi are dying, literally, because they can’t access healthcare.”
A lack of insurance coverage also blocks people with substance use or mental health issues from receiving treatment, which makes them likelier to interact with law enforcement. Mississippi is essentially using its carceral system as its response to matters like the opioid crisis. 
Expanding Medicaid could enable more of a public health approach to issues presently funneled through prisons and jails. Stacey Abrams, Georgia Democrats’ gubernatorial nominee in 2018, ran on a platform that called Medicaid expansion a “vital investment” in “public safety,” a connection that studies have documented

Jim Hood (Rogelio Solis-POOL/Getty Images)

The Hood campaign told the Political Report that criminal justice reform was a factor in the attorney general’s support for expanding Medicaid in connection to mental health. “Jim Hood recognizes the critical role health coverage plays in increasing access to care for Mississippians suffering from mental health issues, as well as the impact mental health care has in reducing incarceration rates and increasing public safety in Mississippi communities, the campaign said in a statement via email. “Certainly accepting federal funding to increase access to care would help these people receive appropriate treatments, reduce incarceration rates, and increase public safety in our communities. By providing mental health care out in the communities, we will be able to also treat those re-entering society.”
Hood has long denounced as inadequate the funds that Mississippi devotes to mental health services; he has called on the legislature to allocate more money, and predicted lawsuits over health care failings. In his role as attorney general this year, however, he has defended the state in court against a lawsuit that challenges whether it is doing enough for people to access services in community settings. The Reeves campaign did not respond to a request for comment on their views on the connection between the criminal legal system and the Medicaid expansion.
A governor who supports this policy may not be sufficient to achieve expansion (Mississippi Today reports that expansion “likely” requires legislative action), but could facilitate negotiations already in progress between state actors and add pressure on lawmakers.
In Mississippi as elsewhere, many formerly incarcerated people face health issues but do not qualify for Medicaid under current eligibility rules.
But they will not be able to weigh in come November. Ten percent of the voting-age population will be barred from voting in this governor’s race due to Mississippi’s harsh Jim Crow-era rules regarding felony disenfranchisement.
The election is further shadowed by another Jim Crow-era law, which requires that a candidate win a majority of the state’s 122 House districts in addition to winning the most votes; otherwise, the election is thrown to the legislature. The rule effectively gerrymanders the governor’s race.