With Medicaid expansion on the verge of passing in Mississippi a year ago but never making it across the finish line, many believed those talks would seamlessly carry to the 2025 session and pick up there. But now, the federal government and a level of uncertainty surrounding what healthcare as a whole might look like under a new administration are causing lawmakers nearly 1,000 miles away from Washington to stop in their tracks and wait and see what President-elect Donald Trump may do.
Trump, a Republican who attempted to repeal large portions of the Affordable Care Act in his first term but failed to get enough congressional support to do so, will walk back into the White House next Monday with both chambers at his disposal as the GOP won a majority in the U.S. House and Senate during the November elections. While Trump did have both chambers on his side from the time of his first inauguration in January 2017 until January 2019 when Democrats bounced back in the midterms, he could never make much headway in changing what government-provided insurance looks like.
Four years and a different president later, Trump will be the second commander-in-chief to serve nonconsecutive terms. In terms of healthcare, the one-time businessman has little to lose as this will be the beginning of his final four years in office – assuming he does not try to overhaul the Constitution’s two-term limit for presidents, as some on both sides of the aisle have predicted he might.
With a gung-ho attitude and an incoming cabinet shaped to promote his goals, Trump has already begun proposing bold, unfettered ideas. Putting his stances on buying Greenland and renaming the Gulf of Mexico to the side, one of the ideas that has gained traction both on and off the internet is the Department of Government Efficiency – being referred to as DOGE. The proposed presidential advisory commission is set to be chaired by billionaire and newfound Trump ally Elon Musk alongside former Republican presidential candidate and techie Vivek Ramaswamy.
Musk and Ramaswamy, tasked with serving more or less as a team of government auditors, came out of the gates aggressively and said they wanted to cut the country’s deficit by $2 trillion before reducing that number to $1 trillion and most recently writing in a joint op-ed they are to take “aim at the $500 billion plus in annual federal expenditures that are unauthorized by Congress or being used in ways that Congress never intended.” If that goal is to be achieved, there are growing rumblings that a way to do it would be to completely reshape the $620 billion annual spending object that is Medicaid.
Currently, the Affordable Care Act allows individual states to extend Medicaid coverage to adults with incomes up to 138% of the federal poverty level, essentially providing health insurance to people who cannot afford private plans. The ACA – which some argue was a brainchild of Republican President Ronald Reagan before eventually being solidified under Democratic President Barack Obama – is set up for when a state votes to expand, it covers 10% of the cost while the federal government covers the other 90%.
Since the ACA model was opened to the states in 2014, 40 have opted in while 10 have decided to stand back. Mississippi is one of those that has not expanded, leaving billions of federal funds and thousands of jobs on the table but also avoiding a society further reliant on “welfare,” if you ask Republican Gov. Tate Reeves.
During the 2024 legislative session, after years of squashing Democratic-led bills to expand Medicaid before they could even get to a vote, Mississippi’s GOP supermajority decided to have a genuine conversation on whether the potential pros of Medicaid expansion outweigh the potential cons. As a result, the state House made history by approving a plan that would fully expand Medicaid to people up to 138% of the federal poverty level but require those insured under it to prove they work at least 20 hours a week or are full-time students. The work requirement was inserted on a tentative basis, meaning if not rubber-stamped by the federal Centers for Medicare and Medicaid Services, the plan would still go through to provide health insurance to hundreds of thousands of Mississippians.
However, it never made it across the finish line. The state Senate never approved the House plan and was unwavering on a strict work requirement. Some Democrats also verbally withdrew their votes toward the end of cross-chamber negotiations and said they would not approve a final package if it was nothing but “Medicaid expansion in name only.”
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Nearly a year later, lawmakers walked back into the state capitol building in Jackson last Tuesday to gavel in for another round of legislating, but optimism surrounding expansion has visibly deflated. In a press conference before the new session began, Republican House Speaker Jason White said there are too many questions on the federal level to immediately move forward with another Medicaid expansion bill.
“All bets are off until we see where the [Trump administration] wants to go,” White said without ruling out lawmakers in his chamber passing a trigger bill that will only go into effect if the current system remains. “I think it does complicate it.”
Questions that Mississippi lawmakers want answers to include but are not limited to: Is the federal match rate going to go down? Are eligibility requirements going to be tightened? Will work requirements be granted? Will it move to a block grant model? Is insurance going to be completely privatized? Will the Affordable Care Act be repealed in its entirety?
According to Sam Creekmore, a Republican who chairs the House Public Health and Human Services Committee, the best idea would be to allow Trump and his cabinet to settle in and then ask these questions before passing any legislation.
