With state elections coming up, one of the hottest issues is expansion of Medicaid.

When Congress passed the Affordable Care Act nine years ago, it included the expansion of Medicaid to cover families and individuals making 138 percent of the poverty level.

Congress agreed to pay states for 100 percent of the expansion. Two-thirds of the states quickly jumped on the opportunity.

Seventeen states, all conservative, most in the south, declined the expansion after the U.S. Supreme Court ruled that the feds couldn’t force states to expand the program.

Mississippi did not expand. Our conservative leadership cited two main reasons: First, it was part of Obamacare. Second, they believed the feds would end up forcing the states to foot more of the bill, which would bust the state budget.

Both of these arguments were somewhat questionable. First, although the expansion of Medicaid was passed at the same time as Obamacare, it is a separate program, one which has a 55-year history. Second, after nine years, the feds are still paying almost all the cost of the expansion.

As a result, Mississippi has passed up about 10 billion dollars in federal money over the past decade.

This federal money would have given up to 300,000 working, low income Mississippi families health care coverage.

Of the current major candidates for governor and lieutenant governor, only Tate Reeves is dead set against expansion. And boy is he dead set.

When asked his reasons for not expanding Medicaid, Reeves simply repeated this line three times in a row: “I am opposed to Obamacare expansion in Mississippi.”

I believe turning down this money is hurting our state. I’m conservative, but if the feds want to pour money into our state, so be it.

Mississippi is a poor state for two main reasons: We lack a major urban area and we are still suffering from the vestiges of slavery, including the devastation of the Civil War.

As a result, our state has traditionally been a big beneficiary of federal dollars, getting two and three dollars back from every dollar we pay in federal taxes. It’s a good deal.

When the Democrats were in power, we took every advantage of federal largesse. But since the Republicans took over, we turn up our noses at this money, because Republicans don’t like welfare, even when it is beneficial to our state.

This could be one reason our state quit growing for the first time in 50 years. States that haven’t expanded Medicaid have much lower levels of job growth.

In rural areas, hospitals that were once the biggest employers in their communities are now going bankrupt and closing. Experts have identified the cause: Failure to expand Medicaid.

The Brookings Institute, one of the largest and oldest think tanks in the country, recently did a report titled “Do States Regret Expanding Medicaid?” Their conclusion: No.

The study found that states did not encounter increased costs.  Instead, Medicaid expansion caused the feds to pay for many services formerly paid for by the states. The study concludes: “The strong balance of objective evidence indicates that actual costs to states so far from expanding Medicaid are negligible or minor, and that states across the political spectrum do not regret their decisions to expand Medicaid.”

Meanwhile in Mississippi, the portion of Medicaid that Mississippi has to pay has skyrocketed from $258 million in 2010 (when Medicaid was expanded) to $840 million in the 2019 budget.

So by refusing to expand Medicaid not only has Mississippi turned down a billion dollars a year in federal manna, but our in-state cost has increased by $582 million a year.

As for the lieutenant governor, I get that Reeves doesn’t think Medicaid expansion is good politics. The first rule of politics is to get elected by the people.

But turning down a billion dollars a year and denying insurance to 300,000 working Mississippians seems a high price to pay for the furtherance of an individual’s political career.

Meanwhile, the current Republican leadership falls all over themselves to hand out billions in tax breaks to huge corporations with billions in net income, not to mention the hundreds of millions that went down the drain subsidizing cockamamie start-up companies now bankrupt.

So billions in public welfare for rich corporations is just fine but federally-subsidized health care for the working poor is socialism?

Should be an interesting political year.