Medicaid expansion, which for more than a decade has been blocked by legislative leaders, passed the House Wednesday 98-20 in less than 15 minutes and now advances to the Senate.

House Medicaid Chair Missy McGee, R-Hattiesburg, explained the policy as a “moral imperative” and said it “should transcend politics.” She also said that lawmakers have yet to propose a viable alternative to expansion to deal with Mississippi’s lack of health care access and poor health outcomes and that “‘No’ is not a policy that has helped.”

No questions followed McGee’s explanation of House Bill 1725. The bill passed with more than the two-thirds majority needed to override a potential veto from Republican Gov. Tate Reeves, who for years has opposed Medicaid expansion and reiterated his opposition multiple times during his successful reelection campaign last year.

The measure now heads to the Senate, which is also working on its own version of an expansion bill, as lawmakers consider making Mississippi the 41st state to expand Medicaid.

Authored by new House Speaker Jason White, R-West, and McGee, the bill would expand Medicaid eligibility to 138% of the federal poverty level or about $20,000 annually for an individual. The bill contains a work requirement for recipients of Medicaid expansion, but states that the expansion would go into effect even if the federal government does not approve the work requirement.

“Finding affordable access to health care is not only compassionate, but it is a smart investment in our workforce,” White said in a press conference after the floor vote. “As this bill is transmitted to the Senate for their consideration, I want to acknowledge that they, too, are drafting legislation that will provide health care accessibility options … Today we have sent them a conservative plan that addresses our shared goal to provide health care coverage for hardworking, low-income Mississippians.”

White expressed optimism the governor would sign the bill, saying he believed Reeves recognizes the importance of expanding health care access. Reeves has vehemently opposed Medicaid expansion, calling it “welfare” and “Obamacare.”

“A healthy workforce projects to a healthy economy,” White said. “… I’m not anticipating a veto at this point. I’m anticipating a business-minded, reasonable governor who weighs all options and all things and I think he is just that — in spite of what others may think.”

McGee in the press conference said: “Moving beyond a decade of simply saying ‘no’ to finding a workable solution to health access takes effort. But it’s a task I believe lawmakers from both parties in both chambers are up for … Most importantly I’m excited about the hundreds of thousands of working Mississippians that now and in the future could have a way toward a better, healthier quality of life.”

The federal government pays 90% of the cost for those covered by Medicaid expansion. Various studies have concluded Medicaid expansion in Mississippi would be a boon for the state economy and provide health care coverage for about 200,000 Mississippians — primarily the working poor. For the first four years, there is projected to be no cost to the state because of $600 million in additional federal funds, offered as an incentive to expand Medicaid.

The bill also has a built-in repealer, meaning the program would automatically end after four years — unless the Legislature chooses to renew it. This likely made it more palatable to Republicans on the fence.

McGee called it a “free pilot program” during a committee meeting and said “if it doesn’t work out, if we decide that our health outcomes have not improved, if it costs too much for the state, if for any reason we do not believe that it is doing the things that we want it to do, the program will simply repeal in 2029.”

Unlike the proposal Senate leaders say they are crafting, the House bill would not make expansion contingent on the Biden administration approving the work requirement. That’s important, since during the Biden administration CMS has rescinded work requirement waivers previously granted under the Trump administration, and has not approved new ones.

Every lawmaker who voted against the measure was a Republican. Several of those lawmakers refused comment after the vote, including Reps. Greg Haney, R-Gulfport; Stacey Hobgood-Wilkes, R-Picayune and Timmy Ladner, R-Poplarville.

Rep. Bill Kinkade, R-Byhalia, voted against the expansion bill, but said that could change if the measure is improved.

“I’m not convinced that the work component is as solid as they are saying it is,” Kinkade said. “I think this is a step in the right direction, and the conversation is going in the right direction on what we are trying to accomplish, but I was just not ready to vote for this measure right now. The narrative has got to change.”

Rep. Jill Ford, R-Madison, said, “It was an easy No vote for me … I represent one of the most conservative constituencies in the state, and my constituents do not support this. This was not about me. It was about the will of my constituents.”

On the other end of the spectrum, all the Democrats in the House, such as House minority leader Rep. Robert Johnson, D-Natchez, voted for the proposal.

“I kind of felt like it was going to be a great day,” Johnson said. Driving to the Capitol Wednesday morning, he said, he reminisced with former House Democrat leader Bobby Moak about how long they had been working to expand Medicaid.

While Johnson said he wished the bill included components of the House Democrats’ plan to provide more private insurance options for people who earn too much to qualify for Medicaid expansion, he said he told his fellow Democrats he would vote for the Republican bill and believed that it would help thousands of Mississippians.

Tamara Grace Butler-Washington, D-Jackson, is a freshman House member who worked years ago for the Mississippi Health Advocacy Program touting the need for Mississippi to expand Medicaid.

“It is a momentous occasion, especially for a freshman legislator to see this, knowing for how long it has been an issue,” she said.

Both Johnson and Butler-Washington praised the leadership of the House for passage of the bill.

Speaker White acknowledged his House colleagues for the overwhelming vote, his Republican colleagues for “strong support on an issue we have neglected for so long,” and the Senate for also drafting expansion legislation.

“In most uncomfortable times is where we make our best marks,” White said at the conclusion of the press conference.

by Sophia Paffenroth and Bobby Harrison, Mississippi Today