Mississippi is one of the most rural states in America, so it should not be surprising that the GOP controls every statewide office there and comfortable majorities in both houses of the legislature. As Senate Minority Leader Mitch McConnell (R-Ky.) once put it, Republicans “pretty much own rural and small-town America.”
That’s unlikely to change any time soon. But Democrats have a chance this year to loosen the GOP’s vice grip on the state by appealing to Republicans’ most loyal constituents on a key issue: Medicaid expansion.
Brandon Presley, the Democratic nominee for governor, understands this, which is why he has been hammering the issue leading up to the November election. Even if his campaign falls short, his surprising strength ought to show Democrats in the other states that have refused to accept the Affordable Care Act’s expansion of Medicaid — in which the federal government picks up 90 percent of the cost of new enrollees — that they can make inroads by showing voters how much the GOP is hurting rural Americans.
It’s hard to overstate just how vital Medicaid is in rural America. Americans in these areas often have lower incomes, higher rates of uninsurance and greater health challenges, so they have a special need for Medicaid coverage.
Rural hospitals, which depend on Medicaid for survival, are also crucial to the communities they serve. When a hospital in a city or a suburb closes, other hospitals nearby can usually pick up the slack. But when a rural hospital closes, it can be catastrophic — both for the economy (local hospitals are often the largest employers in rural areas) and people’s access to care.
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Rural hospitals are in crisis across the country. Data from the University of North Carolina shows that more than 100 have shut their doors since 2005; 15 have closed this year. Before the pandemic in 2019, 41 percent of rural hospitals were operating in the red, a study by KFF found. Now that federal pandemic relief funds have expired, many are again on shaky ground.
In Mississippi, nearly half of rural hospitals are at risk of closing. Medicaid expansion would mean more insured patients utilizing their services, which would shore up their finances. I’ve reported from rural areas around the country over the last year, and everywhere I went, people brought up the problem of accessing health care: the lack of insurance, hospitals shutting down and the distances they have to travel to see a doctor.
This is why Presley is running ads saying, “On day one as governor, I’ll expand Medicaid to keep our hospitals open and our people healthy.” While it’s unlikely he could actually accomplish Medicaid expansion in a single day, he’s setting up a clear contrast with incumbent Gov. Tate Reeves (R), who adamantly opposes expanding Medicaid.
There are 10 states that still refuse to expand Medicaid. Those states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming and Wisconsin — include some present and future battlegrounds, where increasing Democratic margins by even a couple of points could make an enormous difference.
And these states have some of the largest rural populations in the country. Eight of the 10 are more rural than the country as a whole, and Mississippi is the fourth-most-rural state, after Maine, Vermont and West Virginia.
Not surprisingly, these states also have some of the highest rates of people lacking health insurance.
North Carolina recently illustrated how pressure campaigns to accept the expansion — from the public, from doctors and hospitals, from the business community — can be successful. It took years before Republican legislators gave in, but the prospect of free federal dollars to make their state healthier and more economically stable finally overcame animosity toward Obamacare.
The same evolution might be possible in Mississippi. The rural hospital crisis is getting more attention, and polls have shown strong support for expansion. A recent survey by Mississippi Today and Siena College found 72 percent of residents in favor. The state economist determined that expansion would extend coverage to more than 200,000 people, save the state money and improve its economy. Even the Republicans who control the state legislature seem to be reconsidering expansion; the representative likely to be the next House speaker said it will be “on the table,” though he hasn’t endorsed it yet.
As popular as Medicaid expansion might be, Presley still faces long odds in a state that last voted for a Democratic presidential candidate almost half a century ago. But his campaign could show Democrats that convincing rural voters isn’t just about “showing up” and “listening,” the tired advice often given to solve their rural problem.
Instead, if Democrats want to reverse their rural decline, they have to attack the GOP directly. They should explain to rural voters that the party they’ve supported for years isn’t just indifferent to them; it’s actively making their lives worse. There’s plenty of material to make that case.
That’s unlikely to change any time soon. But Democrats have a chance this year to loosen the GOP’s vice grip on the state by appealing to Republicans’ most loyal constituents on a key issue: Medicaid expansion.
Brandon Presley, the Democratic nominee for governor, understands this, which is why he has been hammering the issue leading up to the November election. Even if his campaign falls short, his surprising strength ought to show Democrats in the other states that have refused to accept the Affordable Care Act’s expansion of Medicaid — in which the federal government picks up 90 percent of the cost of new enrollees — that they can make inroads by showing voters how much the GOP is hurting rural Americans.
It’s hard to overstate just how vital Medicaid is in rural America. Americans in these areas often have lower incomes, higher rates of uninsurance and greater health challenges, so they have a special need for Medicaid coverage.
Rural hospitals, which depend on Medicaid for survival, are also crucial to the communities they serve. When a hospital in a city or a suburb closes, other hospitals nearby can usually pick up the slack. But when a rural hospital closes, it can be catastrophic — both for the economy (local hospitals are often the largest employers in rural areas) and people’s access to care.
Press Enter to skip to end of carousel
Rural hospitals are in crisis across the country. Data from the University of North Carolina shows that more than 100 have shut their doors since 2005; 15 have closed this year. Before the pandemic in 2019, 41 percent of rural hospitals were operating in the red, a study by KFF found. Now that federal pandemic relief funds have expired, many are again on shaky ground.
In Mississippi, nearly half of rural hospitals are at risk of closing. Medicaid expansion would mean more insured patients utilizing their services, which would shore up their finances. I’ve reported from rural areas around the country over the last year, and everywhere I went, people brought up the problem of accessing health care: the lack of insurance, hospitals shutting down and the distances they have to travel to see a doctor.
This is why Presley is running ads saying, “On day one as governor, I’ll expand Medicaid to keep our hospitals open and our people healthy.” While it’s unlikely he could actually accomplish Medicaid expansion in a single day, he’s setting up a clear contrast with incumbent Gov. Tate Reeves (R), who adamantly opposes expanding Medicaid.
There are 10 states that still refuse to expand Medicaid. Those states — Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming and Wisconsin — include some present and future battlegrounds, where increasing Democratic margins by even a couple of points could make an enormous difference.
And these states have some of the largest rural populations in the country. Eight of the 10 are more rural than the country as a whole, and Mississippi is the fourth-most-rural state, after Maine, Vermont and West Virginia.
Not surprisingly, these states also have some of the highest rates of people lacking health insurance.
North Carolina recently illustrated how pressure campaigns to accept the expansion — from the public, from doctors and hospitals, from the business community — can be successful. It took years before Republican legislators gave in, but the prospect of free federal dollars to make their state healthier and more economically stable finally overcame animosity toward Obamacare.
The same evolution might be possible in Mississippi. The rural hospital crisis is getting more attention, and polls have shown strong support for expansion. A recent survey by Mississippi Today and Siena College found 72 percent of residents in favor. The state economist determined that expansion would extend coverage to more than 200,000 people, save the state money and improve its economy. Even the Republicans who control the state legislature seem to be reconsidering expansion; the representative likely to be the next House speaker said it will be “on the table,” though he hasn’t endorsed it yet.
As popular as Medicaid expansion might be, Presley still faces long odds in a state that last voted for a Democratic presidential candidate almost half a century ago. But his campaign could show Democrats that convincing rural voters isn’t just about “showing up” and “listening,” the tired advice often given to solve their rural problem.
Instead, if Democrats want to reverse their rural decline, they have to attack the GOP directly. They should explain to rural voters that the party they’ve supported for years isn’t just indifferent to them; it’s actively making their lives worse. There’s plenty of material to make that case.
