Medicaid: And then there were 11

South Dakota and Mississippi, while both small and heavily rural states, are not very similar.

South Dakota is mostly white and freezing cold in winter. Mississippi has the largest black population in the country and is downright mild in winter compared to South Dakota.

But one thing they have in common is a Republican leadership that has shown a stubborn and irrational opposition to extending Medicaid to the working poor in their states.

However, South Dakota last week did one of the few things citizens can do when their governor and legislature don’t listen to common sense. They walked around her to get the job done.

In a statewide vote, South Dakota approved expanding Medicaid by a majority of 56% to 44%. Once the measure is implemented over the course of the next six months or so, South Dakota will become the 39th state, plus the District of Columbia, to accept the federal government’s generous offer to pay most of the cost of covering a significant portion of the population who are currently uninsured.

Seven states have now used the initiative process to adopt the Medicaid expansion.

Mississippi does not currently have this option. Because a legally contestable decision by the Supreme Court of Mississippi in 2021 overruled the state initiative process for formal reasons. Although the lawsuit that led to this finding was aimed at derailing the legalization of medical marijuana, it also blocked other initiatives, including a signature drive that had just begun on the issue of expanding Medicaid.

Although the legislature, after public uproar, responded to that court decision by passing a medical marijuana program into law, lawmakers have not resumed the initiative process, despite early assurances that they would. As long as this is not the case, there is no citizens’ initiative in this state, no matter how legitimate it is.

Republican leadership in Mississippi has ignored all studies, all experiences of other states that have adopted Medicaid expansion, and all financial problems of hospitals stuck with a heavier than necessary burden of providing free care. The reason for this resistance is purely political. Because the Medicaid expansion was part of the Democrat-driven Affordable Care Act, better known as Obamacare, the majority of Republican leaders in that state want nothing to do with it, no matter how badly Mississippi is penalized for spending about $1 billion has declined a year of additional federal funding.

The initiative process was designed to circumvent such unreasonable and politically motivated behavior by the legislature. People need to get that power back. Lawmakers should restore it as promised.

Gov. Tate Reeves, House Speaker Philip Gunn and other Republican opponents of Medicaid expansion say Mississippi would not benefit. A growing coalition of business, medical and civic groups says otherwise.

Let’s let people decide who’s right. Restore initiative so they have a chance to settle the debate. Just like the people of South Dakota just did.