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It’s About Racism: Studies Suggest Why White Politicians’ Still Oppose Expanding Medicaid


White Mississippi leaders are digging their heels in on refusing to expand Medicaid in the state, despite the resulting financial fallout and health problems. With a mountain of evidence favoring expansion critics are beginning to look past the opposition’s illogic and seeing something else in all the stubbornness. Some detect the specter of racism.

“I can’t speak to these political leaders or their motivation (for refusing to expand Medicaid) but they’re clearly motivated by politics and not people’s need,” said Mississippi-Branch NAACP President Corey Wiggins. “Folks have tried to tie entitlement for public assistance programs to Black folk only with that welfare queen (stereotype), but when you look at the population that benefits from expansion, I just don’t think that’s true.”

As part of the Patient Protection and Affordable Care Act (ACA), the federal government covers 90 percent of states’ cost of expanding Medicaid to people who make up to 138 percent of the federal poverty level. That’s about $30,000 for a family of four. Mississippi is one of only 12 Republican-led states to refuse that offer. This leaves about 2.2 million constituents without health insurance. 

Republican leaders like House Speaker Phillip Gunn have always cited money as the reason for their opposition. State taxpayers, he says, should not have to shoulder the financial burden of the expansion.

“We have been very clear on our side that we are just not for that,” Gunn said. “We forget that the people who pay for that (the expansion) are the tax payers and everywhere I go I get that reminder.”

State Economist Corey Miller released a detailed report destroying that argument, however.

“We estimate Medicaid expansion will increase the state’s real GDP each year from 2022 to 2027 between about $719 million and $783 million,” the report claims. “In terms of employment, we find that Mississippi would add 11,300 jobs a year on average from 2022 to 2027 as an indirect result of Medicaid expansion.”

The report also estimates Medicaid expansion in Mississippi to increase enrollment by approximately 228,000 to 233,000 individuals between 2022 and 2027. Additionally, it claims the state “will be able to save funds from a variety of sources” somewhere in the range of “$206 million to $227 million between 2022 and 2027–roughly offsetting the annual costs to the state from Medicaid expansion over the same period.”

Facing increasing pushback on the finances, GOP Governor Tate Reeves is seemingly unhooking money from his reasoning and merely opposing it for opposition’s sake. When asked if the state would accept expansion with additional financial incentives from the federal government, Reeves was adamant.

“No, sir, it will not.” Reeves told Vox.

This, despite rural hospitals being on the brink of closure due to the high number of unpaid emergency room bills from working-poor patients who can’t afford service. The Mississippi Hospital Association claims uncompensated care costs in the state totaled $616 million in 2019. These costs comprised 7.6 percent of hospital operating expenses in 2017 and 7.4 percent in 2018.

Adding to the oppressive burden on money-starved hospitals is the apparent benefit of a healthcare-related population boost. An 11,300-job annual increase over the course of five years amounts to 56,500 new jobs, and bringing this many new jobs could reverse the trend of Mississippi losing population to surrounding states, which have all enjoyed a population increase. Mississippi was already losing millennials in 2017, but more recent Census counts confirmed youth and young adults fleeing the state and taking their money with them. The absence of new people reduces Jackson suburbs and other parasite communities to stealing population from the central city of Jackson in order to fuel their tax base. 

The army of good reasons to allow expansion outnumber the cons, so why do Mississippi leaders still oppose it? And why are most of these leaders here and in other states white? In Southern states, it probably comes down to race.

The Lighthouse tallied Census figures in former confederate states that expanded Medicaid and those that didn’t and we noticed a sinister trend. Southern states with large non-white populations generally refused.

Most former confederate states that accepted the ACA expansion, however, including Kansas, Missouri, and Arkansas, have a comfortable white majority of roughly 80 percent. In fact, Louisiana is the only state with a lower white majority population, 58.4 percent, that has expanded Medicaid. This may have plenty to do with Louisiana’s Democratic governor making Medicaid expansion central to his campaign platform. 

A compelling argument is that white leaders in states with a higher non-white population feel that non-white population needs to be punished.

Studies confirm that racial resentment among white Americans not only endures but fuels political resentment against “Obamacare.” It extends to social welfare programs, in general, actually. Hewing to the derogatory Welfare Queen myth cited by Wiggins, white Americans generally view African Americans as “demanding and undeserving” and unworthy of government assistance. Other studies suggest a higher presence of Black people in a state “increases antagonistic attitudes toward minorities among whites and thus produces racially conservative policies.”

It is perhaps no surprise that state support for Medicaid expansion is just as racialized, especially since white opinion is so strongly connected to race resentment, but Wiggins says by allowing their white elected leaders to deny them life-saving healthcare, white state residents are really only hurting themselves.

“You can look at the people who benefit from the program and see there are plenty of folks, both Black and white, who’ll get the benefits. If you look at the population that benefits from expansion, … the last time I looked, these are places like the Gulf Coast and Northeast Mississippi. (Areas with a lower Black population.”

Wiggins added that this realization is beginning to resonate with more white voters, who probably don’t even oppose expansion anymore. If left to their own, they might even approve expanding Medicaid as a ballot initiative had the state’s conservative supreme court majority not single-handedly destroyed the ballot initiative process earlier this year. Court judges were likely aware the Medicaid-related initiative was brewing in the background.

The state legislature may install a new ballot initiative process during the next legislative session. Meanwhile, political observers like Mississippi data analyst Serita Wheeler say cynical white politicians are leading their white constituents around on a dog leash of idiot racism.

“They use racial resentment to engineer consent for policies that benefit their donors,” Wheeler said. “In whiter states they’d be harming more white people, which would be a political liability.”


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