Medicaid expansion: And then there were 11

South Dakota is predominately white and freezing in the winter. Mississippi has the largest Black population in the nation and, compared to South Dakota, is downright balmy in the winter.

But one thing they do share in common is a Republican leadership that has shown stiff-necked and irrational resistance to expanding Medicaid to cover the working poor in their states.

South Dakota, though, last week did one of the few things citizens can do when their governor and Legislature won't listen to reason. They went around them to get the job done.

In a statewide ballot measure, South Dakota, by a margin of 56% to 44%, approved Medicaid expansion. 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, that has taken the federal government up on its generous offer to cover most of the cost of covering a significant portion of the population that is presently uninsured.

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

Mississippi presently does not have that electoral option. That's because a legally debatable decision by the Mississippi Supreme Court in 2021 invalidated the state's initiative process on a technicality. Although the lawsuit that produced that result was designed to derail the legalization of medical marijuana, it also blocked other initiatives, including a signature-gathering effort that had just begun on the question of Medicaid expansion.

Although the Legislature, following a public uproar, responded to that court decision by adopting a medical marijuana program by statute, lawmakers have not reinstated the initiative process, despite early assurances that they would. Until they do, there's no such thing as a citizen-led initiative in this state, no matter the legitimacy of the cause.

The Republican leadership in Mississippi has ignored all the studies, all the experience of the other states that have adopted Medicaid expansion, and all the financial troubles of hospitals that have been stuck with a heavier than necessary burden for providing uncompensated care. The reason for this defiance is purely political. Because Medicaid expansion was part of the Democrat-driven Affordable Care Act, better known as Obamacare, the majority of Republican leaders in this state want nothing to do with it, no matter how much Mississippi is penalized as a result of rejecting about a billion dollars a year in additional federal funding.

The initiative process was designed to bypass such unreasonable and politically motivated behavior by the Legislature. The people need to have that power back. The Legislature should restore it, as it promised.

Gov. Tate Reeves, House Speaker Philip Gunn and other Republican opponents of Medicaid expansion say it would not be beneficial to Mississippi. A growing coalition of business, medical and citizen groups say otherwise.

Let's let the people decide who is right. Restore initiative, so they can have this opportunity to settle the debate. Just like the people of South Dakota just did.