These efforts are taking place amid Friday’s ruling by a federal judge to repeal the entire health care law. Bryant is among 20 plaintiffs who sued federal government claiming that the Affordable Care Act was unconstitutional. This ruling is likely to be appealed. Bryant and his senior aides have been speaking with executives from the health care sector over the past month about details of a limited Medicaid expansion similar to the 2015 plan. Multiple sources have claimed that Mike Pence was responsible for Indiana’s Medicaid expansion. They were also the ones who spoke directly to him and his staff. Bryant, who is a Trump ally and has twice sued the federal Government over Affordable Care Act aspects, would be making a change by expanding Medicaid. Bryant, in his first year as governor, wrote that he would “continue resisting the expansion of Medicaid” and other aspects of ACA that would have a negative effect on the State’s economy or its citizens. Bryant’s office was contacted Wednesday to downplay Bryant’s role in pushing for an expansion. Instead, the powerful lobby of state hospitals is leading the effort. “Every year, the Mississippi Hospital Association approaches the Office of the Governor with a new plan for expanding Medicaid. Knox Graham, the director of communications for Governor, stated in an email that they don’t expect it to be part of their legislative agenda. Mississippi Today was not able to reach the Mississippi Hospital Association for clarification. Graham replied in an email to Mississippi Today that he didn’t want to answer any questions about hearsay. Graham also stated that if the Affordable Care Act was expanded, it would bring $1 billion per year in federal funds to the state. According to a 2012 report by the Institutions of Higher Learning, this would adversely affect Mississippi’s economy. Four of Mississippi’s rural hospitals declared bankruptcy in the past four months. Five Mississippi hospitals have closed their doors since 2010. According to national studies, hospital closings are linked to state decisions against expanding Medicaid. According to Tim Moore, CEO of Mississippi Hospital Association, the state’s hospitals are losing millions each year in care for uninsured people. Moore spoke with Mississippi Today last January. Moore stated that “Medicaid expansion would have been a great help in stabilizing many hospitals.” Bryant is still opposed to the Affordable Care Act but he has stated that a stable state health care system is essential to the state’s economy. He hosted the Governor’s Health Care Economic Development Summit in August. There, he said to a room of about 200 professionals that health care was an economic driver. But, it is only one thing to publicly advocate for health care investment. The signature piece of legislation that President Obama signed regarding Medicaid expansion remains unpopular with Republicans. 13 of the 14 states which have not expanded Medicaid have Republican governors. The other, North Carolina, has a Republican-controlled legislature. People who spoke to Bryant’s office said that Bryant wants to avoid calling the proposal Medicaid expansion. Pence used the same approach in Indiana for his “Healthy Indiana” program. Its website almost does not mention Medicaid expansion. This plan has stricter eligibility requirements than federal limits. Beneficiaries must share monthly costs and set up health savings accounts. However, 2019 is an election year in Mississippi and some Democrats believe that Republican-backed Medicaid expansion may slow down Democrats’ political hopes. Jim Hood, the Democratic front-runner for governor, has been pushing expansion to stabilize Mississippi’s healthcare industry since his inception. Hood declared that he supports spending federal funds from Washington to keep our hospitals open when he announced his candidacy in October. Hood stated that the money goes directly to a hospital or clinic for medical care. This money is used to pay the highest-paying jobs in our community. This is economic development 101, and it’s an opportunity for me to keep our rural hospitals open. Support for Medicaid expansion has increased by 72 percent since 2013, from 37% in 2013 to 37 percent in 2013. According to the Center for Mississippi Health Policy, that figure represents a double-digit increase in support for the Affordable Care Act. “(Republicans) have) avoided that bullet politically as long they can, but you better believe Jim Hood will make a big deal of it – if anything else it’s an attempt to squelch him momentum and burst His bubble politically,” stated Rep. Steve Holland (D-Plantersville), who has been a vocal advocate for Medicaid expansion for many years. However, it is unlikely that Medicaid expansion will be implemented in a Republican-dominated state such as Mississippi. Legislative action is one way to go. Both Philip Gunn (R-Clinton), the Speaker of Congress, and Lt. Governor remain skeptical. Tate Reeves, as well as their Republican-controlled chambers, have remained cool to Medicaid expansion. When Bryant was asked Tuesday if the Legislature would consider expanding Medicaid in 2019, Bryant said Mississippi Today, “They wouldn’t take up in an election year.” Though the Mississippi Division of Medicaid stated to Mississippi Today that expansion “would likely need legislation,” seven states, including Indiana have expanded their state Medicaid programs by executive order using what is known as a Section 1115 waiver. These waivers allow the federal government to approve pilot or experimental projects that it believes will promote Medicaid’s goals. Like many other states, Mississippi applied last year for a waiver which would have required Medicaid beneficiaries to find work or lose their benefits. The request for the waiver is still being considered. Seema Verma (head of the federal Centers for Medicare & Medicaid Services) has stated that she is concerned about the possibility that work requirements in states that have not expanded Medicaid could lead to a subsidy cliff where beneficiaries suddenly make enough money to lose their coverage. Current Mississippi Medicaid rules make it impossible for anyone to get Medicaid coverage if they earn less than $306 per month. Individuals who earn more than 138 percent of the federal poverty level (or $1,387 per month) could be eligible for Medicaid expansion. CMS has approved five work requirements in expansion states so far. Bryant believes that the greatest obstacle to expansion was deciding how the state would finance it. Standard Medicaid offers Mississippi a cost match of 76 per cent. This means that Mississippi will receive more than three federal dollars per dollar it spends. This is the highest match rate in America. This means that Mississippi spent $935million and received $4.4 million in federal dollars for fiscal 2018. Mississippi could expand Medicaid and that match would rise to 90%, which is nine federal dollars per state dollar. Mississippi would still be responsible for 10 percent, or $117million, of the cost. Ten states have used their tax revenues to pay for expansion costs. Four of them pay a part of the cigarette tax. Although Mississippi did not approve a cigarette tax last year, Bryant and other Republicans quietly supported it. It’s expected to return during the 2019 session. Bryant and other Mississippi Republican officials opposed Medicaid expansion. The Affordable Care Act was introduced by Obama in 2010. It was ironically designed to benefit states like Mississippi which have the highest poverty rates and the lowest health outcomes. Roy Mitchell, executive director, Mississippi Health Advocacy Program (a non-profit that has advocated for Medicaid expansion), stated, “Mississippi with the highest federal matching in the country would have done very well under Medicaid extension.” “We missed an enormous economic windfall.” The 2012-Lt. Governor. Bryant filed privately the first lawsuit challenging the constitutionality and individual mandate of the Affordable Care Act. That lawsuit was dismissed by the court. Bryant and 20 other Republican officials joined Bryant in Texas v. United States earlier this year, arguing that the law is now unconstitutional because Congress had repealed the ACA’s individual mandate. A federal judge agreed to this on Friday. Bryant’s office didn’t respond to a request for comment. While Republican support is not certain, Democrats indicated that they are likely to support any version of the law. Holland stated that he would salute the Republicans if they did something with Medicaid expansion._x000D