Senate Republicans rejected two efforts late Tuesday afternoon to expand Medicaid, which would provide coverage to an estimated 300,000 Mississippians who cannot otherwise afford health care.

Mississippi, the poorest state in the nation and one of just 12 U.S. states not to expand Medicaid, would receive an estimated $1 billion per year in federal funds from the program.

The Tuesday evening vote was the first on expanding Medicaid in the Mississippi Legislature in multiple years. Previous Lt. Gov. Tate Reeves, a staunch opponent of Medicaid expansion who is now the state’s governor, went out of his way to keep the vote off the Senate floor.

Both amendments to expand Medicaid on Tuesday were defeated by the identical 34-16 margin along straight party line votes. Two Republicans in the 52-member Senate did not vote.

“Where is the money going to come from?” asked Sen. Chris McDaniel, R-Ellisville, who was a vocal opponent of Medicaid expansion as is allowed under the federal Patient Protection and Affordable Care Act. He added of the people who Medicaid expansion would cover: “These are able-bodied people. You are talking about childless adults.”

While some of the Mississippians covered by Medicaid expansion would be childless, many would be parents who primarily work in jobs where their employers do not provide health coverage and where they do not make enough money to afford private insurance.

Sens. Angela Turner Ford, D-West Point, and Derrick Simmons, D-Greenville, offered separate but similar amendments to the so-called Medicaid technical amendments bill to join the majority of states and expand Medicaid. The Medicaid technical amendments bill, taken up every few years in the legislative process, deals with various changes in the complex Medicaid program.

“Mississippi will make money if we expand Medicaid,” said Sen. Hob Bryan, D-Amory. “There will be more money in the state treasury if we expand Medicaid than if we don’t.”

The federal government pays 90% of the cost for the expanded Medicaid coverage, which has been estimated could provide health care coverage for about 300,000 Mississippians. In addition, there is now federal legislation pending that would pay 100% of the cost for a number of years for the 12 states that have not yet expanded Medicaid. Those states missed out in the early 2010s when the Medicaid expansion was first enacted and when the federal government was paying 100% of the costs.

The state’s Republican leadership, led by Reeves, has long said Mississippi could not afford the expansion and relied on partisan rhetoric about the program. During his successful 2019 campaign for lieutenant governor, Republican Delbert Hosemann indicated that he might at least consider proposals by the Mississippi Hospital Association to pay for the expansion through a combination of a tax on their member hospitals and a small fee —perhaps $20 — for the people who sign up for the program.

But the Senate where Hosemann presides was not inclined Tuesday to consider such a proposal.

“It (Medicaid expansion) is not an economic panacea,” said Medicaid Committee Chair Kevin Blackwell, R-Southaven. “It has not worked out in other states. We are looking to get people off welfare, not add to the welfare rolls.”

While Blackwell said expansion has not worked in other states, he also said he was planning before the COVID-19 pandemic hit to travel to other states to study how Medicaid expansion had worked in those states.

Simmons said studies by economists have projected Medicaid expansion in Mississippi would add as many as 9,000 jobs.

In Mississippi, the current Medicaid program provides health care coverage primarily to the disabled, pregnant women, poor children and a certain population of the elderly. Mississippi has one of the highest percentage of its citizens without health care coverage of any state in the nation.

Hospitals and many other health care providers have advocated for Medicaid expansion to reduce their uncompensated costs.

At times, the debate on the issue became emotional. Sen. David Jordan, D-Greenwood, asked McDaniel how could he consider himself a Christian and be opposed to providing help to the needy.

McDaniel said he did not consider it Christian to support a program that was adding to the nation’s debt.