Whether Mississippi joins the increasing number of Republican-leaning states to expand Medicaid could be decided Tuesday night in a surprisingly close race for governor.

Mississippi Attorney General Jim Hood, a Democrat who supports expansion of Medicaid coverage for the poor, is in a close race against current Lieutenant Gov. Tate Reeves, a Republican that polls show has been slightly behind headed into Tuesday’s election. The fact that the race is close has already grabbed headlines considering the GOP controls the state legislature, both U.S. Senate seats and Donald Trump remains popular in Mississippi and has campaigned in the state for Reeves.

Perhaps the biggest issue in the race is expansion of Medicaid benefits under the Affordable Care Act and the Democrat Hood has been clear that he would do what he can to enact such coverage, bringing health benefits to 100,000 uninsured Mississippians living in poverty. Reeves, however, is adamantly opposed to Medicaid expansion in one of the more clear differences between the two candidates.

“Jim Hood believes that every Mississippian should have the same access to healthcare,” Hood’s campaign says on its web site. “Hundreds of thousands of Mississippians are without healthcare and Mississippi’s been shortchanged more than $5 billion simply because of petty, partisan politics.” 

To be sure, Mississippi is one of just 14 remaining holdout states that have already missed out on generous federal funding of the Medicaid expansion. From 2014 through 2016, the ACA’s Medicaid expansion population was funded 100% with federal dollars. The federal government still picks up 90% or more of Medicaid expansion through 2020. It’s a better deal than before the ACA, when Medicaid programs were funded via a much less generous split between state and federal tax dollars.

Such expansion has been a boon to doctors, hospitals and health insurers like Anthem, Centene, UnitedHealth Group and CVS Health’s Aetna health insurance unit given these private insurers generally administer most Medicaid benefits in the U.S.

But in Mississippi, several hospitals have closed unlike states elsewhere that have expanded Medicaid.

“Five rural hospitals in Mississippi have closed, and nearly half are at risk,” Hood’s campaign says. “We must finally come together and do what’s best for the state by accepting more than $1 billion per year from the federal government to extend health coverage to more Mississippians. Doing so will help keep our rural hospitals open and reduce the more than $600 million per year in losses that hospitals have been forced to absorb.”

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Will Mississippi Voters Pick Medicaid Expansion Over GOP Rule? – Forbes