Mississippi Republican Lt. Gov. Delbert Hosemann, right, listens as Senate...

Mississippi Republican Lt. Gov. Delbert Hosemann, right, listens as Senate Medicaid Committee Chairman Sen. Kevin Blackwell, R-Southaven, provides details on the body's passing a Medicaid expansion bill at the state Capitol in Jackson, Miss., Thursday, March 28, 2024. Credit: AP/Rogelio V. Solis

JACKSON, Miss. — Mississippi lawmakers will try to negotiate on expanding Medicaid in one of the poorest states in the U.S. after the Senate voted Thursday for a vastly different plan than one proposed by the House.

The upper chamber's proposal would insure fewer people and bring less federal money to the state than the version approved by the House last month. But the Senate's approach includes a tougher work requirement and measures to prevent a wider expansion of Medicaid benefits in the future.

Senators debated the bill for nearly two hours before approving it in a 36-16 vote. The move to increase eligibility for the government-funded health insurance program that covers low-income people has set off a struggle between Republican Gov. Tate Reeves and members of his own party. In a social media post Wednesday, Reeves called the bill “Obamacare Medicaid” and said it would amount to “welfare expansion to those able-bodied adults that could work but choose not to."

Republican Sen. Kevin Blackwell, who chairs the Senate Medicaid Committee, has dubbed the Senate proposal Medicaid expansion “lite,” and said it is much narrower that what is allowed under the Affordable Care Act, a 2010 federal health overhaul signed by then-President Barack Obama.

“Many of the comments I've seen recently on social media are misleading, inaccurate and designed to be inflammatory," Blackwell said. “This bill is not Obamacare expansion. This bill is a very responsible, conservative bill geared toward helping the working poor.”

The Senate's amended bill would extend eligibility only to those making up to 100% of the federal poverty level, just over $15,000 for one person. That is down from the 138% figure, just under $21,000 for one person, approved by the House.

House Medicaid Committee Chairwoman Missy McGee said her proposal could extend benefits to as many as 200,000 people. Blackwell said the new version of the bill approved by his committee could make 80,000 people eligible for expanded coverage, but he projects only about 40,000 would enroll.

Mississippi State Sen. Derrick Simmons, D-Greenville, center, speaks on the...

Mississippi State Sen. Derrick Simmons, D-Greenville, center, speaks on the Senate passing a Medicaid expansion bill at the state Capitol in Jackson, Miss., Thursday, March 28, 2024. Credit: AP/Rogelio V. Solis

Mississippi ranks at the bottom of virtually every health care indicator and at the top of every disparity. Hospitals are struggling to remain open. The state also has one of the nation’s lowest labor force participation rates. Expansion proponents have said the policy could help improve these conditions.

Senate Democrats introduced amendments that would have expanded Medicaid to more people, but Republicans voted them down on the floor. Even still, Senate Democrats all voted for the bill, with Minority Leader Derrick Simmons arguing that Mississippi is experiencing a “health care crisis” and that the bill is better than the status quo.

Opponents of Medicaid expansion say the program would foster government dependency, increase wait times for health services and push people off private insurance.

Republican lawmakers have said expansion without a work requirement is a nonstarter. The Senate version would require people to work at least 30 hours per week to become eligible for expanded benefits, up from the 20-hour work requirement approved by the House.

Mississippi State House Medicaid Committee Chairman Rep. Missy McGee, R-Hattiesburg,...

Mississippi State House Medicaid Committee Chairman Rep. Missy McGee, R-Hattiesburg, seated left, state Rep. Jansen Owen, R-Poplarville, seated right, and state Rep. Rodney Hall, R-Southaven, back right, join state Sen. Bradford Blackmon, D-Canton, back left, in listening to the debate over a proposed Medicaid expansion bill in the Senate Chamber at the state Capitol in Jackson, Miss., Thursday, March 28, 2024. Credit: AP/Rogelio V. Solis

The Senate makes expansion depend on President Joe Biden’s administration approving its work requirement. But the administration has consistently revoked work requirement waivers, arguing people should not face roadblocks to getting health care.

Only Georgia has managed to tie a work requirement to a partial expansion of Medicaid benefits. But the state only requires people to document 80 monthly hours of work, 40 hours less than what Mississippi senators have proposed. Georgia’s program has seen abysmal enrollment.

The House proposal would have allowed expansion to continue without a work requirement, but the Senate version would disallow Medicaid expansion without one. Blackwell said he is counting on Biden losing in November to a Republican whose administration would welcome a work requirement.

Under the reduced eligibility level approved by the Senate, Mississippi would also lose an additional financial bonus for expanding Medicaid that would be available under the House’s version.

The bill now heads back the House, and Reeves is likely to veto the legislation if it reaches his desk. Lawmakers could override his veto with a two-thirds vote from the House and Senate.

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