All States Need Expanded Medicaid Access. Gerrymandering Prevents It.

My job at the Mississippi NAACP is to safeguard the civil rights of those in my state and fight for current and future generations.

When I think about the challenges facing Mississippi, they come down to the “haves” and the “have-nots.” It’s about power — who has it, who’s working to maintain it, and who lacks it.

Two policy issues confronting states, particularly Southern states, include closing the health insurance coverage gap and redistricting. These issues impact people’s quality of life and undermine both physical health and the health of a strong democracy. It appears that states that did not accept Medicaid expansion are also more likely to draw district maps that disadvantage Black, poor and marginalized voters.

Under the Affordable Care Act (ACA), a provision called for the expansion of Medicaid eligibility. This would allow more low-income Americans up to age 64 to access affordable health care. As this expansion was not federally mandated, states were left to decide what course to take. Mississippi (one state in a group of 12 other Republican-led states) has chosen not to expand access, thereby creating a Medicaid expansion gap where 130,000 Mississippians have no options for affordable health care.

There is no legitimate rationale for refusing to expand Medicaid and close the health insurance coverage gap. Many reports have described the health and economic benefits of closing the health insurance gap. Analysis by the Commonwealth Fund estimated that were Mississippi to expand Medicaid, 202,659 adults would be insured, and 110,860 fewer adults would skip needed care because of its costs. The state would create an additional 21,700 jobs from closing the health insurance coverage gap. However, political posturing has resulted in inaction by the state’s leaders.

Conversely, we know redistricting, or the drawing of state and congressional lines, is also influenced by politics — particularly by who has power and who does not. Those in power have the wherewithal to draw new district lines to serve their own needs, interests and ambitions, rather than the communities which elected them.

Simply put, both issues are about resources. Medicaid expansion ensures thousands of Mississippians have access to life-or-death health services. Redistricting is about determining community resources that will impact children and families for years to come. It’s also a way to expand the franchise of voting, while ensuring community members have a say in who represents them.

By denying expanded access to health care and drawing gerrymandered district lines, elected leaders essentially silence the community, preventing already-marginalized people from making progress.

If we want to ensure all people can thrive, we must consider the connection between redistricting and Medicaid expansion. Most Americans want Medicaid expansion. Gerrymandering, however, silences the will of voters and prevents Mississippians and other Americans from accessing life-saving care. This isn’t how it should be. It isn’t how it has to be.

Advocates are pushing back. From Michigan to Ohio, from New York to North Carolina, groups are coming together, filing lawsuits and pressing their legislatures to create fair maps. In several states across the country, voting rights advocates are challenging newly drawn maps, noting they are racially discriminatory and/or constitute gerrymandering. Three have also refused to participate in Medicaid expansion: Alabama (whose maps are grounded in racial discrimination), Georgia (whose maps also represent racial discrimination) and North Carolina (whose maps reveal both racial discrimination and gerrymandering).

The 12 states, including Mississippi, that have not expanded Medicaid are Alabama, Florida, Georgia, Kansas, North and South Carolina, North and South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

Where do we go from here?

We fight back. We unite. We support our colleagues in states where redistricting has yet to begin.

Studies from the Center on Budget and Policy Priorities (CBPP) show that since 2014, when the ACA coverage provisions took effect, there has been a narrowing of the gap between insured and uninsured adults, as well as the gap found in uninsured adults not seeking care due to cost. This is in large part the result of Medicaid expansion. In another CBPP study, those in Arkansas and Kentucky were reported to be likelier to have basic care like a personal physician or receive an annual check-up, compared to Texas, which like Mississippi, has not expanded. Understanding this data helps.

The Mississippi State Conference of the NAACP has been working heavily on redistricting for several months, seeing many ups and downs as we’ve pushed for information to be shared as a series of legislative voting moments have drawn near.

Republicans control the House and the Senate in Mississippi. They have a supermajority, which oftentimes means they can pass what they want, when and how they want it.

The Mississippi NAACP presented an equal representation redistricting plan, though. House Republicans approved a different plan, 76-42. A new district under the Republican plan stretches over 300 miles, making it too large for a single leader to effectively represent it. Mississippi Today noted that “House Democrats, who oppose the plan, said it created a district too large for incumbent 2^nd District U.S. Rep. Bennie Thompson — or anyone — to adequately represent. The proposed district would move a large portion of southwest Mississippi from the 3rd to 2nd District.”

As a Black man who grew up in Jackson in Mississippi’s 2nd district, I have seen firsthand what it looks like when rural areas go without. The legislative map will cause more people to go without.

I care for my community. This desire to ensure those within my community are cared for and have someone fighting for them has been wrapped up in my existence for decades. I will never stop caring, I will never stop this work. I invite my fellow Mississippians to join me. We must involve ourselves in every legislative decision, from Medicaid expansion to the way districts are drawn. We are learning that no decision can be made in isolation.