This was the first year that expansion has received serious legislative discussion in Mississippi, which is one of the poorest states in the U.S. and has some of the worst health outcomes.

Any plan would have needed to pass with at least a two-thirds vote — a wide enough margin to survive an expected veto from Republican Gov. Tate Reeves, who refers to Medicaid as “welfare” and says he does not want more people to enroll.

House Medicaid Committee Chair Missy McGee, a Republican, pushed for expansion and said she was disappointed the issue died.

“We did the very best we could to get it across the finish line, and I’m sad that it looks like we’re ending the session without something for the hardworking, low-income Mississippians,” McGee said.

Medicaid is a government health insurance program that covers people with very low incomes. Then-President Barack Obama signed a health care overhaul law in 2010 that allows states to expand coverage, generally to people who work in jobs that pay modest wages and don’t provide private health insurance. Ten states, mostly Republican-led, have resisted expansion.

Mississippi House and Senate leaders missed a Thursday night deadline to file a final plan, and that killed the issue for the four-month session that is drawing to a close.

Republican Lt. Gov. Delbert Hosemann told reporters that passing Medicaid expansion would be the first order of business during the 2025 legislative session.

“In my mind, we’ve left 74,000 people, working, that could’ve had health care coverage in Mississippi,” Hosemann said. “We didn’t give them that.”

House and Senate negotiators released a proposal Monday to expand Medicaid to tens of thousands more people, but it included a work requirement. House Democrats balked before the plan could come up for a vote, saying it was Medicaid expansion in name only because the federal government has blocked several states from having such mandates.

The House offered a new proposal Thursday to would put two questions on the ballot this November: Should Mississippi expand Medicaid? If so, should the expansion include a work requirement?

White said Thursday that a referendum would have been a good measurement of public sentiment about Medicaid expansion.

“I’m proud of my House Republicans for being willing to have an open mind and think about it in terms of what is best for Mississippi in terms of the health care, the health care economy, the health of our people,” White said.

Hosemann said the proposal to put Medicaid expansion on the ballot “was not well received” by Senate leaders. He said senators were firm about having a work requirement “with necessary exceptions.”

The Mississippi House voted by a wide bipartisan margin in late February to expand Medicaid coverage to about 200,000 people who earn up to 138% of the federal poverty level, or $20,120 annually for one person. Mississippi has about 3 million residents, and its Medicaid program covered 374,823 people in March.

In late March, the Senate passed its own pared-down version that would extend eligibility to people earning up to 100% of the federal poverty level, just over $15,000 for one person. Senate Medicaid Committee Chairman Kevin Blackwell, a Republican from Southaven, said about 80,000 people would become eligible for coverage.