November’s general elections will be upon us sooner than we think, so it’s never a bad time to brush up on Mississippi Civics, something that is only briefly touched upon in public schools these days.

It’s not just kids who are uniformed, either. You would be surprised how many adults have only the vaguest of notions about how our state operates.

On the November ballot, state-wide elections will be held for eight offices: Governor, Lt. Governor, Secretary of State, Attorney General, State Auditor, State Treasurer, Agriculture Commissioner and Insurance Commission.

It makes sense that these offices be chosen by voters throughout the state because the decisions they make affect all of us.

If that’s the criteria that should be used to fill offices, a ninth office should be determined by state-wide vote: Speaker of the Mississippi House.

Currently, the position is vacant. Rep. Phillip Gunn of Clinton, retired from the legislature after serving two terms as Speaker in April. The next speaker will be Jason White, because in Mississippi House Speakers are ordained rather than selected. Officially, the House will take a vote when the 2024 session begins in January, but the back-room deal that will elevate White to Speaker was made even before Gunn stepped down. White was Gunn’s top lieutenant. You will find zero space between Gunn’s ideology and White’s. Gunn may be gone, but his uber-conservative philosophy will be in reliable hands. Of particular interest, Gunn was stubbornly opposed to Medicaid expansion. White will be, too.

Lt. Governor Delbert Hosemann will also certainly be re-elected and is open to Medicaid expansion in some form

The Speaker of the House wields enormous power. He decides what legislation reaches the House floor for a vote and what legislation dies in the committees chaired by his hand-picked disciples. He can kill Senate bills by having them die in conference.

Along with the elected Lt. Governor, who wields the same power in the state Senate, they are the two most powerful people in Mississippi government.

Their power exceeds even that of the Governor, although the Governor does have a couple of good tools in his tool box should he clash with the. Lt. Governor or Speaker. We’ll get to that in a minute.

Jason White represents just 22,000 people in his district, located in east central Mississippi, but the decisions he makes can and does impact almost 3 million Mississippians. You have no recourse if you don’t like something the speaker does unless you are one of the 22,000 in his district. The rest of us can just lump it.

That reality is significant in the upcoming election as the fate of our hospitals hangs in the balance.

Governor Tate Reeves remains adamantly opposed to Medicaid expansion, which could pump $1 billion in federal funds into our state health care system, not only provided access to healthcare for 200,000 Mississippians in low-wage jobs, but wipe out an enormous portion of the $600 million in uncompensated care that our hospitals have to eat every year.

It’s no exaggeration to say bluntly that if Reeves is elected and does not relent in his position, as many as half of our rural hospitals will shudder before his term ends and hospital care everywhere will suffer. The tipping point is just around the corner.

Reeves’ opponent, Brandon Presley, has made Medicaid expansion one of his top priorities. If elected, Presley would have two choices: Expand Medicaid by executive order or call a special session of the legislature where the legislation would not die in some committee. Each legislator would have to go on record on the issue and the broad by-partisan in the legislature for Medicaid expansion would almost certainly prevail.

So, really, the fate of healthcare and the survival of our hospital system comes down to three people, the two candidates for Governor and a Speaker of the House who most of us never voted for.

Slim Smith is a columnist and feature writer for The Dispatch. His email address is [email protected].

Slim Smith is a columnist and feature writer for The Dispatch. His email address is [email protected].