No state has a higher percentage of poor folks than Mississippi. And no state hates poor folks more than Mississippi, either.

The latter guarantees the former and Monday’s late-night deal in the Mississippi legislature to expand Medicaid in theory only is yet another example of the disdain our leaders have for our poorest residents.

In the current session, both chambers of the legislature passed Medicaid expansion bills. The House bill was comparable to those of the 40 states who have expanded Medicaid to cover those whose income falls between 100% and 138% of the federal poverty rate. In Mississippi, it would fill a gap in coverage that would affect somewhere between 200,000 and 300,000 citizens whose income disqualifies them from the current Medicaid program but does not allow them to have access to affordable, comprehensive health care coverage.

The Senate’s bill was an insult, providing coverage to only a fraction of those people (40,000) while rejecting enormous amounts of federal dollars that would make expansion virtually state revenue neutral. The Senate bill also required a work requirement for eligibility, which is the surest indicator of just how much senate leadership – and likely the rank-and-file senators – despise and mistrust Mississippi’s poor folks and will waste no opportunity to vilify them.

Late Monday, the Senate conceded its vacuous, scaled-down expansion plan and adopted the House’s much broader version, but only on the condition that the House plan adopt the Senate’s work requirement.

That work requirement is certain to be rejected at the federal level, cutting off access to almost $1 billion in federal dollars set aside for Medicaid expansion in Mississippi. That means, there will be no real Medicaid expansion.

When Medicaid expansion was offered as a part of the Affordable Care Act in 2011, there were no work requirements, but beginning in 2018, the Trump Administration encouraged states to adopt policies taking Medicaid coverage away from people not meeting work requirements. While 12 states received approval for these policies, several were blocked by the courts, and none are currently in effect. But data from Arkansas’ 10-month implementation of its policy and brief implementation in Michigan and New Hampshire provide direct evidence of these policies’ harmful effects.

In Arkansas, more than 18,000 people — nearly 1 in 4 of those subject to work requirements — lost coverage over the course of just seven months. In New Hampshire, almost 17,000 people, or about 40 percent of those subject to work requirements, would have lost coverage had state policymakers not put the policy on hold. Some 80,000 Michiganders — nearly 1 in 3 of those subject to work requirements — were in danger of losing coverage had a court not stopped the policy.

At first blush, it may seem perfectly reasonable to expect able-bodied adults to work in order to access benefits such as Medicaid, food assistance (SNAP), housing assistance and cash benefits (TANF).

But the state’s insistence on work requirements perpetuates the ugliest of stereotypes of poor people, mostly based on race, but also gender and class.

In truth, most working-age adults receiving assistance from programs like SNAP and Medicaid are already working.

Among those who aren’t working, there are legitimate reasons: access to affordable child care, health issues, transportation issues, those between jobs, full-time students, felons who have paid their debt to society but remain pariahs to employers and those who stay at home to provide childcare for family members who are working.

The prejudice that reigns supreme in this state seems to recognize none of these legitimate factors while fiercely embracing the provably false assumption that most poor folks in Mississippi are able to work, but simply won’t.

If our legislators could somehow put aside the poisonous bile of those false assumptions to see the benefits of expansion – including greatly reducing the uncompensated care that threatens the viability of our rural hospitals and improving the health outcomes of tens of thousands of Mississippians – there would be no work requirement attached to Medicaid expansion. It’s clear: Far too many of our legislators would rather hate than heal.

Even if the state’s work requirement was somehow approved at the federal level, the cost of constantly monitoring the work requirement for up to 300,000 people would require an enormous amount of manpower and create a bloated bureaucracy that would be expensive, punitive and, most likely, ineffective. As is, a 10-year orgy of tax cuts has left state agencies charged with meeting the needs of vulnerable Mississippians – including Medicaid, Health Department, child welfare and mental health – with what amounts to a skeleton crew which – at best – can barely meet their obligations, if they meet them at all.

So what has always been true remains true: There is no state in the union where it is more dangerous to be sick, mentally ill, an abused or neglected child, a pregnant woman or someone living in poverty than Mississippi.

Our legislature is determined to keep it that way, mainly out of spite and prejudice.

The so-called Medicaid expansion passed Monday night is a mockery and an affirmation of just how much we despise 20 percent of our state population whose unpardonable sin is being poor.

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].

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