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Senate Republicans should know: This is literally life-or-death.

Note: This editorial anchored Mississippi Today’s weekly legislative newsletter. Subscribe to our free newsletter for exclusive access to legislative analysis and up-to-date information about what’s happening under the Capitol dome.

The single most transformative policy Mississippi lawmakers have considered since William Winter’s education reform of 1982 is just two Senate votes from becoming law.

Though the Republican-controlled House of Representatives overwhelmingly voted to send a Medicaid expansion plan to the Senate on Feb. 28, Republican senators have some major problems with the proposal.

Lt. Gov. Delbert Hosemann, who leads the Senate, has cautiously supported the idea of expansion for years but has never been a vocal public champion of it. The Medicaid Committee chairman Hosemann appointed, Kevin Blackwell, has lately appeared keen on watering down an expansion plan so drastically that its chances of getting federal approval are next to nothing. Most Senate Republicans have long been more reticent to expand Medicaid than their House counterparts, but even the ones who might want to support it still have no idea what they might be voting on because Hosemann and Blackwell still haven’t put forward a plan. And no, it probably doesn’t help that Republican Gov. Tate Reeves is summoning groups of on-the-fence senators to the Mansion to lobby them against any such proposal.

There will be much hand-wringing over the politics of this decision in coming days and weeks. And make no mistake, these deliberations at the highest level of state politics are critically important and really are the entire ballgame right now.

But the elected officials, the lobbyists, the talking heads and the everyday observers of this debate must keep in mind that the decision that will be made over these next six weeks is literally life-or-death for hundreds of thousands of Mississippians.

Medicaid expansion would, as experts of all political stripes have shown, save countless lives and livelihoods in Mississippi. It would provide health insurance to between 200,000 and 300,000 working Mississippians — many of whom have never been able to otherwise afford it. It would provide a jolt of life to small towns and the rural hospitals that are keeping those towns alive. It could bring more than $1 billion in additional federal money to the poorest state in the nation, freeing up hundreds of millions that could be spent on anything state lawmakers want, not just on health care.

READ MORE: Mississippi leaving more than $1 billion per year on table by rejecting Medicaid expansion

But though Mississippians are closer than ever to having all of those boxes checked, some powerful people are working to keep our sick people sick, our struggling hospitals struggling, and our dying towns dying. The cracked door could soon be slammed shut.

The handful of people working to block Medicaid expansion today are career politicians and their benefactors who haven’t made less than six figures annually in their adult lives. They are on the state’s health plan or even more robust private plans and do not have to think about how they’ll afford trips to the doctor’s office or the people who can think of nothing else.

Today, in the backrooms of the Capitol and the Governor’s Mansion, too many of our politicians are considering this policy through the entirely wrong lens. They seem to care more about the multi-billion dollar insurance company executives sitting in corporate boardrooms in Connecticut than the hard-working, low-income earner sitting in Corinth struggling to keep his family healthy. They’re being swooned by lobbyists who park their BMWs and Benzes right outside the Capitol, and they’ve lost touch with the Mississippians — including, importantly, so many poor and working Republicans — who sent them there.

FAQ: What is Medicaid expansion, really?

The truth is these opponents of expansion face too little accountability. Too many of those corporate insurance executives and their lobbyists cut large campaign checks, and too few of those struggling Mississippians vote because they distrust a system of government that has intentionally never helped them or worked for them.

The losers of this system are, of course, all of us. If you’re not convinced of that, you need to hear this tough love:

If you believe expansion doesn’t affect you because you’re wealthy enough to have private health insurance, understand that your own out-of-pocket health care and insurance premium costs today are higher because your providers are charging you more to help offset their uncompensated care costs.

If you’re certain that the additional federal money is unnecessarily costing you when you pay your federal taxes, know that those federal taxes you’ve paid for more than a decade now have been providing health care coverage for poor, working people in 40 other states — including two of our neighboring states but not here because we’ve refused to expand.

If you care about Mississippi being a place where your kids and grandkids may want to stay or return one day, your opposition to expansion is working against job recruiting efforts that aim to make this state a more suitable place for them to lay down roots.

And if helping and loving your neighbor is truly a key part of your personal or faith ethos, know that few single policy proposals that have been earnestly considered in this state since the 1980s would help your neighbor more than this one.

History will remember what happens at the Capitol over these next few weeks. Senate Republicans may have good reason to tweak the House proposal, which would mandate a few extra votes. Compromise and reason are often necessary for legislation to be truly transformative.

But if the political opponents of expansion succeed in this critical moment, history will beg a few questions of the elected officials who killed it:

How many more Mississippi hospitals have to close?

How many more young Mississippians feel the need to leave our state?

How many more small Mississippi towns have to fade from the map?

How many more Mississippians have to die?

READ MORE: Studies show that not expanding Medicaid is killing Mississippians

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