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Elderly man with cane
A showdown in the state legislature in Mississippi over Medicaid expansion is threatening the entire Medicaid program in this very poor, very unhealthy state. And they have just until the end of this month to come to a resolution that saves the program, and the 700,000 people that are in it.

The Republican-led legislature adjourned in April without passing a Medicaid budget at all, because they couldn't come to agreement on whether or how to take the Medicaid expansion under Obamacare. As of July 1, there is no money from the state to pay for Medicaid unless the impasse is solved. Republican Gov. Phil Bryant has a few options, but to date hasn't done much to resolve the crisis.

Democrats demand a vote on expansion—but they say that if they lose, they won’t stand in the way of renewal of the current Medicaid program. Republicans, though, say they want to cut a deal with Democrats on reauthorizing Medicaid without expansion before calling a vote.

Advocates on both sides expect Bryant to call a special legislative session to save Medicaid—but there aren’t many signs that the two sides are moving closer. At the moment, there’s not much talk about a stopgap fix either.

So deep is the division that Bryant signaled he might just ignore the legislative fight and run Medicaid on his own through executive order. A spokeswoman Monday confirmed that is Bryant’s intent if lawmakers fail to reach an agreement.

But Democrats say Bryant doesn’t have the authority for the unilateral move, and they are furious Republicans are leaving so many people in limbo in one of the poorest and unhealthiest states.

Democrats have some leverage here, because their votes would be required to reach the 60 percent threshold necessary to pass the Medicaid reauthorization. So they are in the position of hostage-taking that's usually reserved for Republicans. The problem for these Democrats, though, is that their Republican counterparts probably don't give a damn if this particular hostage—Medicaid—is killed.

Meanwhile, Mississippi's health care providers are trying to plan for the potential disaster of having no Medicaid funding to cover the 700,000 people they care for. Those 700,000 people are likely sweating it out, as well.

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