Mississippi Lt. Gov. Tate Reeves has won the state’s 2019 gubernatorial election, and his victory both cements Republican power in Mississippi and ends discussion of expanding Medicaid in the state.

Reeves faced a surprisingly close race that saw his rival, Mississippi Attorney General Jim Hood, leading in polls for much of the year. That lead began to falter in the weeks leading up to the election, and Reeves received some last minute get-out-the-vote assistance from President Donald Trump, his son Donald Jr., and Vice President Mike Pence.

Ultimately, Reeves won both the popular vote and the majority of Mississippi House of Representatives districts, avoiding the need for lawmakers to become involved in the gubernatorial contest. (To win statewide office in Mississippi, a candidate must both win the popular vote and the majority of the state’s House of Representative districts. If no candidate wins both, the state’s House chooses who will fill the role.)

Overall, a victory for Reeves means continuity for Mississippians. He is largely expected to continue the policies he promoted as lieutenant governor, which included pro-business tax cuts, rejection of entitlement programs, and a staunchly anti-Medicaid expansion stance.

Who is Tate Reeves?

In the election, Reeves worked to cast Hood — who holds many conservative views — as a “liberal Democrat.” The governor-elect argued he was the race’s only true conservative, highlighting his record on the economy and the key issue of Medicaid.

Reeves sometimes refers to himself as Mississippi’s “fiscal watchdog,” and he used his tenure as lieutenant governor to push for lower taxes.

Reeves — and all Mississippi lieutenant governors — are able to directly influence policy through powers granted in lawsuits brought in the late 1980s and early 1990s that gave lieutenant governors not just the power to preside over the Senate as Mississippi’s Constitution outlines, but to appoint committee chairs and members and assign bills to committees for review.

Reeves has used that power, appointing committee chairs and ushering in 2016’s Taxpayer Pay Raise Act, which fulfilled a campaign promise to lower taxes.

Ahead of that bill’s passage, Reeves argued, “We need to put tax policy in place that’s going to encourage and incentivize long-term job growth.”

In the gubernatorial campaign, he used it to tie himself to President Trump, tweeting, “I believe in low taxes. I agree with Donald Trump that tax cuts are good for the economy.”

Critics of the bill — as well as the roughly 50 other tax cuts that have been rolled out under Reeves’ tenure — argue that, like the president’s signature tax cut, the Mississippi cuts benefit businesses more than citizens and that a loss of revenue has strained the state’s finances.

Reeves told Mississippi Today “all of these cuts generate more economic activity in Mississippi. More economic activity leads to better jobs, more taxpayers, and ultimately, more revenue collected.”

Under Reeves, it’s unlikely Medicaid will be expanded in Mississippi

In many ways, the race between Hood and Reeves was a referendum on Medicaid expansion. Hood was very much for it; Reeves was against it.

Mississippi is one of 14 states that has refused to expand Medicaid under the Affordable Care Act. Those states’ decision to reject the expansion had very real consequences, as Vox’s Matthew Yglesias has written:

A recent study from four researchers — University of Michigan economist Sarah Miller; University of California, Los Angeles public health scholar Laura Wherry; National Institutes of Health’s Sean Altekruse; and Norman Johnson with the US Census Bureau — estimates that failure to expand Medicaid leads to about 15,600 extra deaths per year just among people ages 55-64.

But Republican leaders in Mississippi, including Reeves, have argued that the cost sharing proposed under Obamacare is too risky to accept.

“I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi,” he said during a January luncheon.

In June, Reeves told the Clarion Ledger, “I don’t believe the expansion is nearly as good a financial deal as some would make it out to be.”

He has summed up his position on Medicaid and similar programs as “Mississippians believe the way to a better future is not through handouts or bailouts but through hard work and more freedom.”

This stance means the roughly 100,000 currently uninsured Mississippians who would receive Medicaid under an expansion will not get it, nor will the additional 200,000 insured residents estimated to have received some benefit through an expansion.

However, it is possible that Reeves’s opposition to the expansion could change. Current Gov. Phil Bryant publicly opposes a Medicaid expansion, but according to Mississippi Today, he quietly began conversations about a limited expansion similar to the one overseen by Vice President Mike Pence when he was governor of Indiana.

It is unclear whether Reeves had any role in those talks as lieutenant governor, but they suggest a possible middle route that could at least partially satisfy expansion proponents and critics. Whether Reeves embarks down that middle path, of course, remains to be seen.