JACKSON (AP) — Hospital administrators are pressuring Mississippi lawmakers to expand Medicaid, an option under President Obama’s health care law that state Republicans have so far resisted pursuing.

Some CEOs say they might be forced to lay off employees if, as expected, their facilities lose millions of federal dollars they’ve been receiving to treat uninsured patients. Expanding Medicaid could help fill hospitals’ financial gap by covering an estimated 300,000 people, mostly low-wage workers with no private health coverage.

“It’s ludicrous for the poorest state in the country … not to do expansion,” said Evan Dillard, CEO of Forrest General Hospital in Hattiesburg. Mississippi has some of the nation’s highest rates of diabetes, heart disease and obesity — conditions that can become increasingly expensive if left untreated for long periods.

Republican Gov. Phil Bryant opposes putting more people on Medicaid. About 640,000 of the state’s roughly 3 million residents already are covered by the federal-state health insurance program for the poor and disabled.

Bryant says Mississippi can’t afford it, though the federal law specifies that from 2014 to 2017 the federal government would pay 100 percent of medical costs for people qualifying under new standards. During the three years after that, the federal share progressively drops to 90 percent. The remaining cost must be covered by participating states.

“I don’t trust the federal government to pay 100 percent of Medicaid for the next three years,” Bryant said.

Republican governors were largely unified in criticism of the health care law last year. But half a dozen governors have since said they back accepting federal dollars to expand Medicaid. They include Florida’s Rick Scott, Ohio’s John Kasich and New Jersey’s Chris Christie.

Bryant, Bobby Jindal of Louisiana, and Rick Perry of Texas are among the Republican governors still opposing Medicaid expansion.

The law originally made Medicaid expansion mandatory. When a divided U.S. Supreme Court upheld most of the law last summer, it said states would have an option — not a mandate — to extend Medicaid to people earning up to 138 percent of the federal poverty level. That’s an annual income of about $15,000. Mississippi’s current income cutoff for Medicaid is about $5,500.

Many Democratic lawmakers are pushing for expansion.

“It is the most important issue to us in a generation,” said Rep. Bobby Moak of Bogue Chitto, the House Democratic leader. “We know today, somewhere, a working family of four is trying to determine whether they’re going to send their children out to get health care today and whether they can afford it, when they need the money for other things in the household.”

Ashley Tagert, a 29-year-old mother of three in Pearl, suffers from debilitating migraines and facial swelling. She’s been unable to get the care needed to diagnose the root of the problem. Under the proposed expansion, Tagert and her husband Jeff — a mechanic — would be covered. Jeff earns too much money for them to qualify now.

While the couple could buy insurance through Jeff’s job, the cost would consume half their income. Tagert says she has been laid off from several jobs and dropped out of accounting classes because migraines sometimes cause her to pass out unexpectedly. Medicaid, she says, would help her see a doctor for tests needed to pinpoint the cause.

“Right now they just keep telling me to take more pills,” Tagert said tearfully.

“I wish they would have to live like I do,” Tagert said of legislators who oppose Medicaid expansion.

Many fiscally conservative lawmakers, particularly Republicans, could find themselves in a bind. They don’t want to increase entitlement rolls, and many don’t want to buck Bryant. But, they also don’t want the blame if health care providers cut jobs. Republicans control both chambers of the legislature.

Members of the Mississippi Hospital Association are lobbying lawmakers for expansion. Sen. Chris Massey, R-Nesbit, said he received a letter from James Russell Huffman, administrator and CEO of Baptist Memorial Hospital-DeSoto, near Memphis. Massey said he hasn’t yet developed a position. “I would like to get a little more information,” he said.

Chris Anderson, CEO of the Pascagoula-based Singing River Health System, told lawmakers he “absolutely” supports Medicaid expansion.

“I realize there are pros and cons and there is some cost. But if we do not expand, we are taking taxpayer dollars from the state of Mississippi and we’re giving it to other states,” Anderson said. He said other state’s health systems would be strengthened at Mississippi’s expense.

Sen. Michael Watson, R-Pascagoula, said “communication has definitely increased” as hospitals push Medicaid expansion. He said he opposes it, agreeing with Bryant that Mississippi already spends too much on the program.

“We’re in third gear going off a cliff now,” Watson said. “Expanding it is putting it into fifth gear and going over the cliff faster.”

One of the people on the lobbying trail is Dillard at Forrest General. He said he’s explained the financial conundrum to any lawmaker who would listen.

“My tongue is in a splint, I’ve talked so much,” Dillard said.

Hospitals for years have received federal “disproportionate-share” payments for treating large numbers of uninsured patients. Some are through the federal Medicare program, which primarily covers older people, and some are through the federal-state Medicaid program, which primarily serves the needy.

Dillard said Medicare’s disproportionate-share payments end Oct. 1, and the Forrest Health system, with five hospitals, will lose $13 million. The hospitals also stand to lose money through automatic federal budget cuts and a scheduled reduction in disproportionate-share payments through Medicaid. Altogether, the system could lose about $20 million. Dillard said expanding Medicaid would help cover part of the loss.

Forrest Health employs about 4,000 people. A big loss of federal money would make layoffs inevitable, Dillard said. About 95,000 people work in health care in Mississippi.

“You’re looking at substantial reductions to the tune of thousands of people across the state,” Dillard said.

As the debate unfolds, Mississippians await the outcome.

Petra Kay operates a Jackson child-care facility with 24 employees.

“None of us have health care because we can’t afford it,” she told senators in February.

She said one employee — a single mother — was diagnosed with breast cancer a year ago. The woman qualified for help from a state program, but it runs out this month. Kay said the woman needs drugs for the next five years, and they cost several hundred dollars a month. The cancer is in remission but she has had complications.

Kay said, “It’s going to be very difficult for her.”

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Associated Press writer Laura Tillman contributed to this report.

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