In 2002, during the 83-day special session, the longest in state history, members of the Mississippi Medical Association were out in full force in favor of legislation to provide health care providers more protection from lawsuits.

The Medical Association, the largest organization of physicians in the state, had members in their white coats at the Mississippi Capitol aggressively lobbying lawmakers.

They won.

A few years later, the white-coated members were nowhere to be seen at the Capitol as various groups ranging from the American Cancer Society to the American Heart Association and many more were lobbying lawmakers for an increase in the 18-cent per pack tax on cigarettes, which was the third lowest in the nation and significantly below the national average.

The groups argued that multiple studies had found it was good for the state’s public health to increase the tax on cigarettes. And various studies had confirmed that higher taxes on cigarettes were a deterrent to smoking, especially among teenagers.

Then-Gov. Haley Barbour, a former tobacco lobbyist, blocked all efforts to increase the cigarette tax — and even the bipartisan effort led by Republican Lt. Gov. Amy Tuck to reduce the grocery tax to offset that lost revenue by increasing the cigarette tax.

The Medical Association, which was quiet on the issue, had long supported Barbour.

In Barbour’s second term, he finally acquiesced to an increase in the cigarette tax, but not a reduction in the grocery tax. But at a meeting of legislative leaders where the cigarette tax increase was announced, the head of the Mississippi Medical Association was sitting front and center.

When asked what he was doing at the meeting, he replied his group had been working for years to increase the cigarette tax. As the old saying goes, nobody knows what goes on behind closed doors, but members of the Medical Association were far from front and center on the issue like they had been on efforts to garner themselves more protection from lawsuits.

This year the Medical Association — or at least its political action committee — has endorsed Tate Reeves for governor. Reeves, like Barbour in the early 2000s, is blocking a proposal that many other health care groups argue would help improve health care in the state.

Reeves has adamantly rejected pleas from numerous groups to expand Medicaid with the federal government paying at least 90% of the costs to provide health care to primarily the working poor. Heck, while not uttering the words Medicaid expansion, even the aforementioned Mississippi Medical Association has voiced support for expanding Medicaid.

In January 2002, the Medical Association wrote: “The fact is, there is a sizable gap that exists for working Mississippians who cannot afford private health insurance, yet whose income is too much to qualify for Mississippi Medicaid. When these individuals need healthcare, hospitals are required to treat them regardless of their ability to pay. And because these individuals are uninsured, the hospital is not compensated for this necessary care. Such an economical strain on hospitals is one that even the most successful private business could not endure.”

In the same opinion piece, the Medical Association offered some “considerations” it said should be enacted.

They include a “raise the income eligibility for Medicaid.” Raising the income level is the very definition of expanding Medicaid. And if that is not enough, the Medical Association also proposed considering “the Arkansas model to provide access to care for working Mississippians through the purchase of private insurance for qualified recipients.” The Arkansas model has been approved by the federal government, which pays the bulk of the costs as a form of Medicaid expansion.

When asked if the endorsement of Reeves meant the Medical Association was giving up on Medicaid expansion, Dr. James Rish, chair of the Medical Association’s political action committee, replied via email: “We look forward to further discussion and engagement with Gov. Reeves to address the many healthcare challenges in our state, including improving accessibility, affordability, and the overall statewide healthcare delivery system for all Mississippians.”

If history is an indicator, one thing is for sure: members of the Medical Association will be sitting front and center when and if Medicaid is ever expanded, just as they were when the cigarette tax was finally increased.