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      House Republicans to vote on spending deal that could slash Medicaid funding

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      House Republicans are planning to vote on Tuesday on a spending blueprint central to Donald Trump’s agenda, but the package faces potential derailment over nearly $1tn in Medicaid cuts that could fracture their slim majority.The fiscal year 2025 proposal includes approximately $4.5tn in tax cuts alongside increased spending for defense and border security. To offset these costs, the plan tasks congressional committees with finding about $2tn in spending reductions over the next decade.But some lawmakers are warning that the budget could include an estimated $800bn in potential cuts from Medicaid, a federal program providing healthcare coverage to more than 72 million Americans. Though the resolution doesn’t explicitly target Medicaid, skeptical lawmakers warn there are few alternatives to achieve the $880bn in cuts assigned to the energy and commerce committee.If the budget measure doesn’t pass by the 14 March deadline, the government faces a shutdown – and Democrats are committed to not voting it through.“Let me be clear, House Democrats will not provide a single vote to this reckless Republican budget,” said the House minority leader, Hakeem Jeffries, from the steps of the US Capitol on Tuesday surrounded by Democratic lawmakers and advocates protesting the vote. “Not one, not one, not one.”With Democrats united in opposition, House speaker Mike Johnson’s slim Republican majority cannot afford more than one defection. Several moderate Republicans from vulnerable districts have expressed concerns, particularly those with constituents heavily reliant on Medicaid.Eight House Republicans, including the California representative David Valadao and the New York representative Nicole Malliotakis, warned in a letter to Johnson last week that “slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities”.The Nebraska Republican Don Bacon, representing a district that backed Kamala Harris as the Democratic presidential candidate in November, has demanded leadership to prove the proposal “won’t overly cut Medicaid”.Opposition to the House budget resolution has been steadily building over the last few weeks. During last week’s recess, constituent anger over Republicans’ proposed cuts to Medicaid and other social safety net programs as well as Elon Musk’s efforts to dismantle the federal government boiled over at town halls and congressional offices across the country.At an earlier Capitol Hill rally on Tuesday, Senator Chris Murphy assailed the Republican budget bill as the “most massive transfer of wealth and resources from poor people and the middle class to the billionaires and corporations in the history of this country”.skip past newsletter promotionafter newsletter promotionHe continued: “You’re talking about $880bn of cuts to Medicaid … That means that sick kids die in this country. That means that hospitals in depressed communities and rural communities close their doors, right? That means that drug and addiction treatment centers disappear all across this country.”The vote comes after the Senate passed its own budget bill last week – a less contentious one that Trump does not support as much as the House’s. House leadership must now navigate competing demands within their caucus: some members want deeper tax cuts while others seek steeper spending reductions or protection for social programs.“There may be more than one [defector], but we’ll get there,” Johnson said on Monday. “We’re going to get everybody there. This is a prayer request. Just pray this through for us because it is very high stakes, and everybody knows that.” More

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      Republicans take aim at subsidies that help tens of millions of women

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      As they prepare to take control of the White House and Congress next month, conservatives are eyeing cutbacks to federal programs that help tens of millions of women pay for healthcare, food, housing and transportation.Slashing or overhauling social support programs, long a goal of Republican lawmakers, could be catastrophic for women experiencing poverty. Supporters contend the social safety-net programs are already grossly underfunded.“With this new administration that is coming in … I really am concerned about the lives of women. We are seeing so many policies, so many budget cuts,” said Christian Nunes, president of the National Organization for Women.Republicans say they want to keep campaign promises to cut government spending, and three major programs make easy targets: Medicaid, the joint state/federal health insurance program for people with lower incomes; Temporary Assistance for Needy Families (TANF), a cash-allowance program that replaced welfare; and the Supplemental Nutrition Assistance Program (Snap), widely known as food stamps.While conservatives frame cuts as making government more efficient and even restoring freedom, advocates for and experts on families with little or no income say reducing these programs will throw more people – especially women and children – further into poverty.“It is going to fall heavily on women,” said Elaine Waxman, a senior fellow in the Income and Benefits Policy Center at the Urban Institute, a non-profit research organization.Predicting precisely what Republicans in Congress and the Trump administration will do is difficult. Congressional leaders are close-mouthed about negotiations, and the president-elect has not finished putting together his advisory team. None of the spokespeople contacted for this story returned calls or e-mails.But organizations known to advise top leaders in Congress and the previous Trump administration have laid out fairly detailed roadmaps.Project 2025, the conservative Heritage Foundation’s blueprint for the incoming administration, denies its proposed changes will harm women, saying instead that marriage and “family values” will improve their economic situations. “Marriage, healthy family formation, and delaying sex to prevent pregnancy are virtually ignored in terms of priorities, yet these goals can reverse the cycle of poverty in meaningful ways,” reads the section on proposed changes to TANF and Snap.Numerous other groups that have studied the problem say forcing or even encouraging marriage will not make poverty disappear. And a recent study by a team at the University of South Carolina found that when state laws make it harder for pregnant women to get divorced, they’re more likely to be killed by their partners.Trump has promised not to attack the two most expensive and popular government programs: social security and Medicare. But he and Congress are up against a deadline to extend his 2017 tax reforms, which raised the federal deficit. They’ll have to cut something, and social spending programs, especially the $805bn Medicaid program, are low-hanging fruit for conservatives.Trump repeatedly tried to slash Snap during his last tenure in office: his 2021 budget proposal would have cut the program by more than $180bn – nearly 30% – over 10 years. Conservatives in Congress have continued these efforts and, with majorities in the House and Senate, they may be able to get them through next year.The Republican Study Committee, whose members include about three-quarters of the House Republican caucus, recommends more work requirements for Snap and TANF.“SNAP and our welfare system should embrace that work conveys dignity and self-sustainment and encourage individuals to find gainful employment, not reward them for staying at home,” their plan, released in March, reads.A large body of research questions whether widening work requirements does anything other than force people off benefits without helping them find employment. “I think there is a misperception that people in need of help are not working,” said Mei Powers, chief development and communications officer at Martha’s Table, a non-profit aid organization in Washington DC. “People are a paycheck, a crisis, a broken-down car away from needing services.”Snap currently helps 41 million people buy groceries and other necessities every month. Women accounted for more than 55% of people under 65 receiving Snap benefits in 2022, according to the National Women’s Law Center, a gender justice advocacy group. About one-third of them were women of color, the NWLC said.Among other things, cutting these programs will trap women in dangerous situations, the NWLC said: “SNAP helps survivors of domestic violence and sexual assault establish basic economic security.”TANF, which provides cash assistance, overwhelmingly benefits women. In 2022, 370,000 TANF adult recipients were female and 69,000 were male, according to the Department of Health and Human Services.Perhaps Medicaid is the most tempting target for conservatives because they can use it to undermine the Affordable Care Act, also known as Obamacare. The GOP has been gunning for the ACA since it was signed into law without a single Republican vote in 2010.The federal government shares the cost of Medicaid with states. The ACA aimed to make Medicaid cover more people by offering to pay for virtually all the extra costs. Many Republican-led states resisted for years, but as of November, all but 10 states had expanded coverage to an extra 21 million people, or about a quarter of all Medicaid recipients.Medicaid pays for more than 40% of births in the US, plus it covers new mothers for post-pregnancy-related issues for 60 days. It also pays for medical care for 60% of all nursing home residents, more than 70% of whom are women.According to the health research organization KFF, expanding Medicaid helped improve care for women before and during pregnancy and after they gave birth.But most Republicans in Congress have never approved of this federal spending. Proposed cuts to Medicaid funding, which would save hundreds of billions of dollars, are laid out by the Paragon Health Institute, a conservative health thinktank headed by Brian Blase, a top health adviser to the first Trump administration.Experts predict states would be unable or unwilling to make up the difference. “Facing such drastic reductions in federal Medicaid funding, states will have no choice but to institute truly draconian cuts to eligibility, benefits and provider reimbursement rates,” Edwin Park, research professor at Georgetown University, wrote in an analysis.That would mean women, children, older adults and people with disabilities would lose coverage as facilities closed and providers stopped seeing patients.The effects, says the National Organization for Women, “will be widespread, devastating, and long-lasting”.This story is published in partnership with the Fuller Project, a non-profit newsroom dedicated to the coverage of women’s issues around the world. Sign up for the Fuller Project’s newsletter. More

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      Who is Mehmet Oz, Trump’s pick to lead Medicare and Medicaid?

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      Donald Trump has chosen Mehmet Oz, best known for starring in his eponymous daytime talkshow for more than a decade and leaning heavily into Trumpism during his failed 2022 run for a Pennsylvania Senate seat, to lead the Centers for Medicare and Medicaid Services (CMS). The cardiothoracic surgeon, who faced immense backlash from the medical and scientific communities for pushing misinformation at the height of the Covid-19 pandemic, will oversee the agency that operates on a $2.6tn annual budget and provides healthcare to more than 100 million people.“I am honored to be nominated by [Donald Trump] to lead CMS,” Oz posted on X on Tuesday. “I look forward to serving my country to Make America Healthy Again under the leadership of HHS Secretary [Robert F Kennedy Jr].”In the announcement of Oz’s selection, Trump said that Oz will “make America healthy again” and described him as “an eminent Physician, Heart Surgeon, Inventor, and World-Class Communicator, who has been at the forefront of healthy living for decades”.Oz has been on US television screens for nearly 20 years, first appearing on the Oprah Winfrey show in 2004. In that time, he’s talked to his audience about losing weight with fad diets and what it takes to have healthy poops and, toward the end of his run, touting hydroxychloroquine as a potential remedy for Covid-19.Here’s what to know about the New York University professor and surgeon turned television show host, and now Trump appointee.Who is Mehmet Oz?Oz, 64, is a Turkish American Ohio native best known for The Dr Oz Show, which ran from 2009 to 2022. His father was a surgeon in Turkey, and after Oz graduated high school in Delaware, he was admitted into Harvard. He also served in the Turkish military in order to maintain dual citizenship, the Associated Press reports.Before entering US homes via daytime TV, he had more than 20 years of experience as a cardiothoracic surgeon at Presbyterian-Columbia Medical Center in New York. He was also a professor at Columbia University’s medical school.His bona fides at the prestigious institutions earned him quick credibility with viewers, and his popularity garnered him nine Daytime Emmy awards for outstanding informative talkshow and host.Though his show ended in 2022, Oz maintains a YouTube channel filled with old episodes of his shows where he interviews guests like Penn Jillette about his weight loss and Robert F Kennedy Jr about his 2014 book about the presence of mercury in vaccines. He also has an Instagram account that boasts more than a million followers, where Oz shares photos of his family and sells products from iHerb, an online health and wellness brand for which he is global adviser.Oz’s questionable medical advice and time in politicsThroughout his TV tenure, Oz dabbled in the hallmarks of weight loss culture like detoxes, cleanses and diets that promised rapid weight loss. He also faced a grilling by senators in 2014 over claims he made and alleged false advertising on supplements he promoted on his show. When the Covid-19 pandemic hit, Oz regurgitated misinformation that came from the fringes of the right and medical communities.These comments continued when he threw his hat into the race to represent Pennsylvania in the US Senate in 2022 against John Fetterman. At the time, the Guardian wrote:“Oz was dogged by questions about his actual connection to the state during the campaign. Oz lived in New Jersey for decades before he moved to Pennsylvania in October 2020, into a home owned by his wife’s family. He announced his bid to be the state’s US senator just months later.”Following Fetterman’s stroke, during which he said he “​​almost died”, the Oz campaign launched unsavory attacks against him, with one Oz aide, Rachel Tripp, claiming Fetterman might not have had a stroke if he “had ever eaten a vegetable in his life”.Oz ultimately lost to Fetterman, who garnered 51% of the vote compared with Oz’s 46%.What will Oz run?Oz will succeed Chiquita Brooks-LaSure, the current administrator of CMS, to lead programs including Medicare, the federal health insurance program for people aged 65 or older and disabled people, and Medicaid, the state-based health insurance program for lower-income people, which is jointly funded by states and the federal government. The two programs provide health insurance for more than 140 million Americans.Also in the CMS fold are the Children’s Health Insurance Program (Chip) and the Health Insurance Marketplace, which was created by the Affordable Care Act under Barack Obama in 2010.Trump’s economic advisers and congressional Republicans are currently discussing possible cuts to Medicaid, food stamps and other government welfare programs to cover the costs of extending the president-elect’s multitrillion-dollar 2017 tax cut. More

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      Trump advisers contemplating cuts to Medicaid and other welfare programs

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      Donald Trump’s economic advisers and congressional Republicans are discussing possible cuts to Medicaid, food stamps and other government welfare programmes to cover the costs of extending the president-elect’s multitrillion-dollar 2017 tax cut.The cuts could mean new work requirements and spending caps, according to the Washington Post, citing sources involved in the talks, including aides in Trump’s transition team.Extending the tax cuts – most of which are due to expire next year – could add $4tn to the national debt, which already stands at $36tn.But Republicans fear triggering a political backlash by slashing programmes that serve an estimated 70 million Americans to pay for a tax cut that disproportionately benefits the wealthy.The 2017 tax cuts were criticised for being skewed in favour of the rich, with households in the top 1% income bracket receiving a reduction of $60,000 in 2025, compared with less than $500 for those in the bottom 60%, according to the Center on Budget and Policy Priorities.Trump campaigned on extending the 2017 reduction while also vowing to abolish taxes on tips for restaurant workers.Republicans support the extension but worry that the loss of revenue could add to government borrowing – prompting them to search for savings in others areas.In addition to safety net programme cuts, some Republicans are considering re-purposing clean energy funds passed by Democrats.The GOP has warned that the costs of Medicaid – whose claimants can include low-income people, newborns, people who are blind or disabled, and those suffering from certain illnesses – has ballooned with the expansion of the Affordable Care Act, also known as Obamacare.Jodey Arrington, the chair of the House of Representatives’ budget committee, told reporters that a “responsible and reasonable work requirement” could save $100bn in Medicaid costs, while another $160bn could be cut by checking eligibility more than once a year.The Paragon Health Institute, a rightwing thinktank, published a study in the summer proposing other reductions that it said could save $500bn over a decade. It said rule changes to Medicaid recently enacted over the past year by the Biden administration could cost up to $135bn nationally and between $46.3bn and $82.3bn at state level over the next five years.Alterations to food stamps – officially known as the Supplemental Nutrition Assistance Program – could take the form of limiting which items recipients can purchase with benefits or broadening work requirements. The latter proposal was floated in the Heritage Foundation’s Project 2025 blueprint for radically overhauling US government.Qualifying criteria are tailored to assist the poorest households, with eligibility determined by income and household size. A single person with no dependents needs to be earning less than $1,354 a month to qualify. A household with two or more people but earning $1,800 per month would also be eligible.The projected cuts to welfare entitlement programmes come as the Republicans prepare to control the White House and both chambers of Congress following this month’s election.It also coincides with Trump’s choice of Elon Musk, the Tesla and Space X entrepreneur, to head a newly formed Department of Government Efficiency along with Vivek Ramaswamy, his former Republican primary opponent, with the brief of slashing waste from federal spending. Musk has spoken of making around $2tn in spending cuts.The US is currently running a budget deficit at around 6% of its gross domestic product. The national debt held by the public is currently worth around 97% of the national economy.The non-partisan Committee for a Responsible Federal Budget has argued that, without major spending reductions, the deficit would widen significantly in the next 10 years, while the US national debt could soar to 143% of the economy. More

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      Some States Say They Can’t Afford Ozempic and Other Weight Loss Drugs

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      Public employees in West Virginia who took the drugs lost weight and were healthier, and some are despondent that the state is canceling a program to help pay for them.Joanna Bailey, a family physician and obesity specialist, doesn’t want to tell her patients that they can’t take Wegovy, but she has gotten used to it.Around a quarter of the people she sees in her small clinic in Wyoming County would benefit from the weight-loss medications known as GLP-1s, which also include Ozempic, Zepbound and Mounjaro, she says. The drugs have helped some of them lose 15 to 20 percent of their weight. But most people in the area she serves don’t have insurance that covers the cost, and virtually no one can afford sticker prices of $1,000 to $1,400 a month.“Even my richest patients can’t afford it,” Dr. Bailey said. She then mentioned something that many doctors in West Virginia — among the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We’ve separated between the haves and the have-nots.”Such disparities sharpened in March when West Virginia’s Public Employees Insurance Agency, which pays most of the cost of prescription drugs for more than 75,000 teachers, municipal workers and other public employees and their families, canceled a pilot program to cover weight-loss drugs.Some private insurers help pay for medications to treat obesity, but most Medicaid programs do so only to manage diabetes, and Medicare covers Wegovy and Zepbound only when they are prescribed for heart problems.Over the past year, states have been trying, amid rising demand, to determine how far to extend coverage for public employees. Connecticut is on track to spend more than $35 million this year through a limited weight-loss coverage initiative. In January, North Carolina announced that it would stop paying for weight-loss medications after forking out $100 million for them in 2023 — 10 percent of its spending on prescription drugs.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      In Late-Stage Budget Talks, Hochul Wins Concessions From N.Y. Lawmakers

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      Gov. Kathy Hochul used the $237 billion budget to wedge in contentious issues like extending Mayor Eric Adams’s control over New York City schools.In the days approaching April 1, the corridors and backrooms of the New York State Capitol tend to be filled with tension and chaos, as the governor, lawmakers and staff scramble to meet the deadline to pass a state budget that is as much a policy blueprint as it is a spending plan.This year was different.Budget talks dragged out almost three weeks past the April 1 deadline, leading some to wonder whether Gov. Kathy Hochul, a Democrat in her first full term, had lost control of the process.But by the time the budget was officially passed by the Legislature on Saturday, it was clear that Ms. Hochul had achieved her goal: a final $237 billion budget that included a checklist of her priorities. They included new resources to fight retail crime, a statewide artificial intelligence consortium, and a landmark housing deal aimed at bolstering residential construction — all without raising taxes on the wealthy.The governor’s long-game approach seemed to reflect lessons she has learned in reaching the three budget agreements since she took office in 2021: that a governor can lead while honoring the spirit of collaboration and that a good deal is better than a fast one.After Ms. Hochul announced on Monday that leaders had reached agreement on a budget framework, she continued to negotiate over the next few days, most notably persuading state lawmakers to use the budget to extend mayoral control of New York City schools for two more years.The final budget contains $2.4 billion to support migrant services in New York City, an increase of half a billion dollars over last year’s funding that should cover case management, medical expenses and legal resources. It also includes a substantial new tax break for developers, expanded tenant protections and new enforcement powers for localities to crack down on unlicensed cannabis shops.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Americans Are Signing Up for Obamacare in Record Numbers

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      The NewsMore than 15 million people have signed up for health insurance plans offered on the Affordable Care Act’s federal marketplace, a 33 percent increase compared to the same time last year, according to preliminary data released by the Biden administration on Wednesday.Federal health officials project that more than 19 million people will enroll in 2024 coverage by the end of the current enrollment period next month. That total would include those who gain coverage through state marketplaces, continuing the record-setting pace.“It means more Americans have the peace of mind of knowing that going to the doctor won’t empty their bank account,” Xavier Becerra, the health and human services secretary, said in a statement.An Affordable Care Act sign-up kiosk in a mall in Miami this month.Rebecca Blackwell/Associated PressWhy It Matters: The Affordable Care Act is expanding its reach.Despite a recent warning from former President Donald J. Trump, the front-runner in the race for the 2024 Republican presidential nomination, that he was “seriously looking at alternatives” to the Affordable Care Act, the latest surge in marketplace enrollment is a testament to the law’s enduring power.Legislation passed earlier in the Covid-19 pandemic increased federal subsidies for people buying plans, lowering the costs for many Americans. The Biden administration also lengthened the sign-up period and increased advertising for the program and funding for so-called navigators who help people enroll.“More and more people are realizing they can come onto the marketplace,” said Cynthia Cox, the director of the Program on the Affordable Care Act at KFF, a nonprofit health policy research group.She added: “Just because the A.C.A. has been around for a while doesn’t mean people who need to sign up for it know how to do that.”One Eye-Popping Statistic: 750,000 sign-ups in a single day.On Dec. 15 — the deadline to sign up for coverage that begins on Jan. 1 — nearly 750,000 people opted for a marketplace plan on HealthCare.gov. It was the largest single-day total yet.Dr. Benjamin Sommers, a health economist at Harvard who served in the Biden administration, said that improved outreach helped explain the record sign-ups. “I’m pleasantly surprised,” he said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber?  More

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      A Democratic Governor in Mississippi? He Thinks It’s Possible.

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      With a promise to expand Medicaid and a focus on turning out Black voters, Brandon Presley is confident he can do what no Democrat has done in 20 years. After stopping by a meet-and-greet in Ridgeland, a porch festival in Vicksburg, the Great Delta Bear Affair in Rolling Fork and an event on a baseball diamond in Yazoo City, Brandon Presley entered a packed room in McComb, launching into the message he believes can get a Democrat — namely, himself — elected governor of Mississippi. He would immediately move to expand Medicaid, which would help resuscitate rural hospitals and provide largely free government health insurance to most low-income adults. He would slash a hated tax on groceries. Above all, he assured the crowd, he would be a very different governor than Tate Reeves, the Republican incumbent, whom he denounced as ensconced in privilege and dented by scandal.“The fight in politics in Mississippi is not right versus left,” Mr. Presley, an elected public utilities commissioner and a former mayor of Nettleton, his tiny hometown in northern Mississippi, said in McComb. “And sometimes, it’s not even Democrat versus Republican. It’s those of us on the outside versus those of them on the inside.” Mr. Presley’s campaign has been a built on a bet that his human touch and populist platform can forge a coalition of Black and liberal-to-centrist white voters, some disaffected Republicans among them, that is robust enough for him to win. It is a test of a blueprint that Democrats have long relied on, but to diminishing effect in recent decades, as Republicans have tightened their grip on power in Mississippi and most of the South.Mr. Presley, left, and Tate Reeves, the Republican incumbent, during a debate on Wednesday.Brett Kenyon/WAPT, via Associated PressYet Mr. Presley has gained decent momentum — and with it, the attention of Democrats outside Mississippi. He has raised more than $11 million since January, far outpacing Mr. Reeves, and has used the money to flood television and radio stations with campaign advertisements. The nonpartisan Cook Political Report recently found that the election had “morphed into a competitive fight.” But it also classified the race as “likely to lean Republican” — a splash of cold water underscoring that, no matter how much ground Mr. Presley gains or optimism he has inspired in Southern Democrats, he still faces difficult odds in a state that has not elected a Democratic governor in 24 years.In the race for governor four years ago, Jim Hood, then the state attorney general and the last Democrat elected to statewide office, was seen as the most viable candidate the party had fielded in Mississippi in more than a decade. Yet he lost to Mr. Reeves by about five percentage points.Still, Mr. Presley sensed an opening. He believed that Mr. Reeves’s shaky popularity ratings, fury over a sprawling scandal involving welfare funds being directed to the pet projects of wealthy and connected Republicans, and dissatisfaction over the state’s eternal struggle for prosperity could allow him to accomplish what previous Democratic candidates could not. If neither candidate wins a majority of the popular vote on Tuesday, the race will go to a runoff on Nov. 28. Mr. Presley has invested enormous effort in mobilizing Black voters, a crucial bloc in a state where nearly 40 percent of the population is Black. But turning out the rest of the coalition that Mr. Presley needs — for example, white working-class voters who might have voted for Mr. Reeves last time — will be instrumental.“You can’t win if you don’t win white crossover votes,” said Byron D’Andra Orey, a political science professor at Jackson State University. For months, Mr. Presley has had marathon days ping-ponging across Mississippi, stopping in all 82 counties. He has become a frequent presence at football games on historically Black college campuses, as well as at festivals and small gatherings in community centers. In each place, he has made the same case: He is not a liberal — he opposes abortion rights — and he is certainly no elite. True, Elvis Presley was his second cousin, but a distant relative’s fame did nothing to boost his family’s fortunes. His mother was left to raise him and his siblings on her own after his father was killed when he was 8. Mr. Presley has become a frequent presence at football games on historically Black college campuses, as well as at festivals and small gatherings in community centers.Emily Kask for The New York Times“I’m white, and I’m country — it ain’t nothing I can do about it,” Mr. Presley told a mostly Black audience at one campaign stop. “But I get up every day and go to bed every night trying to pull Mississippi together.”The state fractures along racial and regional lines, creating a landscape that is anything but homogeneous, even as it tilts heavily in the Republican Party’s favor. The western flank, including the flat expanse of farmland in the Delta, votes for Democrats. Mr. Presley has wagered that one of his goals in particular can unify Democrats and Republicans, Black and many white voters: joining the 40 other states that have expanded Medicaid under the Affordable Care Act. Researchers have forecast that doing so would make the coverage available to roughly 230,000 lower-income adults over six years. Polls in Mississippi — where death rates are among the nation’s highest for heart disease, stroke, diabetes and cancer — have indicated overwhelming support.Mr. Reeves has been adamant in his opposition to expanding Medicaid, pointing to the cost (most of which would be a federal responsibility) and dismissing it as “welfare.” In September, he proposed an alternative that, if approved by federal officials, would increase funding for some hospitals but would not provide coverage for the uninsured. Mr. Presley with a supporter in Fulton, Miss.Houston Cofield for The New York TimesGrant Dowdy, a dentist in Greenville who came to the festival in Rolling Fork, said he was prepared to break a consistent streak of voting for Republicans precisely because of Mr. Presley’s support for Medicaid expansion. Mississippi, he said, “needs to be like every other sensible state in the nation.”But in such a polarized political climate, where party allegiance often outweighs all else, recruiting enough Republicans to tip the scale toward Mr. Presley may prove impossible. In 2001, he became the youngest mayor in Mississippi when was elected to lead Nettleton, a city of some 1,900 people in the state’s northeast. Since then, Mr. Presley, 46, has been elected four times to represent a vast swath of northern Mississippi on the state’s Public Service Commission, which regulates telecommunications, electric, gas, water and sewer utilities. Colleagues and supporters said the position — in a district filled with heavily conservative areas — helped him hone the solicitous approach he is bringing to the governor’s race. Mr. Reeves has cast Mr. Presley as a liberal aligned with President Biden, and his campaign as orchestrated by the national Democratic Party. He has pointed out that most of Mr. Presley’s fund-raising haul has come from outside Mississippi. “Ask yourself: Why are they dropping historic money on Mississippi to flip it blue?” Mr. Reeves said on social media in October. “It’s because they know Brandon Presley will govern like a liberal Democrat.”Mr. Reeves is also emphasizing his conservative bona fides, including tax cuts he has signed and a promise to keep pursuing his ambition of eliminating the state income tax. Mr. Presley has been elected four times to represent a swath of northern Mississippi on the state’s Public Services Commission.Houston Cofield for The New York TimesHe has touted the state’s unemployment rate, which has fallen to just over 3 percent — the lowest it has been in decades. He has also campaigned on raises he approved last year for public schoolteachers that were among the largest in state history, amounting to average increase of about $5,100 a year. Mr. Reeves has also said that his administration is trying to claw back money misspent in the welfare scandal, in which more than $77 million was siphoned from the state’s poorest residents to fund projects like one championed by Brett Favre, the former N.F.L. player, to build a volleyball stadium at the University of Southern Mississippi. Mr. Reeves was the state’s lieutenant governor at the time. Mr. Presley knows how to rouse a crowd, evoking a pastor in one moment and insult comic the next. He skewered Mr. Reeves at the candidate forum in McComb to cheers of approval and howling laughter, offering an almost cartoonish depiction of the governor as unfamiliar with and unsympathetic to the hardships facing the working poor.“Like the pharaoh of old, his heart has turned to stone,” Mr. Presley said. He also took particular delight in roasting upgrades reportedly made to the governor’s mansion, like a special shelter for lemon trees and a pricey ice maker (“It better make that good Sonic ice!”).At various stops, he has told crowds about a promise to his wife, Katelyn, whom he married just three months ago: If he wins, they will feed the homeless out of the governor’s mansion. His concern for the needy, he says, grew out his own experience enduring the turmoil and indignities of poverty. Some who came out to hear him speak recently said they were drawn to Mr. Presley because his early struggles sounded familiar — and simply because he was there, reaching out to them.“Look where he is,” said Joseph M. Daughtry Sr., the police chief in Columbus, where Mr. Presley had navigated a maze of country highways to speak to a few dozen people at a community center in a poor, largely Black neighborhood. “We have somebody who understands us,” Chief Daughtry said. “Somebody who cares about us. And somebody who is not ashamed of us.”Mr. Presley walked over to shake his hand. More