Using power and commerce to gut health care
Part 2 in a series: What Title IV of the “One Big Beautiful Bill” means for Mississippi
In this series, The Mississippi Independent explores how House Bill 1 would affect state residents for better, worse, or in ways we do not yet fully understand.
The Title IV section of the “One Big Beautiful Bill” is labeled “Energy and Commerce.” Yet buried within its 1,000 pages are measures that go far beyond the scope of any oil drilling or pipeline plan and would dramatically undermine health care access, especially for people in states like Mississippi.
HB 1, the massive federal budget reconciliation package, was passed by the U.S. House of Representatives in May and is now before the U.S. Senate. Its Title IV measures focus on energy and commerce industry permits, infrastructure and power plants — but also take direct aim at Medicaid, the federal lifeline that keeps rural hospitals open, pays for nursing home care and covers nearly half of Mississippi’s children.
House Republicans wrote the bill to include $880 billion in cuts from programs under the purview of the Energy and Commerce Committee, which has wide-ranging jurisdiction, including over Medicaid.
The Medicaid bombshell
This section of the bill addresses issues related to pipelines and power grids, but also encompasses a sweeping rollback of a range of health care protections. It doesn’t just threaten Medicaid funding -- it rewrites who gets to stay covered, what states are allowed to do, and who gets left out entirely. It eliminates rules that help people stay enrolled in Medicaid, CHIP (the Children’s Health Insurance Program) and other federal health care programs.
It would also:
End continuous coverage for children
Reinstate aggressive deadlines for Medicaid and CHIP renewals (if a family missed a deadline by a single day — even if due to mail delays or internet issues — they could be dropped from coverage)
Prohibit automatic renewals without full reverification
Nationally, that could result in 400,000 children and more than 1 million seniors losing coverage.
As of 2024, more than 740,000 Mississippians were enrolled in Medicaid, including nearly half of all children in the state, 60 percent of nursing home residents and thousands of working adults with disabilities and chronic conditions. These aren’t just numbers. They are everyday Mississippians -- neighbors, family members, people like the cashier at the local Dollar General.
It doesn’t stop there. The bill also:
Strips states of the ability to offer Medicaid to lawfully present immigrants
Ends retroactive Medicaid coverage, meaning applicants would be on the hook for past medical bills
Blocks federal funding for clinics that provide specialized care, even if they serve as a primary care provider in rural areas (many Mississippi counties lack a single OB-GYN or general practitioner)
Cuts care access for low-income patients in already underserved areas
Eliminates access to cancer screenings, birth control, STI testing and routine check-ups for low-income patients who have nowhere else to go
Researchers at Yale and the University of Pennsylvania estimate the bill’s proposed changes could lead to more than 51,000 preventable deaths every year, including 13,000 people in nursing homes due to staffing cuts, and to lost prescription medication coverage for another 18,000 people.
These changes would be devastating in Mississippi, which already suffers under a fragile system. The stats for Mississippi show its existing shortfalls:
One of the lowest life expectancy rates in the U.S.
Since 2015, four Mississippi hospitals have shut down and 54 percent of state hospitals are at risk of closing. Hospitals and clinics that are still in operation are stretched thin, with fewer staff, smaller budgets and aging equipment.
Medicaid in Mississippi is more than insurance. It keeps rural hospitals open, funds labor and delivery units, covers emergency care, and supports long-term care in nursing homes.
Energy promises with strings attached
As with Medicaid, Title IV’s energy provisions, including for coverage of infrastructure, modernization and energy independence, are wrapped in promises with dangerous fine print. They gut billions in funding for clean energy, workforce training and rural grid upgrades just as Mississippi is beginning to catch up to other parts of the country.
Among the provisions:
Unspent funds for clean energy job training are rescinded. That includes money that was supposed to support programs to train electricians, HVAC technicians and energy-efficient crews in states like Mississippi (which reported some of the fastest rates of growth for jobs in renewable energy and energy efficiency jobs).
Loan guarantees and technical assistance for upgrading old fossil infrastructure are stripped despite the fact that many Mississippi towns still rely on power systems built before integration.
Grants for rural energy resilience, microgrids, and community solar are rolled back. These funds were designed to help small towns modernize transmissions systems, which is critical in a state where one bad storm can take out an entire county’s power.
Nearly one-third of Mississippi’s rural electrical infrastructure is rated at-risk or overdue for replacement. More than 60 percent of rural counties are served by co-ops or municipal utilities that can’t afford big capital upgrades without federal help. These cuts would mean fewer jobs, slower grid updates and missed opportunities to modernize.
And once again, the communities that pay the price would be the ones already behind: rural Black majority towns, storm-battered Delta counties and low-income neighborhoods where energy bills already eat up a third of households’ monthly budgets.
Who decides what gets built — and where
Title IV doesn’t just cut funding; it shifts power. We aren’t just talking about megawatts, but about who gets to say “yes” or “no” when pipelines and energy projects are authorized.
Currently, energy projects such as natural gas or carbon dioxide pipelines that cross state borders require federal environmental reviews and what’s known as presidential permits. The existing regulatory process is far from perfect, but it offers some level of transparency, local consultation and legal accountability. The new bill proposes bulldozing those guardrails.
Key changes include:
A new “Certificate of Crossing” that bypasses the presidential permit process
Expanded authority for the Federal Energy Regulatory Commission over infrastructure for carbon dioxide, hydrogen and petroleum pipelines — even on private or state-regulated land
A fast-track process allowing developers to pay fees to skip environmental reviews and public hearings
This isn’t theoretical. Carbon capture pipelines, which transport compressed CO₂ from industrial and ethanol plants, are already in operation, in development or being scouted in north and central Mississippi. There are currently about 5,300 miles of CO₂ pipelines in the U.S., and largely as a result of carbon capture and its use for enhanced oil and gas drilling, that number is expected to grow to 65,000 in coming years.
The technology is largely untested at scale in the South, and the pipelines carry grave risks – just ask the folks in Satartia, Mississippi, where a CO₂ pipeline rupture in 2020 hospitalized 45 residents and forced more than 200 to evacuate. The lingering cloud of carbon dioxide significantly hampered the emergency response, to the point that some residents were unable to flee and had to remain in their homes and face devastating consequences.
Obviously, this is about more than the energy industry. In addition to public health and safety, at stake are land rights, environmental justice, and whether local communities have a voice in their own future.
Should local residents manage to sound the alarm and stop development under weakened standards, the bill provides a parachute for corporations. Imagine that a carbon pipeline company wants to run a line through farmland in Leflore County. Local families and farmers push back due to worries about leaks, health risks and damage to the soil. The county files a lawsuit and wins, stopping the pipeline from being built.
Under Title IV’s new “De-Risking Compensation Program,” that pipeline company could then turn around and bill the federal government for the money it would have made if the project had gone forward. They would get reimbursed for profits they never earned, because the community refused to allow the project to be built as planned.
Meanwhile, the folks who fought to protect their land, their health and their water?
They would get nothing.
Hollow promises, heavy costs
This is about more than policy. The reconciliation bill’s Title IV gives us a window into the values driving this entire budget.
It would:
Cut health care
Slow growth
Centralize decision-making in Washington, D.C. while silencing the voices of local communities
Shield fossil fuel developers while pulling the plug on public health programs
Title IV dangles broadband access, job training and “revitalization,” yet those benefits stand out only if you ignore the clinics and hospitals that are closing down the road.
For Mississippi, a state where need already outpaces resources, this isn’t just a bad deal. It’s a blueprint for deeper harm. It will keep bring deprivation to the sick and the underserved while shunting wealth and control elsewhere.
In the next installment of this series, we’ll look into Title V: Financial Services. From banking rules to consumer protections, we’ll follow the money -- and see whose pockets the budget reconciliation bill will line.
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