OPINION: Memphis, Mississippi, and Medicaid expansion: Growth, health, and the air we share

By Selika Sweet, MD

JA Guest Writer

This year, I am honored to serve as a 2025 Climate and Health Equity Fellow, a program that trains physicians from underrepresented backgrounds to lead in climate and health advocacy. My journey has taken me from monitoring air quality with residents in Gloster to studying heat exhaustion risks in athletes. Again and again, I have seen how growth, politics, and the environment collide – nowhere more urgently than along the Mississippi–Tennessee line, where the futures of DeSoto County and Memphis are bound together by the air we breathe.

On September 18, I drove up Highway 55 from Jackson to a community forum in Southaven. The city sits directly on the Mississippi–Tennessee state line, just minutes from Memphis. Cross Elvis Presley Boulevard or I-55 and in no time you’ve left Tennessee for Mississippi.

The gathering reflected DeSoto County’s fast-changing face – neighbors of every background, some joking that Memphis is “Mississippi’s largest city.” One participant said bluntly: “Mississippi is getting browner and blacker every day because of Memphis.” But the mood shifted when a Tennessean raised the question hanging over both sides of the border:

“Now where do we go about the air quality?”

Growth and Its Consequences

DeSoto County is booming. In 1975, fewer than 50,000 people lived here. Today, that number has soared to nearly 200,000. Families arrive for good schools, new subdivisions, and safer streets. But growth brings not just opportunity – it brings heavier traffic, surging energy demand, and rising pollution.

The latest flashpoint is Colossus II, a methane-fueled turbine facility proposed by Elon Musk’s company, xAI. Similar turbines already operate in Memphis, releasing nitrogen oxides, formaldehyde, and other pollutants tied to asthma, cancer, and smog. Public filings suggest more may be coming to Mississippi.

That is deeply concerning. DeSoto is the only county in Mississippi with an “F” ozone grade from the American Lung Association. Memphis already ranks among the 20 worst U.S. cities for asthma. Additional turbines could intensify an already dangerous health burden – especially for children, seniors, and working families.

The truth is simple: pollution does not stop at state lines. When Memphis breathes dirty air, so does Mississippi. When Southaven grows without planning, Memphis feels the strain. Our communities are tied together – by highways, jobs, families, and the atmosphere upon which we all depend.

 Engines of Growth

Growth also has its upsides. While moonlighting at an urgent care clinic in Olive Branch, I have met patients once struggling to afford care but now hold steady jobs with insurance.

DeSoto’s economy is powered by three engines:

• Logistics and Distribution – With FedEx, the Port of Memphis, and major rail lines, the region has become a global shipping hub.

• Data Centers and High-Energy Tech – Facilities like Colossus II bring engineers and technicians, though at a steep environmental price.

• Biomedical and Life Sciences – Proximity to Memphis’s medical institutions makes DeSoto a natural hub for pharmaceutical and biologics distribution.

These industries can be transformative. But without foresight, they risk locking us into decades of higher emissions and worsening health outcomes. Growth can be an engine for equity – or a driver of inequity.

 Health Beyond Politics

At the Mississippi Legislature, where I once served as “Doctor of the Day,” a nurse reminded me the clinic is one of the few places where Democrats and Republicans still come together. Health should never be partisan.

Air quality is only part of the health equity puzzle. Another urgent piece is access to care. Mississippi and Tennessee are two of the few states not expanding Medicaid, leaving more than 200,000 working adults without affordable insurance.

In DeSoto County – where new jobs arrive alongside new health risks from asthma, heat stress, and pollution – coverage matters. I have treated patients forced to skip medication or delay care because they fall into the coverage gap. These are truck drivers, warehouse workers, and clinic staff – the very people keeping our economy running. Without Medicaid expansion, they remain one illness away from financial ruin.

Growth should mean healthier communities, not deeper inequities. Expanding Medicaid would ensure when families breathe polluted air or face heat illness, they can access the health care they need. Clean air and affordable health care go hand in hand – investments in people, not just profits.

A Shared Future

In the past half century, nearly 150,000 new residents have made DeSoto County their home. That raises urgent questions:

• Where do we go from here?

• How do we balance opportunity with responsibility?

• Can we grow in ways that protect – not endanger – the most vulnerable?

At the forum, I spoke about the role of the Mississippi Department of Environmental Quality (MDEQ) and the need for stronger oversight of industries whose profits depend on our air and water. Environmental enforcement and health coverage are two sides of the same coin: both are safeguards for working families.

As an eighth-generation Mississippian, I believe the answer must be yes. To borrow Sam Cooke’s words, “A change is gonna come.” But only if we choose it.

That means saying yes to cleaner air, yes to healthier families, and yes to progress that does not poison our skies. 

It means Medicaid expansion, so that those building our future – on both sides of the state line – are not left behind when they need health care.

Mississippi and Memphis share more than a border; we share a destiny. Growth is here. The question is whether we will let it divide us – or use it to build a healthier, fairer, and more hopeful future for all who call this region home.