Voters in Mississippi will decide the Republican candidate for governor in a runoff Tuesday between the state’s lieutenant governor and a former chief justice of the State Supreme Court who supports expanding Medicaid under the Affordable Care Act.

Lt. Gov. Tate Reeves, 45, won nearly 49 percent of the vote in the Republican primary election earlier this month, but was forced into the runoff by failing to achieve a majority. His opponent, William L. Waller, 67, captured about 33 percent of the vote.

The winner will face off in November against the Democratic candidate, Jim Hood, an anti-abortion, pro-gun populist who could pose a formidable challenge to Republicans even in a deeply conservative state.

Mississippi is one of the nation’s poorest states, and the campaign for the top elected post has been largely defined by a tension between conservative orthodoxy and some hard realities. In addition to supporting Medicaid expansion, Mr. Waller has also called for raising the state’s gas tax to fund infrastructure improvements.

Supporters of such plans say they are long overdue. A study this year from Navigant Consulting determined that 31 rural Mississippi hospitals were currently at “high financial risk” and facing a high risk of closure. A 2017 report from the American Society of Civil Engineers found that nearly 12 percent of the state’s bridges were “structurally deficient,” and argued that Mississippi’s “deteriorating” infrastructure was impeding its ability to compete for business.

Mr. Reeves, in a recent TV ad full of dark storm clouds and images of the Democratic presidential candidates, slammed Mr. Waller for supporting higher taxes, warning that the United States must choose between a “slide toward socialism” or keeping the country strong.

The ad also compares Mr. Waller to Mr. Hood, the Democratic candidate, noting that Mr. Hood, too, wants “to expand Obamacare in Mississippi.”

Richard Fausset is a correspondent based in Atlanta. He mainly writes about the American South, focusing on politics, culture, race, poverty and criminal justice. He previously worked at the Los Angeles Times, including as a foreign correspondent in Mexico City. @RichardFausset

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