A new report from The Commonwealth Fund ranked Mississippi last in the nation for health system performance. 

The yearly scorecards released by the Fund typically rank Mississippi near the bottom or last across health care access and quality measures, but this year the scorecard also judged how health systems fared during the pandemic.

Among the report’s findings:

• Between August 2020 and March 2022, there were 323 days in which at least 80 percent of ICU beds in Mississippi were occupied. Only Georgia, Rhode Island, Alabama and Texas fared worse by this metric. 
•  Every state has experienced higher-than-expected mortality from all causes due to COVID-19 and the interruptions to routine health care, but Mississippi saw the highest rate of excess deaths in the nation between Feb. 1, 2020 and April 23, 2022. The number of excess deaths varies fivefold across states, from 110 per 100,000 people in Hawaii to 596 per 100,000 in Mississippi. The state saw the highest rates of excess deaths from both COVID-19 and treatable causes like heart disease. 
• Mississippi saw a 55% increase in drug overdose deaths between 2019-2020, the highest in the nation. In 2020, there were more overdose deaths involving opioids than any other substance at 69%. Deaths involving synthetic opioids such as fentanyl accounted for 53% of all overdose deaths. 

Richard Roberson, vice president of state policy and in-house counsel for the Mississippi Hospital Association, said that the failure to expand Medicaid has been a major factor in keeping many Mississippians uninsured and weakening the state’s hospital system.

“The federal government has offered us an option for a decade, and that option is Medicaid expansion,” Roberson said. “If you don’t like that option, then come up with something else. We’ve had a decade to come up with something else, and I haven’t seen leadership on that issue.”

Mississippi is one of 12 states that haven’t expanded Medicaid under the Affordable Care Act, leaving hundreds of thousands of Mississippians without coverage. Those in the coverage gap make too little to enroll in Medicaid, but too much to qualify for subsidized health insurance plans through the Affordable Care Act marketplace. 

Gov. Tate Reeves and Speaker of the House Philip Gunn oppose Medicaid expansion and have long maintained that the state cannot afford the costs despite studies that indicate otherwise.

If Medicaid were expanded, the federal government would cover 90% of the health care costs related to expansion, while Mississippi would have to cover the remaining 10%. Last September, one of Mississippi’s top economists released a study showing that the 10% state match would be more than covered by health care-related savings to the state and new tax revenue generated.

Not only have elected officials failed to offer meaningful alternatives to Medicaid expansion, they haven’t seriously considered the alternatives presented to them, Roberson said.

Roberson points to the Mississippi Cares plan as one example, a provider-sponsored health plan that the Mississippi Hospital Association proposed in 2019. The plan would have extended coverage to Missisippians earning up to 138% of the federal poverty level.

Under the plan, enrollees would have the same benefits as Medicaid enrollees, except for non-emergency transportation services. Dental and vision coverage would be included as well. 

Mississippi Cares would have primarily been paid for through a Medicaid waiver program, with hospitals themselves making up for any excess costs that would have otherwise fallen on the state. Patients would have only paid a $20 monthly fee and $100 copay for certain non-emergency hospital visits. 

Roberson said that Mississippi Cares was never seriously considered by the Legislature.

“‘No’ is not a solution and just sticking your head in the sand doesn’t make it (the problem) go away,” Roberson said. 

In Mississippi, it costs hospitals $1,311 to provide one day of inpatient care according to Kaiser Family Foundation data. This is the lowest cost in the nation, and less than half of the national average, but Roberson said Mississippi’s hospitals don’t bring in enough revenue for the low costs to keep them afloat.

“It doesn’t matter how low your costs are,” Roberson said. “If you can’t have enough revenue to cover your costs, you’re still going to be underwater. So that’s where a lot of our hospitals find themselves.”

Intern Allison Santa-Cruz contributed to this report.

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