But researchers say that finding is not a sign that Mississippi’s health system is working well. The report released Wednesday suggests the opposite: Mississippi performs poorly for nearly every racial and ethnic group measured, leaving the state in a precarious position as sources of federal health funding shrink.
The report evaluated health care access, quality and outcomes across all 50 states and the District of Columbia. In Mississippi, white residents had the highest overall score among groups measured in the state, but also the lowest score nationally for health system performance among white residents.
Racial disparities shown in the data are especially stark in deaths and insurance coverage for Black and Hispanic residents . Black Mississippians died before age 75 from treatable causes at a rate of 191 deaths per 100,000 people, compared with 117 for white residents. And 41% of Hispanic adults ages 19 to 64 in Mississippi were uninsured, compared with 15% of Black adults and 12% of white adults.
“The disparities we are bringing into the spotlight today are not inevitable,” Commonwealth Fund President Dr. Joseph Betancourt said during a briefing with reporters. “They are shaped by policy choices and health system decisions that can be changed.”
Those policy choices are becoming more consequential as various federal health care changes take hold. The report relies mostly on 2023 and 2024 data, meaning it does not yet reflect the full impact of Medicaid funding changes, tighter eligibility rules and the expiration of enhanced Affordable Care Act marketplace subsidies.
The enhanced premium tax credits expired at the end of 2025. KFF estimates the change will increase premium payments for marketplace coverage by 114% on average, or about $1,016 a year.
The Urban Institute estimates about 150,000 people in Mississippi could drop marketplace coverage without the enhanced credits, one of the steepest projected declines in the country.
The projected losses are especially important in states that have not expanded Medicaid under the Affordable Care Act. Mississippi is one of 10 states that has not adopted expansion, which would extend Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level.
Expansion has been a long-running political fight in Mississippi. A serious legislative push collapsed in 2024 after House and Senate negotiators failed to agree on a final plan. Any expansion proposal would have needed enough support to survive an expected veto from Gov. Tate Reeves, who has repeatedly opposed broader Medicaid expansion.
Reeves and other opponents have argued expansion would grow government dependence and leave the state more vulnerable to future federal funding decisions. But Commonwealth Fund researchers say non-expansion states did not avoid reliance on federal support, as many residents in those states who would qualify for Medicaid under expansion turned to subsidized marketplace plans instead.
“Because of the lack of extension of the enhanced tax credits, states that didn't expand Medicaid are going to see the biggest drops in enrollment in the country,” said Sara Collins, a healthcare economist and vice president for health care coverage and access at the Commonwealth Fund.
To soften that blow, Mississippi Insurance Commissioner Mike Chaney says he is working on a private exchange built around short-term health plans that cost less than individual policies sold on the open market. These policies could last anywhere from six months to 364 days and Chaney hopes to have the exchange up and running by September.
“It’s a good option for folks who can’t afford expensive individual plans,” Chaney said. “If these people end up without insurance and they have to go to the doctor, they'll end up going to the emergency rooms for uncompensated care.”
Short-term plans are cheaper in part because they do not have to follow the same rules as ACA-compliant plans. This often results in the exclusion of common benefits like prescription drugs and maternity care. They can also decline to sell a policy based on a person’s preexisting conditions.
Collins said short-term plans were not built to serve as a long-term substitute for comprehensive coverage.
“These short-term plans are always meant for very young people who may be transitioning from college to jobs, but they were never meant as a permanent source of insurance coverage,” Collins said.
