Photo by Drew Beamer on Unsplash

If You’re Black In Mississippi, Health Care Is Quickly Falling Apart

Phil Garber
6 min readMar 30, 2023


To understand why it is so important that the schools teach about the longstanding and continuing effects of enslavement, take a ride through Mississippi.
Mississippi is what institutional racism looks like.
It should come as no surprise but the so-called “Hospitality State” is anything but hospitable when it comes to poor people, specifically African Americans, who constitute around 37.8 percent of the state’s population, and the hospitals that serve them.
The latest inaction by the state’s overwhelmingly Republican government is to refuse to enroll in the federal government’s extended Medicaid program. The inaction is a real death sentence to Mississippians who continue to have at or near the worst death rates in the nation, with African Americans suffering from high rates of heart disease, stroke, diabetes, cancer, kidney disease and pneumonia. Infant mortality is also sky-high, and the state has the nation’s highest rate of foot and leg amputations because of diabetes or hypertension.
True to form, most recently, Mississippi’s state legislators again rejected an estimated $1.35 billion in federal money to expand health insurance for its poor residents. The decision means less money for individuals and health care reimbursements at a time when many hospitals are feeling the financial squeeze and are closing or limiting services.
The decision means that in Mississippi, only disabled adults and parents with extremely low incomes, along with most pregnant women, are eligible for Medicaid. Many of the state’s poor residents are too poor to qualify for the tax credits for insurance under the Affordable Care Act, leaving them without affordable options.
It is especially acute in the delta, home to more than 300,000 people, including nearly 35 percent who are African Americans living in poverty at a rate three times the national average.
Expanded health care means increases in regular checkups, cancer screenings, diagnoses of chronic diseases and prescriptions for needed medicines. In the 40 states that have enrolled in the expanded Medicaid program, a report found that in a four year period, 19,200 more adults aged 55 to 64 survived because of expanded coverage, and nearly 16,000 more would have lived if that coverage was nationwide.
The state’s decision not to enroll means that medical coverage will not be available for around 100,000 uninsured adults making less than $20,120 a year. In Mississippi, African Americans are more than half of those who will not receive expanded Medicaid.
The federal funding is offered under a 2014 increase to the federal government’s Affordable Care Act, known as Obamacare. In states that agreed to Medicaid expansion, the federal government covers all adults with incomes below 138 percent of the poverty line.
To join extended Medicaid, states are required to pay 10 percent of the cost and the federal government will pay the rest. But lawmakers in Mississippi and nine other GOP states, have long opposed Obamacare, and have said they won’t accept the money because they want to limit government funding. This claim flies in the face of several studies that have shown that states enrolling in extended Medicaid find that the health benefits far outweigh the costs.
Mississippi’s political driven decision means less access to everything from intensive care units to neo-natal units to emergency rooms in a state that has the highest percentage of African Americans and is the poorest in the nation. To many who cannot afford traveling to distant health care facilities, the states’ refusal to extend Medicaid care for the poor can be deadly.
The American Hospital Association reported that, between 2010 and 2021, nearly three-fourth of rural hospital closures came in states that opted against Medicaid expansion, or had just recently adopted it.
Mississippi’s decision is in keeping with the state’s tradition of failing to sufficiently serve its African American residents.
Republican Gov. Tate Reeves said that expanding Medicaid is not in the best interests of taxpayers.
“Don’t simply cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine,” Reeves said in his annual State of the State address in January.
The Republican House Speaker, Philip Gunn, said the state should focus on getting people off Medicaid rather than “adding more people to it.”
Advocates for Medicaid in Mississippi planned to start an expansion campaign in 2021 but the effort fell apart after the state Supreme Court nullified the ballot measure plan until state lawmakers fixed it. The lawmakers have yet to fix it.
Mississippi is not alone in its cruel intransigence not to accept the federal funding but is one of 10 Republican dominated states that have done likewise, including Wyoming, Kansas, Texas, Wisconsin, Tennessee, Alabama, Georgia, South Carolina and Florida.
The decision by the 10 red states has left more than 2.1 million people who would qualify for Medicaid but can’t access the needed health care because their state has not adopted the expansion, according to the Center on Budget and Policy Priorities.
Last week, North Carolina ended its longstanding position and became the 40th state to expand Medicaid. The law was sponsored by the state’s two Republican leaders and was signed by Democratic Gov. Roy Cooper.
The Medicaid debacle just adds to the woes of poor African Americans in Mississippi.
Last week, a monster tornado left a wake of destruction nearly 60 miles long and at least 25 deaths, eviscerating many towns, including the mostly black town of Rolling Fork in Sharkey County. Its residents are very poor and many do not qualify for Medicaid. The county’s average median household income is about $32,650, less than half of the national average and lower than all but 27 of the country’s more than 3,000 counties.
The state is ranked last place among all the states for health care and the data shows that Mississippi has the highest rate of infant and neonatal deaths of any state. Age-adjusted data also shows Mississippi has the highest overall death rate, and the highest death rate from heart disease, hypertension and hypertensive renal disease, influenza and pneumonia. In 2011, Mississippi and Arkansas were tied with having the fewest dentists per capita in the country.

The harshness of Mississippi was vividly demonstrated in 2021, when the U.S. Supreme Court ruled that a Mississippi law allowing mandatory sentencing of children to life imprisonment without parole is valid.
Sometimes it may seem that all people have left is prayer and that shouldn’t be too hard in Mississippi where public opinion polls have consistently ranked it as the most religious state in the United States. Polls show that 59 percent of Mississippians consider themselves “very religious.” In a 2009 Gallup poll, 63 percent of Mississippians said that they attended church weekly or almost weekly — the highest percentage of all states. Another 2008 Gallup poll found that 85 percent of Mississippians considered religion an important part of their daily lives, the highest figure among all states.
Until 1961, the state constitution held that “No person who denies the existence of a Supreme Being shall hold any office in this state.” The restriction was held to be unconstitutional by the U.S. Supreme Court in 1961.
And finally, Mississippi is the only state where a passenger and a driver can drink and drive as long as the driver remains under the legal limit of 0.08 Blood Alcohol Concentration. This leads to some sobering facts about alcohol abuse in Mississippi, according to
* 13.7 percent of Mississippi adults over 18 binge drink at least once per month.
* An average of 1,372 annual deaths in Mississippi are attributable to excessive alcohol use.
* Mississippi averages one death from excessive alcohol use for every 2,158 people 18 and older or 6.06 deaths for every 10,000 adults.
* Mississippi taxpayers spent $2.277 billion as a result of excessive alcohol use in 2010; adjusted for inflation, this is equivalent to $3.074 billion or $2.77 per drink in 2022 US dollars.
And this in a state where the state beverage is milk.
On Dec. 10, 1817, Mississippi was the 20th state admitted to the Union. By 1860, it was the nation’s top cotton-producing state and enslaved people accounted for 55 percent of the state population. Mississippi seceded from the Union on Jan. 9, 1861, and was one of the seven original Confederate States, which had the highest number of enslaved people in the nation. Following the Civil War, Mississippi was restored to the Union on Feb. 23, 1870,but in the following years, its government waged a war against providing equal rights to African Americans.



Phil Garber

Journalist for 40 years and now a creative writer