Data Brief | | August 2023

Mississippi Residents Bear Health Care Affordability Burdens Unequally; Distrust of/Disrespect by Health Care Providers Lead Some to Delay and/or Go Without Needed Care

Key Findings

A survey of more than 1,300 Mississippi adults, conducted from May 3 to May 22, 2023, found that:

• Nearly three-quarters (72%) of Mississippi respondents have experienced one or more health care affordability burdens in the past 12 months. Four in five (84%) worry about affording some aspect of health care now or in the future.
• Respondents of color experienced greater affordability burdens than their white, non-Hispanic counterparts: 75% of Black/ African American respondents have experienced one or more health care affordability burdens in the past 12 months, compared to 70% of white, alone non-Hispanic/Latinx respondents and 84% of Hispanic/Latinx respondents have experienced one or more health care affordability burdens, compared to 72% of non-Hispanic/Latinx respondents.
• Respondents living in households with a person with a disability more frequently reported affordability burdens than respondents without a disabled household member, including:  rationing medication due to cost (50% versus 33%); delaying or going without care due to cost (75% versus 56%); and going into medical debt, depleting savings or sacrificing basic needs due to medical bills (63% versus 43%).
• Thirty-seven percent of respondents of color skipped needed medical care due to distrust of or feeling disrespected by health care providers, compared to 18% of white, alone non-Hispanic respondents.
• Fifty-nine percent of all respondents think that people are treated unfairly based on their race or ethnic background somewhat or very often in the U.S. health care system.

Difference in Affordability Burdens & Concerns

Race 

The intersection of racial disparities in health care and affordability issues impact access to care
and beget financial burdens for communities of color, particularly Black and Hispanic/Latino
communities.^1,2 In Mississippi, respondents of color often reported higher rates of affordability
burdens than white respondents, including incurring medical debt, depleting savings, or sacrificing
basic needs (like food, heat and housing) due to medical bills (see Table 1).

In addition to incurring medical debt, respondents of color more frequently reported difficulty
getting mental health treatment and delaying or going without medical assistive devices due to
cost. Hispanic and Latino respondents most frequently reported challenges accessing addiction
treatment and avoiding going to the doctor or getting a procedure done to cost (see Figure 1).³

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Income 

The survey also revealed differences in how Mississippi respondents experience health care affordability burdens by income. Unsurprisingly, respondents at the lowest end of the income spectrum most frequently reported affordability burdens, with two-thirds (76%) of those with household incomes of less than $50,000 per year struggling to afford health care in the past 12 months (see Table 2). Still, over half of respondents living in middle- and high-income households also reported struggling to afford some aspect of coverage or care, demonstrating that affordability burdens impact people in each income group. Likewise, at least 78% of respondents in each income group reported being worried about affording health care either now or in the future.

Additionally, greater than two fifths (43%) of respondents with household incomes of $50,000 or less reported not filling a prescription, skipping doses of medicines, or cutting pills in half due to cost. Lower-income individuals also most frequently reported financial consequences after receiving health care services—up to 54% of individuals who earn less than $50,000 a year either went into medical debt, depleted their savings, or sacrificed other basic needs (like food, heat or housing) due to medical bills, compared to up to 41% of those earning over $100,000.

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Disability Status 

People with disabilities interact with the health care system more often than those without
disabilities and, as a result, tend to face more out-of-pocket costs.⁴ Additionally, people who
receive disability benefits face unique coverage challenges that impact their ability to afford
needed care, such as the possibility of losing coverage if their household income or assets increase
over a certain amount (for example, after getting married).⁵ Mississippi respondents who have or
live with a person who has a disability more frequently reported a diverse array of affordability
burdens compared to others (see Table 3). These individuals also more frequently reported
worrying about health care affordability in general (85% versus 83%) and losing health insurance
specifically (43% versus 25%).

Those with disabilities also face health care affordability burdens unique to their disabilities—26%
of respondents reporting a disability in their household delayed getting a medical assistive device
such as a wheelchair, cane/walker, hearing aid or prosthetic limb due to cost. Just 8% of
respondents without a disability (who may have needed such tools temporarily or may not identify
as having a disability) reported this experience (see Figure 2). Similarly, 28% of respondents
reporting a disability in their household reported problems getting mental health care compared
to 14% of households without a person with a disability.

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Gender 

The survey also surfaced differences in health care affordability burdens and worry by gender.
Women who responded to the survey were more likely to report having experienced at least one
affordability burden in the past year than those identifying as men (76% versus 68%) (see Table 4).
Women also more frequently reported delaying or going without care due to cost in general and
reported higher rates of rationing their medications by not filling a prescription, skipping doses, or
cutting pills in half. While many respondents regardless of gender reported being somewhat or
very concerned about health care costs, a higher percentage of women reported worrying about
affording some aspect of coverage or care than men (86% versus 81%).

Due to the small sample size, this survey could not produce reliable estimates exclusively for
transgender, genderqueer, or nonbinary respondents. However, it is important to note that these
groups experience unique health care affordability burdens— 31 (4% of) survey respondents
reported that they or a family member had trouble affording the cost of gender-affirming care,
such as hormone therapy or reconstructive surgery.

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Distrust and Mistrust in the Health System

Whether a patient trusts and/or feels respected by their health care provider may impact whether
they seek needed care. In Mississippi, just over 1 in 3 (38% of) respondents reported that their
provider never, rarely, or only sometimes treats them with respect. When asked why they felt
health care providers did not treat them with respect, over two fifths of respondents cited their
income or financial status (46%), followed by race (37%), ethnic background (22%), disability
(20%), and gender/gender identity (14%). In lesser numbers, respondents cited experience with
violence or abuse (8%) and sexual orientation (7%) as reasons for the disrespect.

Respondents of color and those with a person with a disability in their household more frequently
reported distrust in and feeling disrespected by their health care providers compared to white and
non-disabled respondents (see Table 5). They also more frequently went without medical care due
to that distrust and/or disrespect.

In fact, 37% of BIPOC respondents reported that they went without needed medical care due to
distrust of or feeling disrespected by health care providers, compared to only 18% of white
respondents. Additionally, 40% of respondents who have/are living with a person with a disability
went without care due to distrust or disrespect, compared to 18% of those without a household
member with a disability.

Additionally, respondents covered through Mississippi Medicaid reported higher rates of
distrusting or feeling disrespected by a health care provider compared to those with private
insurance and Medicare. Respondents earning less than $50,000 most frequently reported
distrust/disrespect as well as going without care due to distrust/disrespect.

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Individual & Systemic Racism 

Respondents perceived that both individual and systemic racism exist in the U.S. health care
system. Fifty-nine percent of respondents believe that people are treated unfairly based on their
race or ethnic background, either somewhat or very often. When asked what they think causes
healthcare systems to treat people unfairly based on their race or ethnic background:

• 1 in 5 (21%) cited policies and practices built into the health care system;
• 1 in 6 (13%) cited the actions and beliefs of individual health care providers; and
• Over 4 out of 10 (42%) believe it is an equal mixture of both.

Dissatisfaction with the Health System and Support for Change

Given this information, it is not surprising that 68% of respondents agree or strongly agree that
the U.S. health care system needs to change. Understanding how the health care system
disproportionately harms some groups of people over others is key to creating a fairer and higher
value system for all.

Making health care affordable for all residents is an area ripe for policymaker intervention, with
widespread support for government-led solutions across party lines. For more information on the
types of strategies Mississippi residents want their policymakers to pursue, see: Mississippi
Residents Struggle to Afford High Health Care Costs; Worry About Affording Health Care in the
Future; Support Government Action Across Party Lines, Healthcare Value Hub, (August 2023).

Notes 

1. Fadeyi-Jones, Tomi, et al., High Prescription Drug Prices Perpetuate Systemic Racism. We Can Change It, Patients for Affordable Drugs Now (December 2020), https://patientsforaffordabledrugsnow.org/2020/12/14/drug-pricing-systemic-racism/  
2. Kaplan, Alan and O’Neill, Daniel, “Hospital Price Discrimination Is Deepening Racial Health Inequity,” New England Journal of Medicine—Catalyst (December 2020), https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0593  
3. A small share of respondents also reported barriers to care that were unique to their ethnic or cultural backgrounds. Two percent reported not getting needed medical care because they couldn’t find a doctor of the same race, ethnicity or cultural background as them and three percent because they couldn’t find a doctor who spoke their language. 
4. Miles, Angel L., Challenges and Opportunities in Quality Affordable Healthcare Coverage for People with Disabilities, Protect Our Care Illinois (February 2021), https://protectourcareil.org/index.php/2021/02/26/challenges-and-opportunities-in-quality-affordable-health-care-coverage-for-people-with-disabilities/  
5. A 2019 Commonwealth Fund report noted that people with disabilities risk losing their benefits if they make more than $1,000 per month. According to the Center for American Progress, in most states, people who receive Supplemental Security are automatically eligible for Medicaid. Therefore, if they lose their disability benefits they may also lose their Medicaid coverage. Forbes has also reported on marriage penalties for people with disabilities, including fears about losing health insurance. See: Seervai, Shanoor, Shah, Arnav, and Shah, Tanya, “The Challenges of Living with a Disability in America, and How Serious Illness Can Add to Them,” Commonwealth Fund (April 2019), https://www.commonwealthfund.org/publications/fund-reports/2019/apr/challenges-living-disability-america-and-how-serious-illness-can; Fremstaf, Shawn and Valles, Rebecca, “The Facts on Social Security Disability Insurance and Supplemental Security Income for Workers with Disabilities,” Center for American Progress (May 2013), https://www.americanprogress.org/article/the-facts-on-social-security-disability-insurance-and-supplemental-security-income-for-workers-with-disabilities/; and Pulrang, Andrew, “A Simple Fix For One Of Disabled People’s Most Persistent, Pointless Injustices,” Forbes (April 2020), https://www.forbes.com/sites/andrewpulrang/2020/08/31/a-simple-fix-for-one-of-disabled-peoples-most-persistent-pointless-injustices/?sh=6e159b946b71  

Methodology

Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ unbiased views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions.   

This survey, conducted from May 3 to May 22, 2023, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,504 respondents who live in Mississippi. Information about Dynata’s recruitment and compensation methods can be found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older. Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving 1,380 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

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Percentages in the body of the brief are based on weighted values, while the data presented in the demographic table is unweighted. An explanation of weighted versus unweighted variables is available here. Altarum does not conduct statistical calculations on the significance of differences between groups in findings. Therefore, determinations that one group experienced a significantly different affordability burden than another should not be inferred. Rather, comparisons are for conversational purposes. The groups selected for this brief were selected by advocate partners in each state based on organizational/advocacy priorities. We do not report any estimates under N=100 and a co-efficient of variance more than 0.30.