Data Brief | | August 2023

Mississippi Residents Struggle to Afford High Health Care Costs; Worry about Affording Health Care in the Future; Support Government Action Across Party Lines

Key Findings

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

• Nearly 3 out of 4 (72%) experienced at least one health care affordability burden in the past year;
• 4 in 5 (84%) worry about affording health care in the future;
• Lower-income respondents and respondents with disabilities are more likely to go without care and incur debt due to health care costs; and
• Across party lines, respondents express strong support for government-led solutions.

Range of Healthcare Affordability Burdens 

Like many Americans, Mississippi adults experience hardship due to high health care costs. All told,
nearly three-fourths (72%) of respondents experienced one or more of the following health care
affordability burdens in the prior 12 months, including:

1) Being Uninsured Due to High Costs 

Nearly one-half (49%) of uninsured survey participants responded that coverage costs are the
primary reason for being uninsured, far exceeding other reasons like “don’t need it” and “did not
qualify for an open enrollment period.”

2) Delaying or Going Without Healthcare Due to Cost 

Well over half (63%) of all respondents reported delaying or going without health care during the
prior 12 months due to cost:

39%—Skipped needed dental care;
39%—Cut pills in half, skipped doses of medicine, or did not fill a prescription¹;
37%—Delayed going to the doctor or having a procedure done;
32%—Skipped a recommended medical test or treatment;
32%—Avoided going to the doctor or having a procedure done altogether;
27%—Skipped needed vision services;
22%—Had problems getting mental health care or addiction treatment;
17%—Skipped needed hearing services; and
14%—Skipped or delayed getting a medical assistive device.

Respondents most frequently cited cost as the reason they or a family member did not receive
needed medical care in the past year, exceeding a host of other barriers like getting time off work,
transportation, and lack of childcare.

3) Struggling to Pay Medical Bills 

Other times, respondents reported receiving the care they needed but struggling to pay the
resulting bill. Half (50%) experienced one or more of these struggles to pay their medical bills:

23%—Were contacted by a collection agency;
16%—Used up all or most of their savings;
17%—Were unable to pay for necessities like food, heat, or housing;
14%—Incurred large amounts of credit card debt;
14%—Borrowed money, got a loan, or another mortgage on their home; and
11%—Were placed on a long-term payment plan.

Of the various types of medical bills, the ones most frequently associated with an affordability
barrier were doctor bills, dental bills, and prescription drugs. The high prevalence of affordability
burdens for doctor visits and prescription drugs likely reflects the frequency with which Mississippi
respondents seek these services. Trouble paying for dental bills likely reflects lower rates of
coverage for these services.

High Levels of Worry About Affording Healthcare in the Future 

Mississippi respondents also exhibit high levels of worry about the costs of care in the future. Four
in five (84%) reported being “worried” or “very worried” about affording some aspect of health
care in the future, including:

66%—Cost of nursing home or home care services;
64%—Medical costs when elderly;
64%—Medical costs in the event of a serious illness or accident;
63%—Health insurance will become unaffordable;
58%—Prescription drugs will become unaffordable;
56%—Cost of dental care;
50%—Cost of vision services; and
50% - Cost of hearing services.

Although two of the most common worries - affording the cost of nursing home care or home
care services and medical costs when elderly - are applicable predominantly to aging adults, survey
results found that these worries were most frequently reported by younger respondents. In fact,
respondents aged 35-54 most frequently reported worries about affording medical costs when
elderly and respondents aged 45-64 most frequently reported worries about affording the cost of
nursing home or home care services. This finding suggests that Mississippi respondents may be
worried about affording the cost of care for both aging parents and themselves.

Worry about affording health care was high among all respondents, but particularly among
Hispanic/Latino respondents and respondents living in lower- and middle-income households (see
Table 1). Still, most Mississippi respondents of all incomes, races, ethnicities, geographic setting
and levels of ability are somewhat or very concerned.²

Concern that health insurance will become unaffordable is also more prevalent among certain
groups of Mississippi respondents. By insurance type, respondents with Mississippi Medicaid most
frequently reported worrying about losing health coverage, followed by residents with coverage
they purchased on their own, not through their employer (see Figure 1).

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Respondents with household incomes below $50,000 per year reported the highest rates of
worry about losing coverage, while those with household incomes between $75k and $99k
reported the highest rates of worry about affording coverage. Similarly, respondents living in
southeastern Mississippi and those living in households with a person with a disability reported
higher rates of worry about losing health insurance than residents living in other areas of the state
or those living in a household without a person with a disability (see Table 2). It is also interesting to
note that concerns about affording coverage exceeded fears about losing coverage across all
income groups, disability statuses, geographic settings, race, ethnicity and coverage types.

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Differences in Healthcare Affordability Burdens 

The survey also revealed differences in how Mississippi respondents experience health care
affordability burdens by income, age, geographic setting, race, ethnicity and disability status. 

Income and Age 

Unsurprisingly, respondents at the lowest end of the income spectrum most frequently reported
experiencing one or more health care affordability burdens. More than three-fourths (76%) of
those earning less than $50,000 per year reporting struggling to afford some aspect of coverage
or care in the past 12 months (see Figure 2). This may contribute, in part, to respondents in this
income group reporting higher rates of going without care and rationing their medication due to
cost (see Figure 3).

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Further analysis found that Mississippi respondents ages 25-34 were most likely to go without care
due to cost, although all respondents aged 18-54 frequently reported forgoing care due to cost
(see Figure 4). Likewise, respondents ages 25-34 most frequently reported rationing medication
due to cost.  

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Disability Status

Of all the demographic groups measured, respondents living in households with a person with a
disability reported the highest rates of going without care and rationing medication due to cost.
Over 7 in 10 (75% of) respondents in this group reported going without some form of care and
50% reported rationing medication, compared to 56% and 33% of respondents living in
households without a person with a disability, respectively (see Table 3).

Those with disabilities also face health care affordability burdens unique to their disabilities—26%
of respondents reporting a disability in their household reported delaying 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 person with a disability (who may have needed such tools temporarily
or may not identify as having a disability) reported having this experience.

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Insurance Type 

Respondents who purchase their health insurance on their own reported the highest rates of going
without care due to cost, followed by respondents who are uninsured. Likewise, respondents
without health insurance coverage and those with coverage through Mississippi Medicaid most
frequently reported rationing medication due to cost (see Table 4). 

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Survey respondents also had the opportunity to share their own stories about going without care
due to cost in the past year. It is important to note that respondents across insurance coverage
type reported similar barriers to care due to cost; to be specific, many respondents, regardless of
coverage, reported challenges affording dental and vision care. Similarly, many respondents
reported challenges finding local care, with several privately insured respondents reporting
concerns about access to in-network care close to their homes (see Table 5). 

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Race and Ethnicity 

Hispanic and Latino residents across Mississippi reported the highest rates of forgoing care due to
cost. In fact, forty-four percent of Hispanic or Latino respondents reported avoiding going to the
doctor or getting a procedure done due to cost in the previous year. Likewise, Hispanic and Latino
respondents also reported challenges affording addiction services and delaying purchasing a
medical assistive device at higher rates than other ethnicities (see Figure 5). However, across all
races and ethnicities reported, at least a quarter of all respondents reported going without care
due to cost in the past year.

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Encountering Medical Debt 

The survey also showed differences in the prevalence of financial burdens such as going into debt
to afford the cost of health care, depleting savings and being unable to pay for necessities like
food, heat, and housing by income, race, ethnicity, disability status, and geographic setting. Survey
results indicate that fifty-five percent of Black respondents and 63% of Hispanic or Latino
respondents reported going into debt, depleting savings, or going without other needs due to
medical bills, compared to 46% of white respondents (see Table 6).

The rate of financial burden is even higher for respondents who have or live with a person with a
disability, with over three-fifths (63%) reporting going into debt or sacrificing basic needs due to
medical debt, compared to 43% of respondents living in households without a disabled member.
Likewise, respondents purchasing health insurance on their own reported the highest rate of the
above financial burdens due to medical bills (64%) compared to respondents with all other
insurance types. Geographically, residents across Mississippi reported similar rates of going into
debt or going without other needs due to medical bills.  

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Impact of Hospital Consolidation

In addition to the above health care affordability burdens, the survey reveals that some Mississippi
residents have been negatively impacted by health system consolidation. Between April 1, 2018
and January 1, 2023, seven hospitals in the state have changed ownership through either a merger,
acquisition, or change of ownership (CHOW).^3,4

Relative to other states, Mississippi has few regulations surrounding hospital change of ownership;
the state does not have any provisions requiring notice, review or approval of any health care
acquisitions mergers or consolidations. Additionally, as of 2023, the state has passed legislation
that exempts hospital acquisitions and mergers from state anti-trust laws.^5,6

In the past year, 11% of respondents reported that they or a family member were unable to access
their preferred health care organization because of a merger, acquisition, consolidation or CHOW
that made their preferred organization out-of-network. When asked about the greatest burden
respondents experienced as a result, the most frequently reported difficulties were:

• 36% of respondents report that the change has created an added wait time burden when searching or a new provider who is accepting new patients;
• 24% said that the change has created an added financial burden; and
• 18% report that the change has created a gap in my continuity of care.

Dissatisfaction with the Health System and Support for Change 

Considering Mississippi respondents’ health care affordability burdens, it is not surprising that they
are dissatisfied with the health system:

• Just 29% agreed or strongly agreed that “we have a great health care system in the U.S.,”
• While 68% agreed or strongly agreed that “the system needs to change."

To investigate further, the survey asked about both personal and governmental actions to address
health system problems.

Personal Actions  

Mississippi respondents see a role for themselves in addressing health care affordability. When
asked about specific actions they could take:

• 58% of respondents reported researching the cost of a drug beforehand; and
• 71% said they would be willing to switch from a brand name to an equivalent generic drug if given the chance.

When asked to select the top three personal actions they felt would be most effective in
addressing health care affordability (out of ten options), the most common responses were:

• 72%—Take better care of my personal health;
• 43%—Research treatments myself, before going to the doctor;
• 29%—Do more to compare doctors on cost and quality before getting services; and
• 23%—There is not anything I can do personally to make our health system better.

Government Actions  

But far and away, Mississippi respondents see government as the key stakeholder that needs to act
to address health system problems. Moreover, addressing health care problems is one of the top
priorities that respondents want their elected officials to work on.

At the beginning of the survey, respondents were asked what issues the government should
address in the upcoming year. The top vote getters were:

• 46%—Health Care
• 45%—Economy/Joblessness
• 35%—Taxes

When asked about the top health care priorities the government should work on, the top choices were:

• 47%—Address high health care costs, including prescription drugs;
• 37%—Get health insurance to those who cannot afford coverage;
• 33%—Improve Medicare, coverage for seniors and those with serious disabilities;
• 30%—Preserve consumer protections preventing people from being denied coverage or charged more for having a pre-existing medical condition; and
• 30%- Improve Medicaid, coverage for low-income people.

Out of more than twenty separate options, Mississippi respondents reported that they believe the
reason for high health care costs lie in:

• 70%—Drug companies charging too much money;
• 68%—Hospitals charging too much money; and
• 65%—Insurance companies charging too much money.

When it comes to tackling costs, respondents endorsed several strategies, including:

• 90%—Show what a fair price would be for specific procedures;
• 89%—Require drug companies to provide advanced notice of prices increases and information to justify those increases;
• 89%—Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription price hikes;
• 88%—Make it easy to switch insurers if a health plan drops your doctor;
• 88%—Cap out-of-pocket costs for life-saving medications, such as insulin;
• 88%—Require hospitals and doctors to provide up-front cost estimates to consumers;
• 87%—Require insurers to provide up-front cost estimates to consumers; and
• 88%—Expand health insurance options so that everyone can afford quality coverage.

Support for Action Across Party Lines 

There is also remarkable support for change regardless of respondents' political affiliation (see
Table 7). The high burden of health care affordability, along with high levels of support for change,
suggest that elected leaders and other stakeholders need to make addressing this consumer
burden a top priority. Moreover, the COVID crisis has led state residents to take a hard look at
how well health and public health systems are working for them, with strong support for a wide
variety of actions. Annual surveys can help assess whether progress is being made.

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Notes 

1. Of the current 63% of Mississippi respondents who encountered one or more cost-related barriers to getting health care during the prior 12 months, 31% did not fill a prescription, while 26% cut pills in half or skipped doses of medicine due to cost.
2.  Median household income in Mississippi was $49,111 (2017-2021). U.S. Census, Quick Facts. Retrieved from: U.S. Census Bureau QuickFacts: Mississippi
3. Centers for Medicare and Medicaid Services. (2023). Hospital Change of Ownership. Retrieved July 17, 2023, from https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-change-of-ownership
4. A CHOW typically occurs when a Medicare provider has been purchased (or leased) by another organization. The CHOW results in the transfer of the old owner’s Medicare Identification Number and provider agreement (including any outstanding Medicare debt of the old owner) to the new owner. The regulatory citation for CHOWs can be found at 42 CFR § 489.18. If the purchaser (or lessee) elects not to accept a transfer of the provider agreement, then the old agreement should be terminated and the purchaser or lessee is considered a new applicant. Most changes of ownership fall into this category. (Centers for Medicare and Medicaid Services. (2023, September). Medicare Fee-For-Service Provider Enrollment – Hospital Change of Ownership: Data Guidance. Retrieved July 17, 2023, from https://data.cms.gov/sites/default/files/2023-01/Hospital_CHOW_Data_Guidance_2023.12.30.pdf)
5. S.B. 2323, 2023 Reg. Sess. (Mis. 2023). http://billstatus.ls.state.ms.us/2023/pdf/history/SB/SB2323.xml#addinf
6. National Conference of State Legislatures. (2023, February 22). Health System Consolidation. Retrieved July 17, 2023, from https://www.ncsl.org/health/health-system-consolidation

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 1514 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.