GULFPORT, Miss.—Federal changes to Medicaid funding and Affordable Care Act subsidies are expected to reshape Mississippi’s health care system, raising concerns about insurance coverage, hospital finances and access to care in a state that already ranks among the nation’s poorest and least insured.
In July 2025, Congress enacted the One Big Beautiful Bill Act, legislation backed by President Donald Trump. The law cuts federal Medicaid spending by $1.1 trillion over the next decade and allowed enhanced subsidies for Affordable Care Act marketplace plans, commonly called Obamacare, to expire at the end of 2025.
Health policy experts and hospital leaders warn the changes could leave tens of thousands of Mississippians uninsured and strain hospitals that already operate on thin margins.
For patients like Tabitha Baker, the stakes are personal.
“If I don’t get the care that I need, I’m not looking at, ‘Oh, I don’t get my medicine,’” Baker said. “I’m looking at not living.”
Baker, 41, is a double lung transplant recipient living in Hattiesburg. Her survival depends on regular specialist visits, lab work and a daily regimen of 43 medications.
She is covered by Medicare, not Medicaid. Still, she worries how federal changes will ripple through hospitals, clinics and insurance markets nationwide.
Coverage Losses and the Affordability Gap
Richard Roberson, president and CEO of the Mississippi Hospital Association, said Mississippi could be among the hardest hit by the expiration of enhanced ACA subsidies.
“We’ve seen the numbers grow by hundreds of thousands of Mississippians who picked up coverage in the last five years, and I think it’s directly because of the subsidies being in place,” he said.
Now that those subsidies have ended, Roberson said hospitals are bracing for widespread coverage losses.
“We’ve just got concerns that we’re going to see tens of thousands of Mississippians—potentially hundreds of thousands … forgo insurance because it’s unaffordable,” he said.
Patients Feel the Impact
Those concerns are already playing out for patients like Gulfport resident Brailey Penny.
After being diagnosed with hypermobile Ehlers-Danlos syndrome—a connective tissue disorder that causes joint instability, pain and hyperextensible skin—Penny lost her job and employer-sponsored insurance. She relied on an ACA marketplace plan until the enhanced subsidies expired.
“It went from $55 a month to $650 a month for the same exact plan without subsidies,” she said. “As someone that relies on medications to have a better quality of life and has to have doctor’s appointments whether I want them or not, you can’t really go without insurance.”
Penny is now working again, but said that without her new job, keeping coverage would have been impossible.
For others, even small premium increases could be enough to push insurance out of reach.
Charlotte, a Gulfport barber who asked to be identified by her first name only, does not receive health insurance through her employer. During the COVID-19 pandemic, she said enhanced ACA subsidies made private insurance affordable for the first time.
“For the first time when I was 29 or 30 (years old), I was finally able to get health care because of the ACA subsidies that were in place,” she said.
Before that, Charlotte said coverage cost about $500 a month.
“That was just implausible for me with (children),” she said.
Her four sons are covered through Medicaid and the Children’s Health Insurance Program, but her own coverage depends on marketplace subsidies. She said a $100 increase in monthly premiums could push coverage beyond what she can afford.
“I would have to go back to the drawing board or rely on … state-funded health programs,” she said. “(But) they’re (already) inundated with people who can’t afford health care or (people who are) homeless—people that are worse off than me.”
For patients across the state, that can mean care becomes dependent on income, clinic capacity or whether a provider is practicing nearby.
“People pride (Mississippi) on being so affordable to live in,” Charlotte said. “But what you lose in what we consider affordability is the ability to have a decent health care structure.”
When Insurance Disappears, Debt Fills the Gap
When coverage becomes unaffordable or disappears, medical bills do not vanish. They shift.
According to the Consumer Financial Protection Bureau, 15 million Americans—many of whom live in low-income communities in the South—put medical bills on medical credit cards, turning medical debt into credit card debt.
Penny is one of them. She used a medical credit card to pay for a $5,000 procedure when she had no other options.
“The interest rate on (medical credit) cards is insane,” she said. “It’s like 32% if you don’t pay it all off within six months.”
While Penny can keep up with payments, she said many people with chronic illnesses cannot.
“I know so many people with chronic illnesses, people that I know personally, that avoid going to the doctor because they just can’t take on the bill, even if they really need to go,” she said.
Research published in the American Journal of Public Health shows medical expenses are among the leading contributors to personal bankruptcy in the United States.
Hospitals Brace for Rising Pressure
Hospitals across Mississippi are preparing for the downstream effects of more patients delaying care.
“Not only does (delaying care) make someone’s condition worse, it makes the care that they receive more expensive later on because it’s more expensive to take care of someone who’s sicker than it is to take care of things in a more preventive fashion,” Roberson said.
Emergency departments must treat patients with emergency medical conditions regardless of their ability to pay, leading to higher levels of uncompensated care if uninsured patients cannot cover the cost.
About two-thirds of Mississippi patients in 2023 were covered by Medicaid or Medicare, which reimburse hospitals at lower rates than private insurance.
To help offset that gap, Mississippi uses the Hospital Access Program, which provides supplemental payments tied to average commercial insurance rates. The federal government matches the state’s contribution, but hospitals fund the state share themselves through a provider tax.
For a state that did not expand Medicaid, Roberson said the program has been essential.
“(It’s) probably the single biggest thing that’s helped the hospitals over the last couple of years,” he said.
But starting in 2029, the One Big Beautiful Bill Act will step those payments down to 110% of the Medicare rate—a change Roberson said could cost Mississippi hospitals up to $160 million annually, or as much as $800 million over a decade.
“The thing that has helped the hospitals so much over the last couple of years is being called a gimmick (by Congress),” he said. “That’s going to have some big consequences for Mississippi.”
At the same time, the law cut $8 billion from Medicaid Disproportionate Share Hospital payments in October 2025, funding that supports hospitals serving large numbers of uninsured and low-income patients—a population expected to grow.
Temporary Help, Long-term Uncertainty
The law created a $50 billion Rural Health Transformation Fund to support rural systems nationwide.
Mississippi received $206 million in 2026, and the Mississippi Hospital Association expects at least $100 million annually through 2030. But Roberson said the funds are temporary and not required to go directly to hospitals.
The state plan for the money—which has yet to be released—is to fund workforce recruitment, telehealth expansion, health technology modernization and rural infrastructure.
Hospital leaders argue Mississippi already operates at the lowest cost per patient nationally. The issue, they say, is not cost control but revenue stability—and the temporary fund may not offset long-term Medicaid payment reductions.
What Comes Next
Roberson said the policy landscape could still shift.
“Congress can always delay cuts, they can reinstate programs, they can extend the subsidies,” he said. “You know, there’s all sorts of things that can change.”
On Jan. 8, the House passed a bill to extend enhanced ACA subsidies for another three years. The measure now heads to the Senate, where similar legislation failed in December. President Trump has said he may veto the extension if it reaches his desk.
For hospitals, Roberson said the immediate priority is delaying upcoming Medicaid and Medicare payment cuts.
If nothing changes, he warned, the consequences could reach beyond balance sheets.
“If nothing changes, and if those rural health transformation funds don’t go to benefit hospitals and really improve the infrastructure of our health care system,” Roberson said, “I think we’re in for some really tough times over the next five years in health care.”
This coverage is supported by a grant from Press Forward Mississippi, part of a nationwide philanthropic effort to strengthen local news so communities stay informed, connected and engaged.
This article first appeared on RHCJC and is republished here under a Creative Commons Attribution 4.0 International License.