Mississippi ranks 49th out of 50 states and the District of Columbia when it comes to accessible and affordable healthcare, according to a study released this week by the Commonwealth Fund.

The purpose of the study was to examine whether the Affordable Care Act had made it easier for people to pay for medical care. Nationally, the number of Americans who said they couldn’t afford seeing a doctor or getting medical care dropped 19% in the first two years of the Affordable Care Act.

“The United States is closer than it has ever been to achieving near-universal coverage, an essential component of a high-performing health system,” said the Commonwealth Fund Study. “The historic decline in uninsured rates has been accompanied by widespread reductions in cost-related access problems and improvements in access to routine care for at-risk adults.”

Mississippi’s numbers reflect this national trend to a degree. The number of Mississippians who said they couldn’t afford medical treatment dropped 14 percent between 2013 and 2015, according to the study released Wednesday.

For low income Mississippians the decline was more drastic, falling 21 percent between 2013 and 2015. The study defined low income Mississippians as those making under 200 percent of the federal poverty level ($20,160 for a family of three).

Still, Mississippi remains one of several states that still has high percentages of uninsured adults. Last year, 19 percent of adults in the state were uninsured. Only Texas, Oklahoma and Florida had higher percentages.

The numbers are even higher among minority groups. In Mississippi 21 percent of African American adults went without insurance in 2015, compared to just 16 percent of whites. Among Hispanics the uninsured number was 53 percent, the highest in the country.

According to the Commonwealth Fund study, high numbers of uninsured were more common in states that did not take the Medicaid expansion. This program allows residents who earned up to 400 percent of the federal poverty level to qualify for Medicaid. None of the states with high uninsured rates took the expansion. In Mississippi, adults can only qualify for Medicaid if they become pregnant or have a disability.

States with the lowest percentage of uninsured residents, such as Massachusetts (4 percent), Hawaii (6 percent) and the District of Columbia (5 percent) all expanded Medicaid.

The Commonwealth Fund is a nonprofit foundation that promotes access to high quality healthcare, particularly for these with lower or no income.

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.