Center for Mississippi Health Policy

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Key Points

• Uninsurance rates and public insurance rates slightly decreased from 2021 to 2022 for Mississippi adults, aged 19-64 years.
• In 2021 and 2022, uninsurance rates were higher for Mississippi non-elderly adults than the national average rate.
• Statewide trends show a decrease in uninsurance rates and an increase in private healthcare coverage rates.
• Compared to other adult age groups in Mississippi, young adults, aged 19-25 years, had the highest rates of uninsurance.
• Over half of Mississippi young adults, aged 19-25 years, are insured through private healthcare coverage.
• From 2017 to 2022, there was a steady decrease in uninsurance rates for Mississippi young adults, ages 19-25 years.
• Over half of Mississippi adults, ages 26-44 years, had employee-sponsored and/or military-sponsored healthcare coverage.
• Mississippi adults, ages 46 to 64 years, had the lowest levels of uninsurance when compared to other age groups.
• Private healthcare coverage rates have steadily increased for adults, ages 46-64 years, since 2018.
• In 2022, over one-third of the state’s Hispanic population and over one-fifth of the state’s Native American population were uninsured.
• Mississippi adults with the lowest levels of education experienced both the highest rates of public healthcare coverage and uninsurance rates.
• From 2021 to 2022, the amount of adults below 401% FPL who were uninsured decrease by 85,000.
• Adults working part time, those with and without children, had the highest uninsurance rates.

Source

Researchers from the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota compiled Mississippi data from the 2021 and 2022 United States Census Bureau’s American Community Survey (ACS) at the request of the Center for Mississippi Health Policy. The ACS asks a representative sample of households about their health insurance coverage. This chartbook summarizes the responses provided by non-elderly (19 through 64 years of age) Mississippi adults. Data found at Integrated Public Use Microdata Series (IPUMS) (https://usa.ipums.org/usa/index.shtml).

This chartbook also includes a summary of the responses provided by Mississippi employers who were asked about health insurance offered in 2021 and 2022. The Agency for Healthcare Research and Quality (AHRQ) conducts the survey, known as the Medical Expenditure Panel Survey (MEPS). This chartbook is available at http://www.mshealthpolicy.com.

Distribution by Type of Coverage

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

Uninsurance Rates & Public Insurance Rates Slightly Decreased From 2021 To 2022.

Most non-elderly adult Mississippians’ private insurance coverage is obtained via employmentbased and military plans (59.1%). The remaining plans are privately purchased (7.6%).

Non-elderly adults are more likely to be uninsured than children or the elderly due to eligibility standards for public programs.

In both 2021 and 2022, there were more adults who were uninsured than there were adults with public healthcare coverage.

Health Coverage Comparison, United States Versus Mississippi

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

In 2021 and 2022 Uninsurance Rates Were Higher for Mississippi Non-Elderly Adults than the National Average.

In 2021 and 2022, the uninsurance rate for Mississippi non-elderly adults was
higher than the national average.

For both 2021 and 2022, the rate for public healthcare coverage was less for Mississippi nonelderly adults than the national average.

In 2022, the private healthcare coverage rates were higher for Mississippi non-elderly adults than the national average. This applies to employment-based and military insurance plans and individually purchased insurance plans.

Health Coverage Trends by Type

Mississippi Adults, 19-64 Years of Age | Data Range: 2013 – 2022

Statewide Trends Show a Decrease in Uninsurance Rates And An Increase in Private Healthcare Coverage Rates.

For the past three years, statewide trends in uninsurance rates have steadily decreased.

In 2022, the uninsurance rates for non-elderly, adult Mississippians was at an all-time low. Inversely, private healthcare coverage rates (employment-based/
military insurance plans and individual, privately purchased insurance plans) were at an all-time high.

Health Coverage by Age Group

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

Compared to Other Adult Age Groups, Young Adults, Aged 19-25 Years, Had the Highest Rates of Uninsurance.

We see uninsurance rates were greatest for adults aged 19-25 years, a change from 2021, and lowest for adults aged 45-64 years in 2022.

In both 2021 and 2022, more Mississippi nonelderly adults used private health insurance plans instead of public health insurance plans.

Out of all age groups, adults aged 45-64 years had the highest rates of public healthcare coverage for both 2021 and 2022.

Distribution of Coverage

Mississippi Adults, 19-25 Years of Age | Data Range: 2021 – 2022

Over Half of Young Adults, Aged 19-25 Years Old Are Insured Through Private Healthcare Coverage.

In 2021 and 2022, the majority of young adult Mississippians had private healthcare coverage. Over half of this private healthcare coverage was gained either through employment-based plans or military-based plans. The remainder was composed of privately-purchased plans.

Uninsurance rates slightly decreased from 2021 to 2022 for this age group.

In both years, the rate of uninsurance was greater than the rate of public healthcare coverage.

Health Coverage Trends

Mississippi Adults, 19-25 Years of Age | Data Range: 2013 – 2022

From 2017 to 2022, There Was a Steady Decrease In Uninsurance Rates for Young Adults, Ages 19-25.

From 2019, we see an increase in public healthcare coverage for young Mississippi adults, aged 19-25 years old, in 2021 and 2022. The majority of this age group is covered through private health insurance plans.

In both 2021 and 2022, uninsurance rates are much lower than in previous years.

Distribution of Coverage

Mississippi Adults, 26-44 Years of Age | Data Range: 2021 – 2022

Over Half of Adults, Ages 26-44, Had Employer-Sponsored and/or Military Healthcare Coverage.

In 2021 and 2022, there was a decrease in uninsurance for Mississippi non-elderly adults aged 26-44 years old.

For this age group there was also a increase in employment-based and military-based private healthcare coverage during this time. However, more than half of the adults in this age group were covered by employment/militarybased health insurance during both years.

Lastly, we see that both public healthcare coverage rates and privately purchased healthcare coverage experienced growth during 2022.

Health Coverage Trends

Mississippi Adults, 26-44 Years of Age | Data Range: 2013 – 2022

Uninsurance Rates Have Decreased by 8% for Adults, Aged 26-44 Years Old, Since the ACA Was Adopted In 2014.

In 2021, private healthcare coverage rates for non-elderly Mississippi adults were higher than what they were before Mississippi’s adoption of the ACA in 2014¹. The rate slightly increases in 2022, but is still low compared to pre-2020 private healthcare coverage rates for this age group.

In a similar fashion, uninsurance rates for nonelderly Mississippi adults aged 26-44 years have also decreased greatly when compared to 2013 rates.

Inversely, public healthcare coverage rates for this age group have steadily increased from 2018 to 2022.

Distribution of Coverage

Mississippi Adults, 45-64 Years of Age | Data Range: 2021 – 2022

Adults, Ages 46 to 64, Had the Lowest Levels of Uninsurance Compared to Other Age Groups.

In 2021 and 2022, there was a decrease in uninsurance for Mississippi non-elderly adults aged 45-64 years old. Compared to other adult groups, this age
group exhibits the lowest rates of uninsurance.

In 2022, we see that private insurance healthcare coverage slightly increased from what it was in 2021 while uninsurance rates and public healthcare coverage rates slightly decreased.

Health Coverage Trends

Mississippi Adults, 45-64 Years of Age | Data Range: 2013 – 2022

Private Healthcare Coverage Rates Have Steadily Increased for Adults, Ages 46-64, Since 2018.

The uninsurance rates for non-elderly, Mississippi adults, aged 45-64 years old, have decreased by roughly a third since 2013. Similarly, public healthcare
coverage rates coverage rates for non-elderly Mississippi adults were lower in 2022 than what they were before Mississippi’s adoption of the ACA in 2014².

Inversely, private healthcare coverage rates have steadily increased since 2018.

Uninsurance by Race and Ethnicity

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

In 2022, Over One-Third of The State’s Hispanic Population and Over One-Fifth of The Native American Population Were Uninsured.

In 2022, almost half of the uninsured non-elderly adult population in Mississippi identified as white (45.5%), closely followed by adults who identified as black (41.5%). The remaining uninsured non-elderly adults identify as Hispanic (7.3%), Other (5.0%), and Native American (0.6%).

The 7.3% uninsured, non-elderly adults, who identified as Hispanic, represented 37.1% of the state’s Hispanic population. The 0.6% of the uninsured, non-elderly adults, who identified as Native American, represented
23.1% of the state’s Native American population.

Coverage by Educational Level

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

Adults with the Lowest Levels of Education Experienced Both the Highest Rates of Public Healthcare Coverage & Uninsurance.

Private healthcare coverage rates are least at the lowest level of educational attainment. Inversely, private healthcare coverage rates are greatest at the highest levels of educational attainment. Public healthcare coverage rates
also decrease as educational levels increase.

Uninsurance by Federal Poverty Level (FPL)

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

For Both 2021 and 2022, An Inverse Relationship Between Income Levels and Uninsurance Rates.

For both 2021 and 2022, uninsurance rates decreased as income levels increased above 100% FPL. Adults below 100% of the FPL experienced the highest rates of uninsurance. The table below shows the income levels at 138% FPL.

138% FPL INCOME LEVELS, 2021-2022

	Single Person	Family of Four
2021	$12,880	$26,500
2021	$13,590	$27,750

Coverage by Federal Poverty Level (FPL)

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

From 2021 to 2022, the Amount of Adults Below 401% FPL Who Were Uninsured Decreased by 25,554.

In both 2021 and 2022, the highest levels of private healthcare coverage were found in nonelderly Mississippi adults whose income levels fit within the 139%-400% FPL bracket.

Meanwhile the highest levels of uninsurance were experienced by adults whose income levels fit into 0-99% FPL bracket. The highest levels of public healthcare coverage could be found within this bracket, as well.

268,000 Mississippi adults, below 401% FPL, were uninsured in 2021 and 242,000 Mississippi adults, below 401% FPL, were uninsured in 2022.

Uninsurance By Federal Poverty Level (FPL)

Mississippi Adults, 19-64 Years of Age | Data Range: 2013 – 2022

The Number of Uninsured Adults Have Decreased by 110,000 Since the Adoption of The ACA in 2014.

The amount of uninsured non-elderly, Mississippi adults within the 0-99% FPL income bracket in 2022 has decreased by 48% from what it was in 2013.

In every year, there is a greater amount of uninsured adults within the 0-99% FPL income bracket than the 100-400% FPL and >401% FPL brackets. This mirrors the trends among previous pages where we see an inverse relationship between income levels and uninsurance rates.

Coverage at or Below 138% Federal Poverty Level (FPL)

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

Over a Quarter of Mississippi Adults at or Below 138% FPL are Uninsured.

At Least One Third of Mississippi Adults at or Below 138% FPL Are Covered by Public Health Insurance.

Since the passage of the Affordable Care Act, states have been granted the option of expanding Medicaid eligibility to individuals with income below 138% FPL. Because of this, it is relevant to view the types of insurance coverage held by adults within this income bracket as it could indicate how many uninsured adults could be impacted should Mississippi choose to expand healthcare coverage under Medicaid.

In both 2021 and 2022, over a quarter of Mississippi adults at or below 138% FPL are uninsured.

Uninsurance At Or Below 138% Federal Poverty Level (FPL)

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

In 2021 and 2022, the highest percentage of uninsurance was experienced by those who listed their occupation as a “cook” or “cashier”. That is over 11,000 uninsured Mississippi adults being listed in these occupations. Furthermore, we see that Nursing assistants and Personal Care Aides are being listed here both years. That’s an average of 4,000 healthcare workers per year who do not have healthcare coverage.

Uninsured, Non-Elderly Mississippi Adults By The Top 20 Occupational Categories, 2021

Name	Uninsured Count	Uninsured Percent
Cooks	7,147	4.2%
Cashiers	6,835	4.0%
Laborers (Freight, Stock, and Material Movers, Hand)	4,984	2.9%
Unemployed (No work experience in the last 5 years or never worked.)	4,538	2.7%
Stocker and order fillers	4,232	2.5%
Janitors and Building Cleaners	3,520	2.1%
Landscaping and Groundskeeping Workers	3,516	2.1%
Driver/Sales Workers and Truck Drivers	3,516	2.1%
Maids and Housekeeping Cleaners	3,349	2.0%
Retail Salespersons	3,320	2.0%
Construction Laborers	3,154	1.9%
Waiters and Waitresses	3,062	1.8%
Nursing Assistants	2,917	1.7%
Customer Service Representatives	2,285	1.3%
First-line Supervisors of Retail Sales Workers	2,041	1.2%
Carpenters	1,860	1.1%
Nail Salons and Other Personal Care Services	1,788	1.1%
Cleaners of Vehicles and Equipment	1,786	1.1%
Fast Food and Counter Workers	1,595	0.9%
Personal Care Aides	1,561	0.9%

Uninsured, Non-Elderly Mississippi Adults By The Top 20 Occupational Categories, 2022

Name	Uninsured Count	Uninsured Percent
Cooks	6,011	4.3%
Cashiers	5,385	3.8%
Construction Laborers	4,976	3.6%
Waiters and Waitresses	4,444	3.2%
Landscaping and Groundskeeping Workers	3,939	2.8%
Laborers (Freight, Stock, and Material Movers, Hand)	3,405	2.4%
Customer Service Representatives	2,931	2.1%
Driver/Sales Workers and Truck Drivers	2,860	2.0%
Maids and Housekeeping Cleaners	2,660	1.9%
Personal Care Aides	2,546	1.8%
Retail Salespersons	2,309	1.7%
Unemployed (No work experience in the last 5 years or never worked.)	2,199	1.6%
Other Assemblers and Fabricators	2,063	1.5%
Janitors and Building Cleaners	2,048	1.5%
Carpenters	1,466	1.0%
Stockers and Order Fillers	1,444	1.0%
Food Preparation Workers	1,390	1.0%
Nursing Assistants	1,385	1.0%
Security Guards and Gambling Surveillance Officers	1,286	0.9%
Fast Food and Counter Workers	1,093	0.8%

Insurance Status For Working Adults

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

There Are More Mississippi Working Adults Who Lack Healthcare Coverage Than Those Who Have Public Healthcare Coverage.

In both 2021 and 2022, over 80% of Mississippi working adults had private healthcare coverage. Less than 5% of this group had any kind of public healthcare coverage, and more than 10% of Mississippi working adults were uninsured.

Insurance Status for Unemployed Adults

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

Over One-Fifth of Unemployed Mississippi Adults are Uninsured.

In 2021 and 2022, over 40% of unemployed Mississippi Adults had some kind of public healthcare coverage. Additionally, over a third of this group had some kind of private healthcare coverage. Over a fifth of this group lacked any kind of healthcare coverage.

Uninsured By Work Status

Mississippi Adults, 19-64 Years of Age | Data Range: 2021 – 2022

Over Half of Working Mississippi Adults have no Health Insurance.

In 2021 and 2022, we see almost half of uninsured Mississippi adults are employed full-time and almost one-fifth are employed part-time. Roughly one-third of unemployed Mississippi adults are uninsured.

Health Coverage by Work Status

Mississippi Adults, 19-64 Years of Age, Parents and Childless | Data Range: 2021 – 2022

Adults Working Part Time, those with and Without Children, Had the Highest Uninsurance Rates.

In 2021 and 2022, we see that the highest percentages of uninsured Mississippi adults are those who were working part time, the highest percentage of Mississippi adults covered by private healthcare coverage are those who were working full time, and the highest percentage of public healthcare coverage was seen in those who were not working.

Uninsurance By Federal Poverty Level (FPL)

Mississippi Adults, 19-64 Years of Age, Parents and Childless | Data Range: 2021 – 2022

At Least One Third of Childless Adults At 0-99% FPL Had No Health Insurance.

In 2021 and 2022, the highest levels of uninsurance were experienced by childless, Mississippi adults in the 0-99% FPL range. The lowest levels of uninsurance were seen amongst parents whose income levels were at or above 401% FPL.

Health Insurance Offered To Employees By Employer Size

Private Sector Employers In Mississippi | Data Range: 2021 – 2022

In 2022, Only Half of Mississippi Employers Offered Health Insurance.

The Agency for Healthcare Research and Quality (AHRQ) conducts an annual Medical Expenditure Survey (MEPS) of employers for health coverage offered. This is relevant because, as shown in the previous pages, many Mississippi adults gain coverage through private employment.

In both 2021 and 2022, the majority of private employers in Mississippi had fewer than 50 employees (the current legal cut-off for requirements to offer
health insurance coverage or pay a penalty).

While almost all 50+ employee-sized companies offered private healthcare coverage, the percentage of employers offering healthcare coverage decreases greatly when looking at companies whose size is less than 50 employees.

Health Insurance Offers & Enrollment

Private Sector Employees In Mississippi | Data Range: 2006 – 2022

In 2021 there was an increase in employees who were eligible, offered, and enrolled in their companies’ healthcare insurance plans while and a slight increase in those who chose family coverage plans. However, in 2022, there was a decrease in all categories.

Enrollment Rates By Work Status

Mississippi Adults, 19-64 Years of Age, Parents and Childless | Data Range: 2006 – 2022

Despite the Slight Decrease in 2022, Enrollment in Employee-Based Coverage for Full-Time Employees Was Still 10 Times Greater than Part-Time Employees.

For over ten years, there has been a noticeable difference between the full-time, private-sector employees enrollment and the part-time, private-sector
employee enrollment. On average, the numbers for full-time employee enrollment in employee-based coverage were ten times greater than part-time employee enrollment numbers.

It appears that in 2021 and 2022, full-time enrollment slightly decreased while part-time enrollment slightly increased.

The MEPS survey definition of a full-time employee is determined by the survey respondent. No specific minimum number of hours is specified in the
questionnaires. An employee not defined by the survey respondent as being full-time is classified as part-time.

Annual Premiums & Employee Contributions for Single Coverage

Mississippi Adults, 19-64 Years of Age, Parents and Childless | Data Range: 2006 – 2022

Mississippi’s Employee Contribution Rate was Double the National Safe Harbor Pay Rate in 2021 and 2022.

In 2014, Section 4980H was added to the Code by section 1513 of the Patient Protection and Affordable Care Act, Public Law 111-148.³ In this section, the “Safe Harbor” Pay Rate is set up to ensure that the the lowest cost self-only coverage that provides the minimum value does not exceed 9.5 percent of the employee’s monthly salary.⁴ In 2021, the IRS changed this percentage to 9.83%.⁵ In 2022, this rate was changed again to 9.61%.⁶ Mississippi’s rate of of employee contribution was 23.6% in 2021 and 26.3% in 2022. This is over double the affordable threshold set by the ACA’s safe harbor laws.

Annual Premiums & Employee Contributions for Family Coverage

Mississippi Adults, 19-64 Years of Age, Parents and Childless | Data Range: 2006 – 2022

In 2022, Employee Contribution Rate for Employment-Based Family Healthcare Coverage Was Over 35%.

Annual premiums and employee contributions for family coverage have steadily increased from 2006 to 2020. In 2021 there was a slight decrease in both the annual premium and employee contribution, but begins to increase again in 2022. Comparing the annual premium and employee contribution
for family coverage, from 2022, it can be seen that the employee contribution is 36.3% of the annual premium. This is less than the 38.9% seen in 2020.

Footnotes

1. Mississippi Insurance Department. (2013) Affordable Care Act: What you Need to Know, Changes Already In Place And Changes Coming In 2014. https://apps.mid.ms.gov/healthcare/aca-what-you-need-to-know.aspx
2. Ibid.
3. Federal Register. (2014). “Shared Responsibility for Employers Regarding Health Coverage”. https://www.federalregister.gov/documents/2014/02/12/2014-03082/shared-responsibilityfor-employers-regarding-health-coverage
4. Ibid.
5. Internal Revenue Service. (2020). Rev. Proc. 2020-36. https://www.irs.gov/pub/irs-drop/rp-20-36.pdf
6. Internal Revenue Service. (2021). Internal Revenue Bulletin: 2021-https://www.irs.gov/irb/2021-35_IRB#REV-PROC-2021-36