Mississippi has waged decades of political battles over health care policy that can run almost as hot as the fights over the symbols of the old Confederacy. Most crucially, the state rejected a proposal to expand Medicaid, the federally subsidized health insurance program for low-income residents, a decision that critics say has deprived Mississippi of a much-needed infusion of federal money that might have strengthened small hospitals on the brink of failure and allowed them to recruit and retain doctors and nurses. That debate is being revisited by advocates who hope the pandemic will force a new reckoning.

What Mississippi has been left with, after years of infighting, is a system believed to be the weakest in the nation. According to a 2020 report from the Commonwealth Fund, a New York nonprofit group, Mississippi ranks at or near the bottom among states on key health care measurements, including infant mortality, childhood and adult obesity, and adults who have gone without care because they could not afford it.

The hospitals that have shut down in recent years cited the same factors plaguing many of those still operating in the state: not enough money from patients with private insurance, not enough government help to care for the poor. Money is also at the root of the health care personnel shortage: Doctors and nurses can often make significantly more money elsewhere.