By Sid Salter

As the Republican majority in Washington begins to “repeal and replace” the Affordable Care Act or “Obamacare” with their American Health Care Act, it’s important for Mississippians to remember that our state has a higher percentage of our population who are dependent on public health care or uninsured that the rest of the nation.

Specifically, Mississippi has four percent more of our state’s population that is uninsured and five percent more dependent on public health care programs than the rest of the country, according to the Kaiser Family Foundation’s analysis of Census Bureau data.

In the U.S. in 2015, some 56 percent of Americans had either employer-provided or individual health insurance while 20 percent were on Medicaid, 14 percent were on Medicare, two percent were on some other form of public health coverage and nine percent were uninsured.

In the same year in Mississippi, some 46 percent of the state had either employer-provided or individual health insurance while 23 percent were on Medicaid, 15 percent were on Medicare, three percent were on some other form of public health coverage and 13 percent were uninsured.

Mississippi actually had higher percentages of privately insured citizens in 2015 than West Virginia, New Mexico and Arizona. In addition, Mississippi had lower percentages on Medicaid than Arizona, California, D.C., New Mexico, New York, Oregon, and West Virginia.

But in the poorest state in the union, Mississippi’s health care disparities create a huge problem in terms of paying for health care.

Medicaid is the federal-state public health care program for the aged, the blind, the disabled and members of low-income families with dependent children. The majority of Medicaid enrollees in Medicaid are adults and children, but the majority of Medicaid expenditures are for the elderly and the disabled.

How important is Medicaid in Mississippi? Well, about 46 percent of all federal funds received in Mississippi is tied to Medicaid. In 2011, 37 percent of Medicaid spending in Mississippi was for Medicare (health care for senior citizens) beneficiaries with 162,000 dual eligible — those eligible for both Medicare (by age) and Medicaid (by poverty).

In Mississippi, the Medicaid or Children’s Health Insurance Program (CHIP) covers 1-in-7 adults under the age of 65, 1-of-2 low income Mississippians, 1-of-2 children, 3-of-4 nursing home residents, and 2-of-5 people with disabilities.

Medicare is projected to be able to meet obligations through the year 2028. In calendar year 2015, Medicare provided benefits to about 55.3 million people (46.3 million people aged 65 and over, and nine million disabled people) at an estimated total cost of $648 billion.

Perhaps no single card is wilder in the public health care deck — not the repeal or replacement of Obamacare and not the specifics of the Medicaid and Medicare programs — than that of indigent care.

Mississippi’s high rate of uninsured residents coupled with uncertainty in the wake of congressional efforts to repeal the ACA, adopt the new AHCA, and change the Medicaid or Medicare programs will have the practical impact of more uninsured patients walking into hospital emergency rooms in need of medical care with little or no ability to pay. Remember, some 44 percent of Mississippi’s population is considered low-income.

So, now that Republicans have a total majority in Washington, the future of public health care in the U.S. now depends on the leaders of the GOP. In Mississippi, public health care affects the lives of over half the state’s population.

With Baby Boomers careening toward retirement and their golden years — when the need for health care increases — there will be no bigger issue. Republicans have the power to repeal Obamacare now, but with that comes the responsibility to replace that public health care delivery system with something more efficient, effective, and affordable.

That will be far easier said than done.

Sid Salter is a syndicated columnist. Contact him at sidsalter@sidsalter.com.