MISSOURI, Miss.

— The Mississippi health care system is struggling to cover more than 4 million uninsured residents, leaving some with no health insurance and forcing many others to pay higher premiums, officials say.

The Mississippi Health Care Authority says it will spend $4.7 billion on its insurance marketplaces next year and is already trying to reach some of the uninsured.

But that plan does not include a federal program that provides subsidies to help low-income people afford coverage.

It’s the latest sign that the health care overhaul is far from fully working, despite efforts by GOP governors to lure millions of people into the exchanges.

Health care officials say they’re already seeing some health care issues.

Mississippi health officials say in a new report that 1 in 5 residents have a pre-existing condition, compared to 2 in 10 in 2016.

That’s an increase of more than 20 percent.

The number of uninsured in the state is projected to climb from 17.7 million in 2016 to 27.4 million in 2021.

And the state’s uninsured rate is expected to climb by 2.5 percentage points, from 7.5 percent in 2020 to 10.9 percent in 2021, according to the Mississippi Health and Human Services Department.

The state also says that 5.9 million of its residents are either covered by Medicaid, the federal government health insurance program for the poor, or the Children’s Health Insurance Program, which provides health coverage for children in low- and moderate-income families.

More than half of Mississippians are on Medicaid.

In the final year of the ACA, the number of Mississipians covered by state programs fell from a high of more then 10.8 million in 2020 and was projected to fall by more than half to about 7.7 to 7.4 millions by 2021.

That would mean nearly 2.3 million Mississippian residents are now uninsured.

The new figures, which come from the state Medicaid department, do not include people who have signed up for private insurance through the exchange, which is being rolled out in Mississippi, but the numbers do not count those who have not enrolled in the exchange.

Officials say they plan to hire more workers to help with the rollout, which they expect to begin by the end of the month.

The federal government is providing $8 billion in subsidies to insurers who offer plans through the exchanges, with an additional $2 billion to $4 billion in tax credits.

The subsidies are supposed to help lower-income residents buy insurance on the exchanges at a lower cost than if they had not gotten the subsidies.

The new estimates show that only 2.4 percent of Mississiamans have gotten subsidies so far.

Under the law, the state must offer at least one option to cover people who cannot get insurance through an employer or government program.

Many Mississippans who cannot find insurance through their employers are eligible for the federal subsidies.

“The bottom line is that the state has to keep the door open,” said Sen. Mike Johnson, R-Jackson.

Johnson, who was chair of the Senate Health, Education, Labor and Pensions Committee, has been pushing to expand the state exchange.

“The people who need the help the most are the uninsured,” he said.

“We have to keep going forward and we have to make sure that everybody who is eligible for Medicaid, Medicare, CHIP, is covered.

We can’t continue to wait on this to be a success.”