For 2016, none of the three carriers that offer individual health insurance in Mississippi’s exchange have requested double digit rate increases. The only exchange plan requesting a rate increase of ten percent or more is a small group plan from UnitedHealthcare. Rate increases of at least ten percent are published on Healthcare.gov’s rate review tool, and the only individual market Mississippi plans on the list are off-exchange.
Outside the exchange, Blue Cross Blue Shield of Mississippi has requested an average rate increase of more than 25 percent. At ACAsignups, Charles Gaba has estimated an overall individual market average rate increase of 14.9 percent in Mississippi, but that includes all the off-exchange plans sold by BCBS of Mississippi. If we only consider the plans sold by the three exchange carriers, the average rate change for 2016 will be less than ten percent.
According to an analysis published by The Commonwealth Fund, average premiums in Mississippi are 19 percent lower in 2015 than in 2014. The weighted analysis looks at premium amounts, differences in premiums between urban/suburban/rural areas within states, and insurer participation. In 2014, Mississippi’s pre-subsidy average premium was $438/month – the fifth-highest among the 36 states that used Healthcare.gov.
Approved rates will be published on Healthcare.gov in late October. Open enrollment for 2016 starts on November 1, for coverage effective January 1, 2016
2015 enrollment data
About 103,600 Mississippi residents selected health plans through HealthCare.gov during 2015 open enrollment. While that’s 42,000 more signups than during 2014 open enrollment, it is still just 37 percent of those eligible to enroll according to Kaiser Family Foundation estimates.
And attrition has been particularly high in Mississippi. By the end of March, just 80,011 people had effectuated exchange coverage in place, and that had dropped to 73,223 by the end of June. That’s 71 percent of initial enrollments; nationwide, 85 percent of enrollees had effectuated coverage by the end of June, so Mississippi is well below average in that regard.
The Kaiser Family Foundation estimated that 28 percent of Mississippi’s eligible population had enrolled in coverage through the exchange by the end of March – a little lower than the national average of 36 percent, but higher than twelve other states.
Mississippi’s exchange population tended to be relatively low-income, with 89 percent having incomes under 250 percent of the poverty level. Those enrollees were eligible for cost-sharing subsidies, and 85 percent of them selected silver plans, meaning that they obtained coverage that included the cost-sharing subsidies (cost sharing subsidies are only available if you purchase a silver plan). In all, more than 77 percent of the 73,223 people who had coverage at the end of June were enrolled in plans that included cost-sharing subsidies.
King v. Burwell – subsidies no longer in danger
On June 25, the Supreme Court ruled that subsidies are legal in every state, regardless of whether the exchange is run by the state or the federal government. That’s great news for Mississippi residents, insurers, and healthcare providers; 95 percent of the people who are enrolled in private plans through the Mississippi exchange are receiving premium subsidies.
The Mississippi Business Journal reported that Insurance Commissioner Mike Chaney had a contingency plan to protect subsidies for state residents if the Supreme Court had eliminated them. Rather than creating a state-run exchange, “it would entail funneling federal money through the existing Mississippi Comprehensive Health Insurance Risk Pool Association to private insurers.” But the Journal noted that the plan would be contingent upon approval from the Governor, Lt. Governor, and the Speaker of the House (Chaney had worked to establish a state-run exchange back in 2011 – 2012, but was foiled by the Governor and the legislature).
Politico also reported that the state had a back-up plan, but they explained that Chaney “wants Mississippi to use existing private health insurance exchanges to enroll people, qualifying for subsidies while avoiding the federal government’s technology.”
The Mississippi Comprehensive Health Insurance Risk Pool is the state run high-risk pool that pre-dates the ACA. Private health insurance exchanges are not run by the government – rather, they’re set up by health insurance carriers, brokers and benefits managers to provide a platform for people to shop for coverage. Mississippi’s Insurance Department did not return phone calls to clear up the discrepancy, but it did appear that in early 2015, the state was working on a back-up plan that could have been put in place if the Supreme Court had eliminated subsidies. In many states, there were no such contingency plans, and enrollees would have had few options but to terminate their coverage if subsidies had been eliminated.
Some consumers can still enroll for 2015
While the 2015 open enrollment period is over, you may still be able to get health insurance with a 2015 effective date.
- Individuals who qualify for Medicaid can sign up anytime during the year.
- Native Americans can also enroll year-round.
- Anyone who experiences a qualifying life event — such as having a baby or losing other health insurance — has 60 days to sign up on HealthCare.gov.
UnitedHealthcare joined the Mississippi marketplace for 2015, bringing the total number of insurers on the individual exchange to three in the state. Humana and Magnolia Health Plan were part of the marketplace in 2014 and returned for 2015.
United’s entry brought welcome competition to Mississippi. For 2014, residents of some counties had access to just a single insurer’s plans through the exchange. In 2011 and 2012 – back when Mississippi was in the process of creating it’s own State-run exchange – Blue Cross Blue Shield of Mississippi (which had more than 80 percent of the market share in Mississippi) had told Insurance Commissioner Mike Chaney that they would participate in the exchange. But due to conflicts among the state’s leadership, HHS rejected Mississippi’s exchange application (more details below), and at that point, BCBS of Mississippi pulled out.
That left Humana and Magnolia Health Plan as the only two carriers for 2014. But leading up to the federally-run exchange’s fall 2013 debut, Mississippi had a problem. The two carriers had selected the counties in which they wanted to operate, and 36 of the state’s 82 counties had no participating carriers at all. Humana ultimately decided to go ahead and offer coverage state-wide, but in 2014, only four of the state’s counties had plans available from both carriers.
But in 2015, when UnitedHealthcare joined the exchange, every county in Mississippi had at least two participating carriers, and 13 counties had coverage options available from all three carriers.
The University of Mississippi Medical Center got the lion’s share of the Navigator grants that were awarded by the federal government in August 2013 to fund enrollment efforts in Mississippi for 2014. Of $1.1 million that Mississippi received, $832,000 went to UMMC. Oak Hill Baptist Church got the remaining Navigator funding that year, but by 2015, Oak Hill had become the primary Navigator grant recipient in Mississippi, receiving $547,867 to assist with enrollment efforts for 2016 (another $415,224 was awarded to the University of Southern Mississippi in September 2015).
Small business marketplace
Mississippi began operating its own Small Business Health Options Program (SHOP) exchange — which is called One, Mississippi — in May 2014. One, Mississippi is open to employers with 50 or fewer full-time employees.
How many Mississippians enrolled in 2014?
Mississippi was 33rd in terms of the percentage of eligible individuals who enrolled in a qualified health plan (QHP) through the marketplace in 2014. According to the Kaiser Family Foundation, 61,494 people signed up for health plans, and another 13,779 people qualified for either Medicaid or the Children’s Health Insurance Program (CHIP) under existing eligibility criteria.
Among Mississippi residents enrolling in QHPs, 94 percent qualified for financial assistance, compared to 85 percent nationally. A report released in June by the U.S. Department of Health and Human Services showed the average monthly premium, after tax credits, for Mississippi consumers was just $23. That’s the lowest average in the nation.
Eight percent of Mississippi residents selected a bronze plan (20 percent nationally), 79 percent selected a silver plan (65 percent nationally), 5 percent selected a gold plan (9 percent nationally), 7 percent selected a platinum plan (5 percent nationally) and 1 percent selected a catastrophic plan (2 percent nationally). Thirty-one percent of Mississippi enrollees were between the ages of 18 and 34.
40,000 of the state’s 61,000 exchange enrollees in 2014 selected a plan from Humana (in all but four counties, Humana was the only carrier available in 2014).
Exchange creation battle in Mississippi
State Commissioner of Insurance Mike Chaney clashed with two governors as to what form a health insurance exchange should take in Mississippi. Chaney, current Gov. Phil Bryant, and former Gov. Haley Barbour are all Republicans and on record as opposing the Affordable Care Act. However, Chaney consistently maintained that the state would be better off running its own exchange.
Chaney pushed hard for a state-run exchange. In 2011, he announced that the Mississippi Comprehensive Health Insurance Risk Pool Association would operate an exchange. The Risk Pool Association developed a plan in which the exchange would be developed in four phases, with work outsourced.
Early exchange planning was carried out by the board of directors of the Risk Pool Association and an advisory board appointed by Chaney. The Risk Pool Association, the advisory board, and the insurance department continued working throughout 2012, and in November, Chaney notified the U.S. Department of Health and Human Services (HHS) that Mississippi intended to implement a state-run exchange. However, Bryant told HHS in December 2012 that Chaney had overstepped his authority.
It was also in 2012 that anti-ACA influences from outside Mississippi (including the Koch Brothers and the Cato Institute) began pressuring Cheney to give up his push for a state-run exchange. But OneMississippi, the state-run exchange that Cheney created, opened in October 2012, a year before the ACA-sanctioned exchanges nationwide. OneMississippi didn’t have any premium subsidies (those wouldn’t be available until the first ACA open enrollment period began in October 2013), but it did have coverage for sale. The task at that point switched to obtaining federal approval to have OneMississippi be the state’s official ACA exchange.
But ultimately, Governor Bryant’s opposition to the exchange was its downfall. In February 2013, HHS rejected Mississippi’s exchange blueprint, telling Chaney that it simply wouldn’t work without the Governor’s support. The exchange would have needed to work with the Mississippi Medicaid program – overseen by a Bryant appointee – and there were too many concerns that Bryant would be able to derail the exchange via funding or hiring decisions. The federal government said at the time that they “didn’t feel that [they] should get involved in a battle between two elected state officials.”
Mississippi was the only state whose exchange blueprint was rejected by the federal government, and in February 2013, OneMississippi shut down. The federal government runs the individual exchange in Mississippi, but OneMississippi opened back up as the state-run SHOP exchange in the spring of 2014, offering health insurance options for small businesses.
Several factors constrain marketplace enrollment in the Magnolia State. Political opposition to the Affordable Care Act is very strong, many residents are distrustful of government assistance, and outreach efforts are limited. In a state with a 22 percent poverty rate, many people find premiums too expensive — even with subsidies factored in. And the Medicaid coverage gap is significant in Mississippi: Kaiser Family Foundation estimates that 108,000 of Mississippi’s 359,000 uninsured residents are in the coverage gap – ineligible for Medicaid (because the state has refused federal funding to expand Medicaid) and ineligible for subsidies in the exchange because their income is under the poverty level.
Mississippi health insurance exchange links
State Exchange Profile: Mississippi
The Henry J. Kaiser Family Foundation overview of Mississippi’s progress toward creating a state health insurance exchange.
Health Help Mississippi
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 314-3843 / email@example.com