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.
Charles Gaba of ACAsignups estimated that 84,000 Mississippi residents would have lost their subsidies if the Court had ruled that subsidies could only be provided in state-run exchanges. Rates in the individual market for people who don’t currently get premium subsidies would likely have increased by 60 – 90 percent in 2016 if subsidies had been eliminated, and the individual market would have become destabilized and considerably smaller.
A state contingency plan?
The Mississippi Business Journal reported that Insurance Commissioner Mike Chaney has a contingency plan that would protect subsidies for state residents if the Supreme Court eliminates 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 notes that the plan would be contingent upon approval from the Governor, Lt. Governor, and the Speaker of the House.
Politico also reported that the state has 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 one way or another, it does appear that the state is working on a back-up plan that could be put in place if the Supreme Court eliminates subsidies.
2016 rate proposals
Assuming subsidies remain in place, none of the individual plans available in Mississippi’s exchange have requested double digit rate increases for 2016. The only exchange plan requesting a rate increase of ten percent or more is a small group plan from United HealthCare. 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.
Rates are still under review, and won’t be finalized for another few months. Open enrollment starts again 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 – 77 percent of the total enrollments – had effectuated exchange coverage in place. Nationwide, 87 percent of enrollees had effectuated coverage by the end of March, so Mississippi was 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).
Some consumers can still enroll
While the 2015 open enrollment period is over, you may still be able to get health insurance.
- 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.
2015 participating insurers
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. Humana originally intended to participate in just a few counties in 2014, but greatly expanded its offering to provide consumers a second option in 36 additional counties.
Average premiums drop sharply for 2015
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.
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.
How the marketplace evolved 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. In February 2013, HHS rejected Mississippi’s exchange blueprint.
The federal government runs the individual exchange in Mississippi, while the state operates the small-business exchange.
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.
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 / firstname.lastname@example.org