Open enrollment for 2018 coverage began November 1, 2017 and ended December 15, 2017 — the first time that open enrollment has ended before the start of the new year, with all plans effective January 1. But people in seven counties in Mississippi (George, Hancock, Harrison, Jackson, Pearl River, Stone, and Greene) had until March 31, 2018 to enroll. This was a special enrollment period that was granted as a result of Hurricane Nate, which hit Mississippi in the fall of 2017.
The uninsured rate in Mississippi was 17.1 percent in 2013, but had fallen to 11.8 percent by 2016, according to US Census data. Although that’s a substantial improvement, Mississippi still lags behind the national average, which had fallen to 8.6 percent by 2016. And the state is among the least healthy in the country.
For many residents, the ACA has made coverage in the individual insurance market both affordable and accessible, with premium subsidies, cost-sharing subsidies, and guaranteed-issue coverage (ie, medical history is no longer a factor in eligibility). 94 percent of Mississippians enrolled in plans state’s federally facilitated exchange receive subsidies – tied with Alabama and Nebraska for the highest percentage in the country.
But Mississippi has not accepted the ACA’s federal funding to expand Medicaid. The uninsured rate would be considerably lower if they had, and there are an estimated 99,000 people in the Medicaid coverage gap in Mississippi due to the state’s rejection of federal funding for Medicaid expansion.
And instead of expanding coverage, Mississippi has asked the federal government to approve a work requirement for some of the people who are already eligible for Medicaid. If it’s approved, very low-income parents would have to work in order to maintain eligibility for Medicaid, and the expectation is that the work requirement would result in about 5,000 people losing their Medicaid coverage each year.
Mississippi health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance ranks the 50 states and DC in terms of overall health. Again in 2017, Mississippi maintained its bottom of the barrel, 51st place ranking. The Magnolia state came in last in the categories of Avoidable Hospital Use & Cost, as well as Equity, and was in 50th place for Prevention & Treatment, and Healthy Lives.
After placing last in the United Health Foundation’s America’s Health Rankings for 2014, Mississippi improved to 49th in 2015, but dropped back to 50th place in the 2016 ranking. Mississippi faces challenges related to physical inactivity, a high premature death rate, a high prevalence of tobacco use, low birth weight, and children living in poverty. America’s Health Rankings has been issued since 1990, and Mississippi has consistently been ranked among the bottom three states ever since the first edition.
To learn more about Mississippi’s health as a state, see Key Health Data About Mississippi from the 2016 edition of Trust for America’s Health. Data from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin allow you to compare the health of counties within Mississippi.
Has Obamacare helped Mississippi?
Mississippi uses the federally-run exchange for individuals, at HealthCare.gov. But the state runs its own Small Business Health Options Program (SHOP) exchange, which is called One, Mississippi. The state has not accepted federal funding to expand Medicaid under the ACA.
94 percent of Mississippi exchange enrollees were receiving premium subsidies in 2017, and 80 percent were receiving cost-sharing reductions (CSR), which is the highest percentage in the nation (nationwide, 57 percent of exchange enrollees receive CSR benefits). These benefits serve to make individual health insurance and health care more affordable and accessible for Mississippi residents than they would be without the ACA.
Mississippi’s uninsured rate has dropped by about 31 percent under the ACA, falling from 17.1 percent in 2013 to 11.8 percent in 2016. But the state’s uninsured rate remains higher than the national average.
Mississippi enrollment in qualified health plans
During the ACA’s 2014 open enrollment period, 61,494 Mississippians enrolled in qualified health plans (QHPs). Ninety-four percent of those selecting QHPs qualified for financial assistance, and the average premium after tax subsidies was $23 a month.
During the 2016 open enrollment period, 108,672 Mississippians selected private health plans through Mississippi’s federally facilitated health insurance exchange, but that number dropped to 88,483 during the 2017 open enrollment period (lower enrollment was common for 2017 in states that use HealthCare.gov, due in part to the incoming Trump Administration’s decision to reduce advertising and outreach in the final days of open enrollment).
By early 2017, effectuated enrollment (ie, paid-up and in force) in Mississippi’s exchange stood at 67,203. Most of those enrollees — 94 percent — were receiving premium subsidies that averaged $380/month, and 80 percent were receiving cost-sharing reductions that lowered their out-of-pocket costs.
Open enrollment for 2018 coverage was only half as long as previous open enrollment periods had been. But enrollment for 2018 still reached nearly 95 percent of the prior year’s enrollment, with more than 83,600 people signing up for 2018 coverage.
2018 Mississippi health insurance rates
Humana is no longer offering coverage in the individual market after 2017, leaving Magnolia/Ambetter as the only insurer in Mississippi’s exchange (UnitedHealthcare had previously offered coverage in the Mississippi exchange, but exited at the end of 2016). Blue Cross Blue Shield of Mississippi offers individual market coverage in the state, but only outside the exchange.
The average rate increase for Magnolia plans was 47.3 percent for 2018, but the bulk of that was due to the federal government’s decision to end funding for cost-sharing reductions (CSR). The cost of CSR was added to all of Magnolia’s ACA-compliant plan premiums for 2018 (on and off-exchange), whereas insurers in most other states added the cost of CSR only to silver plan premiums.
The average rate increase for Blue Cross Blue Shield of Mississippi was 10.8 percent for 2018, but those plans are only available outside the exchange, which means consumers can’t get premium subsidies or cost-sharing reductions with BCBSMS plans.
Mississippi and the Affordable Care Act
At the federal level, both Sens. Thad Cochran and Roger Wicker voted against the ACA in 2010. Cochran and Wicker are both Republicans and both are still in the Senate, and still opposed to the ACA.
Breaking with a strong majority of their party, two Democratic representatives from Mississippi voted against the ACA in 2010, as did Rep. Gene Taylor. Rep. Bennie Thompson, a Democrat, was the sole Mississippi vote for the ACA. Republicans now hold three of Mississippi’s four seats in the U.S. House, with Thompson the lone Democrat in Mississippi’s Congressional delegation.
At the state level, State Commissioner of Insurance Mike Chaney clashed with two governors in an effort to establish a state-run insurance exchange. Chaney, current Gov. Phil Bryant, and former Gov. Haley Barbour are all Republicans and on record as opposing the Affordable Care Act. However, Chaney insisted that a state-run exchange was a better option for the state.
Chaney went so far as notifying the U.S. Department of Health and Human Services that Mississippi intended to implement a state-run exchange. However, Bryant told HHS that Chaney didn’t have the authority to make that decision, and HHS rejected Mississippi’s exchange blueprint.
Mississippi defaulted to the federally facilitated exchange, and the state also declined to expand Medicaid.
Mississippi Medicaid and CHIP eligibility
Mississippi did not expand Medicaid through the Affordable Care Act. The state’s decision leaves 99,000 individuals in what is known as the coverage gap – about 28 percent of the state’s uninsured population.
Without Mississippi Medicaid expansion, non-elderly, non-disabled adults without children are not eligible for Medicaid. Adults with dependent children qualify for Medicaid only if the family’s income is 29 percent or less of the federal poverty level (FPL), which works out to under $6,000/year for a family of three. Medicaid eligibility for Mississippi children varies by age and ranges from 133 percent to 194 percent of FPL.
Children in Mississippi up to age 19 qualify for the Children’s Health Insurance Program if not eligible for Medicaid and the family income level is 209 percent or less of FPL.
Despite the state’s decision not to expand, average monthly Medicaid enrollment has increased slightly (by 4 percent) since 2013, although it’s noteworthy that by late 2016, average enrollment was up 9 percent, and has dropped since then. Nationwide, average enrollment in Medicaid/CHIP is up 29 percent since 2013.
If Mississippi receives federal approval for the Medicaid work requirement that the state has proposed, some of the low-income parents who are currently eligible for Medicaid will have to work in order to maintain eligibility for Medicaid. The state projects that 5,000 people could lose access to Medicaid each year, due to non-compliance with the work requirement or with related reporting requirements.
Other ACA reform provisions
The Consumer Operated and Oriented Plan (CO-OP) Program is a federal loan program established through the ACA. CO-OPs are directed by their customers and intended to offer consumers more choice in medical insurance options.
CO-OPs operated in 23 states in 2014, but nearly all of them have closed. Only four are continuing to offer coverage for 2018.
No CO-OP was created in Mississippi.
Does Mississippi have a high-risk pool?
Before the ACA’s reforms to the individual health insurance market, eligibility for private coverage was contingent on medical history. People with pre-existing conditions were often unable to purchase private plans, or could only buy policies that excluded their pre-existing conditions.
The Mississippi Comprehensive Health Insurance Risk Pool (the “Association” or MCHIRPA) was established in 1992 as a means of providing coverage for people who were unable to purchase comprehensive plans in the private market because of pre-existing conditions.
Now that the ACA has brought guaranteed issue coverage to the private individual market, high risk pools are largely obsolete. Mississippi’s Association remained operational through 2016, with a message on its homepage reassuring members that the ACA was not bringing any immediate changes to their existing coverage. But by 2017, the website simply said “these policies are no longer being offered.” People with pre-existing conditions can instead obtain coverage in the individual market in Mississippi, since medical history is no longer a factor in determining premiums or eligibility for coverage.
In 2018, Mississippi enacted HB1196, which states that “upon the cessation of operations” by MCHIRPA, the distribution of any remaining funds held by the association will have to be approved by the Commissioner of Insurance.
Medicare enrollment in the state of Mississippi
About 76 percent of the state’s Medicare beneficiaries qualify for coverage based on age alone, and 24 percent qualify due to disability – the third highest percentage in the country. Medicare spends about $10,005 annually per enrollee in Mississippi. In 2009, the state ranked 29th in terms of overall Medicare spending with $5.2 billion per year.
In 2015, about 14 percent of Mississippi Medicare recipients selected a Medicare Advantage plan instead of Original Medicare, compared with 31 percent of total U.S. Medicare beneficiaries. About 57 percent of Mississippi Medicare beneficiaries enrolled in stand-alone prescription drug coverage through a Medicare Part D plan in 2015.
State-based health reform legislation
Scroll to the bottom of the page for s a summary of recent Mississippi legislation related to healthcare reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.