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Mississippi health insurance

95% of Magnolia State exchange enrollees receive subsidies

Mississippi has not embraced the Affordable Care Act, which has impacted the state’s residents. However, despite low health rankings and high rates of uninsured, the state has seen some improvements.

This summary provides a snapshot of health indicators from several sources and briefly examines Mississippi’s decisions on key provisions of the Affordable Care Act.

Mississippi health ratings

Again in 2014, Mississippi ranked 51st among the states and the District of Columbia in overall health. The ranking comes from the most recent Scorecard on State Health System Performance, which is published by The Commonwealth Fund. Review Mississippi’s individual Scorecard for a list of all measures evaluated.

Mississippi also ranked at the bottom of the states in America’s Health Rankings in the 2014 evaluation, the most recent available, by the United Health Foundation. Mississippi’s 50th ranking is based on high rates of physical inactivity, obesity, diabetes; low immunization rates among adolescents; a high infant mortality rate; and a high prevalence of low birthweights. Mississippi does have some public health positives, including a low prevalence of binge drinking, high immunization rates for children, and little disparity in health status by level of education completed.

See Key Health Data About Mississippi from the 2014 edition of Trust for America’s Health for more health rankings. If you’re more interested in comparing counties within Mississippi, use theseshealth rankings from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

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 remain in office. Cochran ran for reelection against Rep. Travis Childers in November 2014 and was elected for another term.

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.

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.

How did Obamacare help Mississippi?

The uninsured rate in Mississippi decreased 1.8 percentage points after the ACA’s individual mandate took effect. In 2013, the rate was 22.4 percent. As of mid-2014, the rate was 20.6 percent. By August 2015, that number had dropped another 6.4 percentage points to 14.2 percent. Across the U.S., the uninsured rate fell from 17.3 percent in 2013 to 11.7 percent in the first half of 2015.

Mississippi’s uninsured rate remains well above the national average. It’s also above the 13.4 percent average seen among other states that have not embraced the ACA; i.e., those that have not implemented a state-run marketplace or expanded Medicaid, or have only implemented one of those measures.

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 2015 open enrollment period, there were 104,538 Mississippians who selected QHPs through Mississippi’s federally facilitated health insurance exchange. However, the state saw high attrition rates. As of June 30, about 73,223 still had their coverage – about 70 percent of the initial 2015 enrollees. Of the remaining enrollees, 95.4 percent were in health plans with an advanced premium tax credit and 77.4 percent were receiving cost-sharing subsidies. Mississippi has the highest percentage of private plan enrollees that receive either of these subsidies.

For the 2016 open enrollment period, none of Mississippi’s three exchange carriers — UnitedHealthcare, Humana and Magnolia Health Plan — requested double-digit rate increases.

Mississippi Medicaid and CHIP eligibility

Mississippi did not expand Medicaid through the Affordable Care Act. The state’s decision leaves 108,200 individuals in what is known as the coverage gap – about 30 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). 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 10 percent since 2013 – the state’s percent change in Medicaid enrollment since the ACA’s individual mandate took effect is in the bottom third. Enrollment for Medicaid and CHIP is open throughout the year. Visit the Mississippi Division of Medicaid to learn how to apply for Medicaid or CHIP.

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, and three are expanding into neighboring states in 2015. See where CO-OPs were launched and where they have closed.

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”) 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.  But the Association has remained operational, and has a message on its homepage reassuring members that the ACA is not bringing any immediate changes to their existing coverage.

State-based health reform legislation

Here’s a summary of recent Mississippi legislation related to healthcare reform: There is no new healthcare reform legislation to report at this time.

Medicare enrollment in the state of Mississippi

Mississippi Medicare enrollment reached 556,994 in 2015, which is 18.6 percent of the state’s population. About 73 percent of the state’s Medicare beneficiaries qualify for coverage based on age alone, and 27 percent qualify due to disability – the third highest percentage in the country.

About 15 percent of Mississippi Medicare recipients select a Medicare Advantage plan instead of Original Medicare, compared with 32 percent of total U.S. Medicare beneficiaries who make this choice. Medicare Advantage provides an alternative for those who want some additional benefits. About 57 percent are enrolled in stand-alone prescription drug coverage through a Medicare Part D plan, compared with 43 percent nationwide.

Medicare spends about $10,66 annually per enrollee in Mississippi, and the state ranks 29th in terms of overall Medicare spending with $5.2 billion per year.