Mississippi may be 30th in the U.S. in terms of population, but it is a state that typically sees low health rankings and high rates of uninsured. Despite failing to embrace the Affordable Care Act, the state has seen some improvements.
This summary provides a snapshot of health, health insurance, and Obamacare-related healthcare legislation in Mississippi.
Mississippi health ratings
Again in 2015, Mississippi maintained its bottom of the barrel ranking of 51st among the states and the District of Columbia in overall health. The ranking comes from The Commonwealth Fund’s most recent Scorecard on State Health System Performance. The Magnolia state came in last in the categories of Avoidable Hospital Use & Cost, as well as Healthy Lives.
An estimated 308,717 uninsured adults ages 19 to 64 and 30,309 uninsured children ages 0 to 18 would gain coverage and be more likely to receive needed healthcare if Mississippi improved its performance to the level of the best-performing state for those indicators. Review Mississippi’s individual scorecard for additional details on all measures evaluated.
After placing last in the United Health Foundation’s America’s Health Rankings for 2014, Mississippi improved to 49th in 2015. The state saw improvements in physical inactivity and the disparity in health status by education. However, the state still faces challenges related to physical inactivity, a high premature death rate and low immunization coverage among children and adolescents.
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 is among the 10 states with the largest reductions in percentage of uninsured since the ACA’s individual mandate took effect.
From 2013 to 2015, the state’s uninsured rate decreased 7.7 percentage points—a tie with Rhode Island. Nationwide, the uninsured rate dropped 5.6 percentage points from 17.3 percent to 11.7 percent.
However, at 14.7 percent, Mississippi’s uninsured rate remains above the national average. Seven of the 10 states whose uninsured rates have fallen most have both expanded Medicaid and implemented a state-run marketplace. Mississippi. Mississippi runs its own Small Business Health Options Program (SHOP) exchange, which is called One, Mississippi, but uses the federally facilitated exchange for individual plans. The state has not expanded Medicaid.
MS 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. However, the state saw high attrition rates. As of June 30, about 77,747 still had their coverage. Of these enrollees, 94.2 percent were in health plans with an advanced premium tax credit and 77.6 percent were receiving cost-sharing subsidies.
For the 2017 open enrollment period, none of Mississippi’s two remaining exchange carriers — Humana and Magnolia Health Plan — requested double-digit rate increases.
2017 Mississippi health insurance rates
UnitedHealthcare will exit Mississippi’s individual health insurance market at the end of 2016. The state’s individual exchange will have two remaining carriers: Magnolia/Ambetter and Humana.
Insurers that plan to raise premium rates 10 percent or more must submit them to the state or federal government for review. Rate and form filings for 2017 coverage were due June 10, 2016. As of early July, Mississippi was not among the states proposing increases of 10 percent or more.
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.
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 9 percent since 2013 – the state’s percent change in Medicaid enrollment since the ACA’s individual mandate took effect is in the bottom third.
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.
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.
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
Here’s a summary of recent Mississippi legislation related to healthcare reform: